Wikipedia talk:Manual of Style/Medicine-related articles

Product pricing

Should there be a separate section or just the current brief mention? QuackGuru (talk) 17:31, 1 October 2019 (UTC)

• Would support such a section. Definitely an independent source is required. Doc James (talk · contribs · email) 20:05, 1 October 2019 (UTC)

• I think it merits discussion. One issue is that WP articles are usually about the active molecule and not about any product(s) containing that molecule. Another one is that list prices in cases of innovative drugs can be very misleading, as actual, negotiated prices are confidential and frequently carry rebates up to 70% (and more) from the list price. Then, there are also risk-sharing agreements that affect the effective price; pay-per-result arrangements; bundle pricing, etc. etc.

Until we agree on how we present the prices keeping in mind the requirement to be WP:GLOBAL, I suggest to leave out a separate section. Deinitely, adding it after just a few hours of "discussion" between just two participants, even if highly respected as they are, seems premature. — kashmīrī ^TALK 18:38, 2 October 2019 (UTC)

I was trying to find guidance on product pricing and I missed it. I moved one sentence and just added "The pharmaceutical industry has tried to conceal medication prices because of their continuing legal cases in the United States. There is a lack of transparency regarding medication and vaccine prices among non-governmental organizations." Numerous articles have content about pricing. It needs a separate section. If you disagree with the content I added you can just comment it out or delete it for now. QuackGuru (talk) 19:13, 2 October 2019 (UTC)

The prices in the BNF and from medicaid are fairly sound. Sure a bit of work may be required to find appropriate sources and craft the appropriate wording. Doc James (talk · contribs · email) 21:45, 2 October 2019 (UTC)

Again, the world is not just the US - in Europe, prices are not disclosed for an entirely different reason - and also the way you used "pharmaceutical industry" is incorrect: the majority of pharmaceutical companies are manufacturers of generic drugs and dietary supplements (sic!). — kashmīrī ^TALK 22:15, 2 October 2019 (UTC)

Please edit the section to improve the wording or you can just deleted the content I wrote. I'm not sure what the best wording should be. I think the separate section should remain because so many articles discuss pricing. QuackGuru (talk) 01:30, 3 October 2019 (UTC)

I have re-written it. WhatamIdoing (talk) 00:08, 12 October 2019 (UTC)

Thanks and looks good. Doc James (talk · contribs · email) 02:53, 24 October 2019 (UTC)

• I'm not convinced we need a pricing section or that the text there is understandable. Do we generally want prices on our drug articles or treatment sections? I think this section might encourage trivia. It isn't clear from the text that the do-this/don't-do-this follows. It asks lots of questions but the consequence would appear to be original-research. I certainly don't support QuackGuru's text, which was replaced by WhatamIdoing. The unreasonable increase in the cost of insulin is a notable issue in the US only and perhaps properly belongs in some article on drug company pricing. Is this sort of thing relevant in general (which a guideline should cover) or just a special case of including information per WP:WEIGHT. There may be merit in noting that some treatments are popular/uncommon due to pricing issues if that issue is covered by reliable sources. But to be honest, that seems to me to be pretty standard WP editing practice. -- Colin°^Talk 10:03, 12 November 2019 (UTC)
  • I think that the consequence of answering those questions, in most cases, is going to be accurate reporting of what your source says. One of the biggest problems in the foreseeable-and-solvable category is someone getting a good source on third-world wholesale prices and writing "The price is two cents per pill", which some reader is going to interpret as "My prescription will cost 60 (local) cents at the pharmacy". The meaning of those questions is "don't write 'the price'. Instead, write down which price your source is talking about". I do not think there is any scope for OR in that. I think that it militates against OR.
  • As to whether we want prices, we probably do, in some cases. Those cases are IMO mostly WHO essential medicines (for which "The estimated average wholesale price worldwide, according to the WHO, is around two cents per pill" is a not unreasonable answer) and fancy new medicines (for which the answer probably sounds like "The company announced a list price of $120,000K per year in the US, but the revenue per patient is expected to be lower due to negotiated discounts and the patient assistance program", assuming that my [probably business magazine] source mentioned that kind of reality). This information isn't being included for medical reasons. It's being included because some of our readers are interested in money. WhatamIdoing (talk) 15:29, 12 November 2019 (UTC)
    • In what way are they interested in money? Is it "Can I afford to buy this" (paying privately for a drug); "Will my insurance/health-service provide this?"; or just generally interest in which drugs are very very cheap, fairly cheap, expensive, eye-wateringly expensive... At the moment I can see the text provoking some kind of table with all countries and with wholesale, retail and discount prices if such were available. Ibuprofen lead (only) says "The wholesale cost in the developing world is between US$0.01 and US$0.04 per dose. In the United States, it costs about US$0.05 per dose". It isn't covered by the body nor do we list details about generic vs brand pricing. Aspirin also only covers cost in the lead, and only wholesale cost for "developing world". It lists the monthly cost in the US, but per your notes does not say whether that is wholesale, but also doesn't say what that is treating. Valproate is the same. Hmm, information about developing world prices added only to the lead. Hmm, could that possibly be done by a certain editor with a focus on a medical translation project? The prices are of course now 4-5 years old and not maintained. The fact that this is being only added by one editor, only to the lead, not maintained, very specific prices that get out-of-date, all rings alarm bells for whether Wikipedia really is the place for this. Isn't there a better way to cover this, and one that doesn't waste precious space in our lead sections for what is a trivia detail. The "very cheap ... borderline acceptable to NHS" scale may be significant, but whether the wholesale price in the US in 2014 was 4c or 5c really isn't. -- Colin°^Talk 21:44, 12 November 2019 (UTC)
      • The "money" audiences that I happen to care about are public policy (the "very cheap ... borderline acceptable to NHS" scale) and business stuff (e.g., someone trying to figure out why this company's in the news for over charging). If it's easier to write US$0.04 than "very cheap" (which is additionally a value judgment and therefore not something we could say without a source saying that), then that doesn't worry me.
        I'm not overly worried about keeping them up to date (although I mostly wouldn't put prices in the lead). As most of the prices for generics are stable over the years, being strictly up to date isn't terribly important. People aren't going to have radically different understandings of a drug if it turns out that the price has changed from one to four cents to now being two to five cents. For fancy new drugs, what gets the most attention in sources (and therefore what's most WP:DUE) is their announced initial price, which is always going to be its initial price, even though it will likely drop later. WhatamIdoing (talk) 02:31, 13 November 2019 (UTC)
        • Limited guidance on drug pricing was already in WP:PHARMMOS before the section in question was added here. Does it need covering at both MOSs? (My guess is "probably".) If not, which should be the one to talk about drug pricing?
          Having guidance on pricing might prove useful when discussing medical tourism, and the reasons why grey and black markets exist in medical care. Little pob (talk) 09:42, 13 November 2019 (UTC)
          • Although WP:PHARMMOS says "Economics: Global sales, distribution, cost in major English speaking countries, etc" it doesn't really offer guidance. I see now valproate does mention the cost later in a Cost section. I think "Econonomics" is a better title, which would encourage other economic data such as sales (particularly for blockbuster drugs that influence company shares) and whether the drug has been rejected on economic grounds (such as NICE rejection for drugs too expensive). I don't think there is any WP:WEIGHT/MOS:LEADREL argument to include specific cost details in the lead at all, though the other economic factors may be relevant for a small set of drugs. The cost-per-dose is not widely covered by reliable sources on drugs or medical treatments, largely because it is so variable per country and also over time. I think it is very difficult to justify including "The wholesale cost in the developing world is between US$0.01 and US$0.04 per dose.[13] In the United States, it costs about US$0.05 per dose." in the lead. This is noisy trivia which in a reliable source would merely get "this very cheap drug" or some such one/two word adjective. If we lack reliable sources to turn price details into an adjective, then probably better to simply remove from the lead on the grounds that nobody is commenting on the price as being something worth noting. I suspect it has been added to the lead because the medical translation project only translates the lead and the information was felt relevant to developing countries. I reject that argument, if that is the case, on the grounds that en:wp is here for its readers and not to be some source-code for other wp -- the translators can always be advised to include cost details from the body if that is felt relevant on other WPs. -- Colin°^Talk 10:38, 13 November 2019 (UTC)

Proposal

Add the following to the "product pricing" section: "Detailed cost information does not belong in the lead, though some significant economic points may be relevant for some drugs (blockbusters, drugs rejected as too expensive, etc)." The "product pricing" section be renamed "Economics" to fit with the earlier heading examples.

The current wording could be shortened to "The cost of medicine or procedures should include specific details regarding the kind of price (e.g., wholesale, retail, discounted), scope (e.g., US-specific, worldwide average) and the year." I don't think it worth including "if covered by reliable sources" because that is true of everything. I don't think the "indirect costs such as lost wages for the patient" is relevant to product pricing. This seems more relevant to disease articles, covering time off due to to sickness or to attend hospital for treatment or tests. -- Colin°^Talk 10:45, 13 November 2019 (UTC)

• Strong support. I am dead against having drug prices in the lead section and only mention them in the article body where it is specifically discussed in reliable sources as a matter of public interest (like Zolgensma being the most expensive drug in the world). — kashmīrī ^TALK 15:27, 13 November 2019 (UTC)

I've rewritten the section mostly per the proposal above. I agree with Kashmiri that it is hard to justify the routine addition of specific pricing details even in the article body. We have perhaps a difficulty translating raw figures into a more appropriate adjective that our sources would do. Few of our sources mention specific costs, so WP:WEIGHT makes it hard to argue for. There are of course drugs whose price is especially notable.

I've written the lead advice as: "Detailed cost information is rarely appropriate for inclusion in the lead." To be honest, I feel somewhat that we are having to include this guidance merely because one editor chose to ignore our basic rules for WP:LEAD: that they summarise article bodies. Any such prices in the lead could be moved/removed simply per WP:LEAD. -- Colin°^Talk 13:58, 14 November 2019 (UTC)

It is irrelevant you rewritten the content. That's not the consensus across med articles. QuackGuru (talk) 14:06, 14 November 2019 (UTC)

QuackGuru articles do not have "consensus"; editors do. That is why we are discussing this here. You tried to add the text "Cost information may be included in the lead, but this is done on a case-by-case basis.", this was reverted, and you restored it again without attempting to achieve consensus. That's edit warring, which will get you blocked. I see from your earlier edit to include "The pharmaceutical industry has tried to conceal medication prices because of their continuing legal cases in the United States. There is a lack of transparency regarding medication and vaccine prices among non-governmental organizations." that you have an agenda. That's even more reason for you to avoid editing or warring over guidelines. The statement you added about the lead is meaningless because all information may be included on a case-by-case basis. Further the specific issue is "detailed cost information" whereas in our reliable sources, a lead section/page would merely note if a drug is cheap or expensive: our reliable sources know how to summarise.

MEDMOS cannot supersede WP:LEAD. Let's examine this consensus of editors. I looked at the first bunch of anti-infective medicines on the WHO list:

• Albendazole added by Doc James.
• Ivermectin added by Doc James.
• Levamisole added by Doc James.
• Mebendazole added by Doc James.
• Niclosamide added by Doc James.
• Praziquantel added by Doc James.

So this is a practice followed by exactly one editor, who also has an agenda about information in the lead.

The information doesn't even seem to be correct. Albendazole says "The wholesale cost in the developing world is between 0.01 and 0.06 USD per dose". The 2014 source gives the dose at 400mg and the table strength at 200mg and from $0.0115 to $0.0341 per table (i.e., from $0.023 to 0.0682, which would be rounded to "0.02 and 0.07 USD per dose"). By the following year the highest price is only 0.04 USD, so already out-of-date. Who knows what 2018 or 2019 is. The article claims "in the developing world" though I can't see where this is is indicated in the source. Their own sources of buyers and suppliers does seem to be focused on such nations, but I don't know if that is representative of the developing world. The website does not seem to include prices any newer than 2015, which is a strong concern. For the US price, the source given is a database which is not an allowed source. Readers need to search through the database for the drug then average the individual records themselves.

I see this issue was discussed Wikipedia talk:WikiProject Medicine/Archive 84#Price of medications and concluded "Except in the cases where the sources note the significance of the pricing (which did have consensus), there is no consensus to add the pricing to the articles". Therefore it seems that Doc James and QuackGuru are editing against consensus. It's going to take me a while to read through all the discussions, but once again I see a few folk at WP:MED having ideas the rest of Wikipedia do not support. We don't include the prices of potatoes, televisions or package holidays to Greece. It seems fairly obvious that specific price information is not the role of an encyclopaedia for the general reader. We have a "source" for wholesale prices that appears to be no longer maintained as of 2015. This "source" material is raw data, not meaningful data or commentary that could be used in a lead summary. If we have no consensus to add pricing to articles, except for significant notable cases, then there is very much no consensus to add this to the lead. I request QuackGuru reverts themselves. -- Colin°^Talk 18:44, 14 November 2019 (UTC)

I see from Doc James talk page that this issue has become a recent hot topic. James edit warred four times with two editors. He also claimed that the RFC requirement "where the sources note the significance of the pricing" was met merely by a US Database including the drug price among its records. That is a strange way of assessing WP:WEIGHT. And a very deep rejection of what constitutes a "source" -- a pointer to the first page of database results showing 25,095 records. James writes "We know that the pharmaceutical industry is trying really hard to hide medication prices with ongoing legal cases in the United States. Many NGOs including Doctors Without Borders and UNICEF struggle with the lack of transparency around medication and vaccine prices. WP:NOTCENSORED applies here." I am reminded what a wise editor once wrote about people citing NOTCENSORED as a justification for including material: "Anyone who defends their edits by citing WP:NOTCENSORED doesn't have the first clue." The key requirement made by WhatAmIDoing in 2010 was "cost is discussed by significant sources". A database is not a discussion. A number in the BNF (a drug database) is not a discussion.

I think we should summarise and clarify (for those who think a database is a source) the RFC conclusion as "Except in the cases where reliable sources discuss the significance of drug pricing, drug price information is not appropriate in articles. In such cases where price information is relevant, the article should indicate why. The lead, as a summary of article content, should not include specific detailed price information." -- Colin°^Talk 19:15, 14 November 2019 (UTC)

It appears that QuackGuru does not wish to justify their edits or explain why the consensus at the RFC Wikipedia talk:WikiProject Medicine/Archive 84#Price of medications is being ignored. I'm also guessing that User:DocJames is ignoring the discussion because the current text supports his position. It seems very clear from the RFC that James does not understand that WP:WEIGHT is not met by the inclusion of a figure in a database. I can get multiple sources for the bus timetable and journey times, yet this raw data is not encyclopaedic. In their discussion with User:Rhododendrites, James also claims that a wide interest in drug prices (particularly those on the WHO essential list) is sufficient to include detailed wholesale pricing for all such medicines. But this is the difference between raw data and encyclopaedic information. The encyclopaedic issue that people are discussing is whether and where the price is low or high, why the price is enormously higher in some countries (e.g. US) and whether price has affected availability of the treatment to patients (e.g., NICE does not consider it's cost/benefit justified). This is the sort of information our articles might include, case by case. Most of the price sources suggested are either now no longer maintained, or incomplete or are merely a link to a database result-set of 25,000 records, none of which meet the standards required for sourcing. User:WhatamIdoing reminded us in 2010 that "cost is discussed by significant sources" is the requirement.

I think that unless those who lost the argument in the RFC desist from edit warring on this page, we may need some administrative action here or another community RFC. I'll reword my text from just above, since it seems some think general discussion of drug pricing justifies absolute inclusion of drug pricing everywhere. Here's what I think the RFC demands MEDMOS says:

"Except in the cases where reliable sources discuss the significance of the price of a particular drug, drug price information is not appropriate in an article. In such cases where price information is relevant, the article should explain why. The lead, as a summary of article content, should not include specific detailed price information."

-- Colin°^Talk 12:34, 16 November 2019 (UTC)

You pinged the incorrect user name. The sources being used qualify per WP:MEDRS. Lots of sources that discuss the price in greater detail are avaliable. There is an in depth discussion by WHO for example for each medication listed as essential. Sure I could write an entire section on this for every medication. Wikipedia is also a work in progress. Doc James (talk · contribs · email) 18:47, 21 November 2019 (UTC)

The 2016 RFC concluded, “Except in the cases where the sources note the significance of the pricing (which did have consensus), there is no consensus to add the pricing to the articles.”

Colin, could you have a look at Epipen as an example? Both of your versions are truer to the RFC and more helpful than QuackGuru’s version, which I oppose, but what a useless mess of information at Epipen, presented in an unhelpful fashion, while the pricing controversy is not summarized to the lead at all. Your phrase “... should not include specific detailed price information ...” is still warranted, as the Epipen pricing controversy could be summarized to the lead as a due weight portion of the article without getting into detailed and cumbersome pricing exammples. For an example like Epipen, where there was a pricing controversy, I prefer your 12:34 16 Nov proposal above to either of these.. QuackGuru’s detailed examples are just a repeat of basic editing practice, but are apparently misleading some editors to go against the RFC. Could you bold your new proposal please? SandyGeorgia (Talk) 14:58, 16 November 2019 (UTC)

I also prefer parts of what Colin wrote to what I wrote, especially his list of factors ["include specific details regarding the kind of price (e.g., wholesale, retail, discounted), scope (e.g., US-specific, worldwide average)"], rather than the questions I wrote. I think that including an example (although the specific example likely could be improved) will be useful to people whose writing skills are less developed than Colin's and SandyGeorgia's (and that's probably about 99% of us). WhatamIdoing (talk) 04:47, 19 November 2019 (UTC)

• Add prices I have commented at many of these drug price discussions over the years. Prices are necessary context for understanding drugs and treatment. Consumers, physicians, journalists, and policy makers all want this information. Challenges for Wikipedia are that (1) prices vary by time, place, and by medical insurance (2) there are international price catalogs, but these are challenging for individual readers to interpret and (3) Wikipedia still does not have good policy of when to include or exclude primary information, and pricing has to come from primary sources. The information that I really want is context of the order of magnitude. Wikipedia articles should clearly communicate whether the price of a dose of a drug is closer to US$0.001, 0.01, 0.10, 1.00, 10, 100, or 1000. If the reader is left thinking that a $100 dose drug is generally affordable, or that a very inexpensive drug is inaccessible, then that reader is lacking a fundamental understanding of the nature of the drug. The most reasonable proposal we have for communicating order of magnitude pricing is to import and publish some price catalog for everything. Blue Rasberry (talk) 17:28, 16 November 2019 (UTC)

What I wrote originally was:

"The cost of medicine or procedures should include specific details regarding the kind of price (e.g., wholesale, retail, discounted), scope (e.g., US-specific, worldwide average) and the year. Some medicines contribute significantly to a pharmaceutical company's turnover (blockbuster drugs), or their high price is a factor in their rejection or difficult acceptance by state health services or insurance companies. Detailed cost information is rarely appropriate for inclusion in the lead."

Upon reading the RFC and thinking more about what a lead should be, I proposed:

"Except in the cases where reliable sources discuss the significance of the price of a particular drug, drug price information is not appropriate in an article. In such cases where price information is relevant, the article should explain why. The lead, as a summary of article content, should not include specific detailed price information."

There is perhaps merit in merging the two. I agree Epipen is a mess and a sort of OR. Same with the WHO essential drug leads that James has added prices to. Here we have the leads of drug articles juxtaposing "developing world" and "US" prices, making some point but lacking a source that makes any point. Bluerasberry, I'm afraid I disagree with some of your points and don't think this is the place to rerun the RFC discussion. Wikipedia does have policies against raw data being dumped in articles and does have guidelines about leads. While price of drugs clearly is a concern, if our sources aren't making commentary on international drug price of drug XXX, then our articles also should not include that information. This is just basic WP:WEIGHT stuff. We are only writing this price information so badly because of using bad sources (online databases containing multiple prices from multiple sources) and the lack of skill of the writer. It smells of the kind of Wikipedia editing where folk just add random factoids and data without thinking about how to present information to the reader and where to put it in the article. Currently we have QuackGuru edit warring and just chucking out all of what I wrote and inserting his own agenda. There doesn't appear to be anyone who likes his edits, but nobody fixing it. I don't edit war, and right now I have a few real-world issues on my plate. So I hope you can together try to agree on a form of words that respects that RFC and our WP:WEIGHT and WP:LEAD guidelines. If you don't like the outcome of the RFC then it needs to be raised again for the whole community to comment, not just the handful with this page watchlisted. -- Colin°^Talk 13:11, 19 November 2019 (UTC)

When faced with edit warring, I am disinclined to revert the damage, but support anyone who attempts to restore to RFC-based consensus wording. Also, I will be traveling over the US holiday and unlikely to follow this for a while, so hope someone addresses the issue. I, too, disagree with Bluerasberry's points. SandyGeorgia (Talk) 14:54, 19 November 2019 (UTC)

@Colin: I agree with you on all points about the difficulty of adding price: we lack quality data, the data requires intense regular updating at massive scale, our diverse audience will have challenges interpreting data, and we in Wikipedia lack the social norms, technical infrastructure, and labor base to manage this to our normal standards of quality. In so many ways you have said all these things and your case is well made.

Somehow, this is the development path I want:

1. We have discussion where somehow, we place a value on including price information. I value general price information highly, and roughly, would like to place all drugs into categories of "nearly free, accessible by most, moderate price, expensive, very expensive", or some such scale. I care less about particular prices and more about informing readers about cost barriers. Other people may have another goal in mind, such as exact price information, but I care more about interpreting price for general readers than having exact financial data at points in time and place. The point here is to develop consensus about what is appropriate to include in infoboxes.
2. We scope the ideal price system in Wikipedia, which we would have if we had all data, technology, etc.
3. We identify whomever has the best drug price communication system in the world, and compare ourselves to them, and not necessarily to that ideal pricing system
4. Based on the existing global norms of whom communicates pricing and how, we compromise from our ideal, and start experiments in communicating pricing in some circumstances with intent to develop our price communication policy. All wiki practices develop over years, and if we will communicate price in 10 years, the time to experiment is now.

Colin, this conversation could go lots of ways. Which way seems most productive to you? What do you see as the long term ending consensus in this? Blue Rasberry (talk) 14:58, 19 November 2019 (UTC)

Recognizing and understanding your wants/wishes/desires as good faith, nowhere in your list of wishes do you mention the policies and guidelines Wikipedia has in place that cover content. Colin has named several of those policies and guidelines ... I can name more (WP:NOT, WP:RS, WP:WEIGHT, WP:V, WP:LEAD, etc.). The best way forward (in this, and in any discussion) is to focus not on wants and wishes, but actual policies and guidelines governing content. Colin's position is rooted in policy and guideline. I gave Epipen as an example hopefully to help focus on the policy-driven addition of pricing information. When MEDRS sources discuss pricing, we can include it, to the extent we also respect WP:WEIGHT, WP:NOT and WP:LEAD. Getting ahead of Wikipedia-wide policy and guideline via "the time to experiment is now" would be folly for WPMED. SandyGeorgia (Talk) 15:30, 19 November 2019 (UTC)

Bluerasberry I appreciate your list of desirable information. It represents an aim that a publisher of original material could target if they hire the right people and pay for access or research. But on Wikipedia we are led by sources. We have seen the rather odd interpretation of WP:WEIGHT and 'reliable sources' to mean that just because someone has a database of arbitrarily-sourced prices from a handful of developing countries in 2014, or a database of US wholesale prices in any given week, that means this information is warranted in not only articles but also the lead. We can only give price information the weight that reliable sources do, when discussing price for that article. A database cannot 'discuss' and has no weight. I'm not sure that infoboxes will work for this, nor does that meet the RFC consensus. The price of a drug is too nuanced and varied to just add 'Low' to an infobox. This is a wiki, however, so it is possible that in future we do identify a good source or measure of weight for this. We currently don't appear to have one. --Colin°^Talk 10:24, 21 November 2019 (UTC)

@SandyGeorgia and Colin: I agree with both of what you are saying about the present. Colin expresses that he understands me by saying that we could have reliable drug information from databases in the future, and in the future we might have our choice of expressing that information in any way we like. My objective in this discussion is to seek comments on what realistic expectations anyone has for including prices in Wikipedia if we have the right content quality and technology. I take for granted that consumers need price information, such as what Consumer Reports and similar publish, and that Wikipedia / Wikidata are going to have this information. If an argument needs to be made that reliable sources publish prices and expect consumers to have access to them, then it is possible to make a strong case for that. We are talking about drug prices and the pharma industry here, so it is plausible to imagine that there could be a multi-million dollar investment in Wikipedia just to sort prices any way that we imagined was appropriate if we had the best of everything available to us. I am not suggesting a price roll out everywhere now, but I want experiments and policy development now, and I want to talk through what we would do and how we would do it if we could be the best at this. 10 years ago Wikipedia had to generally dismiss database content, but with the advent of AI publishing / web 3.0 / Semantic Web, publishing is getting weird fast, and algorithmic interpretation is becoming routine in reliable publishing. I see no harm in small controlled live experiments and for anyone who wishes to speculate to develop policy which does not fit now, but which could in the future. Blue Rasberry (talk) 13:44, 23 November 2019 (UTC)

Here's my attempt at merging what we have currently and Colin's two paragraphs above: Unless reliable sources discuss the significance of the price of a particular drug or procedure, it is not appropriate to include that price information in an article. In articles where price information is relevant, the article must explain why it is being mentioned (e.g. claims of price gouging). Some medicines contribute significantly to a pharmaceutical company's turnover (blockbuster drugs), or their high price is a factor in their rejection or difficult acceptance by health services or insurance companies. Prices of medications and procedures can vary significantly between countries, for different brand names, and other factors. So include the specific details regarding the kind of price (e.g., wholesale, retail, discounted), scope (e.g., US-specific, worldwide average) and the year. The lead, as a summary of article content, should not include specific or detailed price information. Little pob (talk) 13:46, 20 November 2019 (UTC)

WhatamIdoing, Bluerasberry, SandyGeorgia, what do you think of Little pob's proposal? I think it is a good mix and also adds 'price gouging' to 'blockbuster' and the health-service/insurance rejection issues. So we have some pointers as to what kind of commentary editors should look for when thinking about price. If we have a consensus then we can move forward to updating the guideline. Currently QuackGuru is refusing to engage in discussion and citing 'competence is required' in his edits, which is a clear insult towards us. Let's demonstrate how collaborative editors work. --Colin°^Talk 10:24, 21 November 2019 (UTC)

On iphone at airport, briefly agree with Little pob but first sentence merely repeats policy ... must we restate policy to get the point across? I guess so ... but it seems strange to me that we even need to say any of this ... it is policy. But I defer so we can move forward. SandyGeorgia (Talk) 12:09, 21 November 2019 (UTC)

PS, prices in infobox, never, adamant oppose. SandyGeorgia (Talk) 12:11, 21 November 2019 (UTC)

I like much of what Little pob wrote.

User:SandyGeorgia, it is sometimes useful to repeat policy.

The main point that concerns me this morning is that I'm not entirely certain that "Unless reliable sources discuss the significance of the price of a particular drug or procedure" is something that holds as strong a consensus as it did during the last major discussion, which was nearly a decade ago. Since that time, there has been so much discussion about the cost of drugs in general, or the cost of drugs in terms of categories (e.g., the new anti-hypertensives are so x% more expensive than the old anti-hypertensives) that I think editors might think that drug costs are more worth mentioning.

They might also hold a different opinion about the costs of specific procedures. These can be quite interesting and discussed in detail by reliable sources (e.g., ultrasounds are much cheaper in Japan than in the US; MRI prices can vary by an order of magnitude within the same metropolitan area in the US), but there is much less emphasis on these. (Also, prices aren't Wikipedia:Biomedical information, so a business magazine is a reliable source for most price information.)

The sentence is also incomplete, because it doesn't mention disease costs. The economic costs of diseases is a routine calculation in the medical literature (and reflected in headlines about "Depression costs the national economy billions of dollars per year"), but that's an easy fix.

I think we might need to go back to editors and ask them where they fall among a range of options. I don't think we're going to get a response of "never, even if extraordinarily well-sourced" or "always, assuming you have any half-decent source at all", but I'm uncertain whether their answer will be closer to "usually yes" or "usually no" these days. To put it another way, encyclopedia articles need to cover the topic comprehensively (the best we can, which is constrained by the existence of sources), and I don't know whether editors currently believe that having some information about the price would be necessary for a comprehensive understanding of the topic. WhatamIdoing (talk) 18:24, 21 November 2019 (UTC)

Yes, I agree with the little pob text here. There are more issues to sort - this little pob text is for prose in Wikipedia, and the biggest part of this price discussion is about the circumstances under which we put prices in the infobox. That infobox discussion is another issue, and while we use default policy for infoboxes usually now, I am expecting another set of policy for infoboxes in the future and in development now. Blue Rasberry (talk) 13:27, 23 November 2019 (UTC)

Thanks for comments. I've taken on board what has been said, and hopefully addressed the majority of the points:

second pass

When adding price information to medical articles, it is important to establish the reason why the price is being stated. Some examples of when it might be appropriate to mention cost information in an article include: The drug is on the WHO Model List of Essential Medicines There have been claims of price gouging or anti-competitive practices Has blockbuster drug status, or is a high-value medication that contributes greatly to a pharmaceutical company's turnover The high price of a drug, or procedure, was a factor in it being rejected or received difficult acceptance by a health service or insurance company Prices of medications and procedures can vary significantly; so include the specific details regarding the kind of price (e.g., wholesale, retail, discounted), scope (e.g., US-specific, worldwide average) and the year: Y Do this: In the US, between 1987 and 2017, the wholesale price of long-acting insulin increased from US$170 to $1,400 per vial. N Don't do this: Insulin costs US$1,400. The lead, as a summary of article content, should not include specific or detailed price information.

I switched the examples to a list layout for easier reading and stylistic consistency with the rest of the MOS. Copied in the do and don't from current, as I think they're useful. I'm not 100% sold on that last sentence, but I'm not sure why. Might just be where I've placed it, or it could be that it's written as an absolute yet there may well be exceptions needed. Little pob (talk) 12:59, 23 November 2019 (UTC)

See "When adding price information to medical articles, it is important to establish the reason why the price is being stated." I don't get this. This suggests if I can't establish the reason why the price is being stated then it should not be included.

See "The lead, as a summary of article content, should not include specific or detailed price information." Prices are already in the lede in numerous med articles. The Current wording does not have these obstacles in place. Please stop trying to add content to this page that would result in deleting pricing from the lede.

Including the examples is fine. QuackGuru (talk) 13:45, 23 November 2019 (UTC)

@QuackGuru: This suggests if I can't establish the reason why the price is being stated then it should not be included. Precisely! If any editor can't justify the reason for adding content – i.e. give the reliable sources without interpretation – they shouldn't be adding that content. It should go without saying, but for clarity; I'm in no way trying to say that same content can't be added by an editor who does have the sources.

Prices are already in the lede in numerous med articles. That doesn't mean they should be in there. Several policies and guidelines have been listed, by much more competent editors than I, as to why there should not be detailed price information in the lead. It's also important to understand that the inclusion of "specific or detailed" is significant, used deliberately, and shouldn't be ignored. <aside>I think it's the fact that the sentence changes meaning if you do, accidentally, skim over the "specific or detailed" bit that has me unhappy with it. Thank you, QuackGuru, for helping clarify that thought process.</aside>

Please stop trying to add content to this page that would result in deleting pricing from the lede. As this is the talk page, no. Discussion around having prices in the lead is ongoing. Some editors are not seeing an issue. Some are strongly against prices in the lead (and apparently infoboxes). Some, myself included, think there is a middle ground to be found. I don't know what that middle ground is, wouldn't dare to guess what numbers each viewpoint has, and nor would I ask those whose opinion differs from mine to hold their tongue. That's not how we find consensus. Little pob (talk) 15:13, 23 November 2019 (UTC)

Proposing content that puts stiff barriers in place is not a middle ground. QuackGuru (talk) 13:31, 27 November 2019 (UTC)

Couple of points, as I know we've butted-heads previously elsewhere:

Re "stiff barriers" specifically – This might come back to bite me on the arse; but WP:IAR would still apply regardless of the wording we all settle on.

Re "the whole": Middle ground is found through discourse. We have to allow all concerned editors to set out their stall, and be willing to engage with them, to find that fabled land.

Little pob (talk) 15:13, 27 November 2019 (UTC)

• Add prices per Blue. Prices in the infobox would be excellent, especially if we can automatically upload them based on high quality sources. User:Seppi333 was working on something like this. Doc James (talk · contribs · email) 18:27, 21 November 2019 (UTC)
• add prices per Blue Rasberry--Ozzie10aaaa (talk) 19:08, 21 November 2019 (UTC)
• Add prices is the way forward. Adding specific wording to this guideline to delete prices from all med articles is not going to work. QuackGuru (talk) 20:12, 21 November 2019 (UTC)
  • Could we please stop voting? Really, this situation is lot more complicated than just "add prices". You can "just add prices" to articles about some subjects, but can any of you premature voters tell me what the price is for a pregnancy?
    The conversation that we need to have here is (a) a conversation, not a vote, and (b) about all the complicated and diverse details, not just some one-size-fits-none "add prices and quit bothering me about the details" opinion. I don't necessarily mind if you want to add prices, but you need to tell me which prices you want to add, and which articles you want to add them to. WhatamIdoing (talk) 21:43, 21 November 2019 (UTC)
    • You are asking what is the typical "cost" of an inhospital delivery in various countries? Average in the US in 2013 was $32,000 but it varies fairly widely.[1] Doc James (talk · contribs · email) 22:34, 21 November 2019 (UTC)
      • No, that's the price of hospital-based childbirth and postpartum care in the US. If it's so easy to "just add prices" that we don't need to have an actual conversation about which prices to add, which articles benefit from prices, and what kinds of situations we should be including and excluding, then you should be able to tell me what the price of the pregnancy itself is. There's millions of pregnancies each year. You want to "add prices". Okay, what price would you add to Pregnancy to explain the costs of getting pregnant? WhatamIdoing (talk) 22:50, 21 November 2019 (UTC)
        • One is directly by the avaliable sources. There is the field of health economics that revolves around this. Would need to look at the sources. We have an entire article called Price of oil. Doc James (talk · contribs · email) 00:16, 22 November 2019 (UTC)
          • Okay, so that's something we should be talking about: "Add prices", but only if and when we've got good sources. But it's more complicated than that, isn't it? The price of pregnancy can be free. It can be hundreds or thousands or tens or even hundreds of thousands of dollars, if the couple is infertile. The price can also be measured in terms of morbidity and mortality for the pregnant woman: the price is weeks of vomiting, or months of depression, or years of worsened body dysmorphia, not to mention the number of women who die by suicide or murder as a result of an unintended pregnancy. And then there are straight economic costs, of lost wages and lost jobs and increased expenses for everything from bigger clothes to more food to prenatal healthcare costs (if any is obtained). So you want to "add prices". Pregnancy is well-studied; we can get sources for any of these. Which of these prices do you actually want to add? WhatamIdoing (talk) 00:36, 22 November 2019 (UTC)
            • Most stuff is much more well defined like the average price of a C-section versus in hospital vaginal birth or the price of a hip replacement or the price of a single medication. Doc James (talk · contribs · email) 01:59, 22 November 2019 (UTC)
              • Does that mean that you want to "add prices" only to these more discrete items, and not to "just add prices" to every article? Do you want to add only certain kinds of prices, like the price of the surgical procedure or the hip prosthesis, or do you want to include the price of the pain, medical equipment, caregiving, physical therapy, lost wages, etc. that go along with that hip replacement surgery? WhatamIdoing (talk) 02:28, 22 November 2019 (UTC)
                • • Include the "price of pain"? Not sure if you have sources for that but I do not think I do. Price of lost wages is avaliable for some conditions as is the price of caregiving. Doc James (talk · contribs · email) 21:25, 22 November 2019 (UTC)

@WhatamIdoing: Some years ago I looked for and could not find "price of pain" or total cost of medical care info.

• Wikipedia:Articles for deletion/Medical harm
• Undesirable health care outcomes
• Talk:Iatrogenesis#Requested_move_Iatrogenesis_→_Medical_harm

I still think we need a general article on non-financial costs. I am not aware of any source which presents this concept. Blue Rasberry (talk) 13:19, 23 November 2019 (UTC)

Perhaps you had the wrong key words for your search? If you are trying to put a dollar value on the experience, I undestand that you measure the pain in DALYs and multiply that by whatever number your economist tells you is the relevant price for a year of (healthy) potential life lost. You can also state the cost directly: "Most people experience moderate to severe levels of pain for n weeks after the surgery". This may be preferable, just like "most people can't work for n weeks" is usually more informative to individuals (especially individuals outside the US) than "People lose US $X in wages". WhatamIdoing (talk) 02:59, 24 November 2019 (UTC)

We include a lot of DALY data. Agree for surgery the typical length of pain is more useful when looking at that measure. The average cost or range of costs for a procedure is also useful. Doc James (talk · contribs · email) 14:47, 26 November 2019 (UTC)

Informative to some (e.g., Americans), but less to others (e.g., anyone in the developed world). "Two-hour surgery that can usually be handled at an outpatient surgical center" translates across time and place better than "Cost US$12,000 in the US in 2015". The same isn't really true for mass-produced products (drugs, supplies, devices, etc.), although if we wanted to avoid numbers altogether, it'd be possible to place most products in some sort of price range ("higher price than most similar devices"). WhatamIdoing (talk) 15:54, 26 November 2019 (UTC)

What's wrong

No editor has explained what is the problem with the current wording and if an editor wants to add content that appears to violate WP:CREEP then that editor should explain why they want to violate CREEP. Telling editors what should or should not be included in every med article is not productive. For example, Onasemnogene abeparvovec says "It carries a list price of US$2.125 million per treatment, making it the most expensive medication in the world as of 2019.[6] In its first four months of sales US$160 million of medical was sold.[7]" We should not add content that would delete this from the article for no good reason. If anyone wants to add content to this guideline that would delete the US$2.125 million price tag from the article then that would be a violation of CREEP. QuackGuru (talk) 14:02, 21 November 2019 (UTC)

Quack, you are not actually entitled to an explanation that you can understand or that will WP:SATISFY you. At some level, I want you to remember that Wikipedia:Policy writing is hard and that it's a skillset that most editors, including you, don't have to any significant degree. But since you have asked, an incomplete list of the problems includes:

• Redundancy: Some versions say the same thing twice. For example (NB: I'm only giving one example of this problem. This is not an exhaustive list of all instances of redundancy), the current version tells editors to mention the "scope (e.g., US-specific, worldwide average)" and then asks them to consider "Is it in a particular country, or a worldwide average?" Saying this twice is pointless.
• Incompleteness: Some versions do not include all of the information that editors think would be helpful. For example (NB: again, just one example), some versions do not mention whether (or under which circumstances) a price should be mentioned in the lead.
• Divergence from consensus: Some versions do not align with the current consensus in all points. In some cases, I am even uncertain what editors would recommend. For example (NB: just one example), perhaps editors have changed their minds, and now they think that the price of drugs is worth mentioning in a greater proportion of articles than they thought several years ago.

The bottom line is that even though these problems are (apparently) not obvious to you, they do exist, and they are worth fixing. WhatamIdoing (talk) 18:08, 21 November 2019 (UTC)

Current wording

Economics may include prices of medications or the cost of procedures, if covered by reliable sources. Cost information may be included in the lead, but this is done on a case-by-case basis. The cost of medicine or procedures can include specific details regarding the kind of price (e.g., wholesale, retail, discounted), scope (e.g., US-specific, worldwide average) and the date or year. Certain medicines contribute significantly to a pharmaceutical company's turnover (blockbuster drugs), or their high price is a factor in their rejection or difficult acceptance by state health services or insurance companies. Prices may vary significantly between countries, for different brand names, and other factors, so include specific information. For example, is your source reporting the list price or the actual selling price? Is it in a particular country, or a worldwide average? Is it the total cost, including indirect costs such as lost wages for the patient, or the initial price?

Y Do this: In the US, between 1987 and 2017, the wholesale price of long-acting insulin increased from US$170 to $1,400 per vial.

N Don't do this: Insulin costs US$1,400.

• Support current wording and current section name. What is the problem with the current wording? If it ain't broken then don't fix it. QuackGuru (talk) 14:02, 21 November 2019 (UTC)

• Comment: please guys let's do a proper RfC, a local consensus cannot overturn a previous RfC, so this vote is bound to be pointless anyway. Please let's revert back to the RfC state and follow a proper BRD procedure, the MED community can do better than that. --Signimu (talk) 15:32, 21 November 2019 (UTC)
  • WP:RFCs do not result in binding decisions. An RFC is an advertising process for an otherwise normal talk-page discussion. Wikipedia:Consensus can change (that's the actual policy; neither WP:RFC nor WP:BRD are policies), and if the consensus disagrees with the outcome of a previous RFC-advertised discussion, then any convincing discussion is adequate to "overturn" it – just like any other discussion. WhatamIdoing (talk) 17:18, 21 November 2019 (UTC)

    Ah just saw your reply, we discussed this on my talk page, but just to write it down here too, yes consensus can change, but it should be at least on a similar level of "strongness" to avoid relying on a WP:SHAM consensus. It's just that I'm sure we can reach a better consensus by discussing more, and more broadly Signimu (talk) 19:34, 27 November 2019 (UTC)

• This isn't the best we can do. Let's keep talking above about how to improve it, rather than just voting. WhatamIdoing (talk) 17:52, 21 November 2019 (UTC)

• Looks like a good start. Doc James (talk · contribs · email) 21:27, 22 November 2019 (UTC)

It is complicated and you are forgetting WP:WEIGHT

I'm really disappointed at the level of argument from QuackGuru and DocJames. QuackGuru insists the "current wording" be left because "If it ain't broken then don't fix it". We didn't have anything on Price a month ago, but it is worth reminding ourselves of what QuackGuru added:

"Economics may include prices of medications or cost of procedures if covered by reliable sources. The pharmaceutical industry has tried to conceal medication prices because of their continuing legal cases in the United States. There is a lack of transparency regarding medication and vaccine prices among non-governmental organizations."

The first sentence is in direct contradiction to and misunderstanding of policy. Our policy doesn't just say (as James further above claims) that if a "reliable source" mentions something, then we can also mention it, in whatever detail we choose and however prominently we choose. Whether or not to include things, and whether they are significant enough to appear in the lead, and how much detail to afford to them, is determined by WP:WEIGHT: "in proportion to the prominence of each viewpoint in the published, reliable sources". Our policy goes on to say "Undue weight can be given in several ways, including but not limited to depth of detail, quantity of text, prominence of placement, juxtaposition of statements and imagery". Weight isn't just about viewpoints, but about any aspect of a subject and how it is presented. This is explained in policy: "An article should not give undue weight to minor aspects of its subject, but should strive to treat each aspect with a weight proportional to its treatment in the body of reliable, published material on the subject". The second two sentences added by QuackGuru are his own agenda and not appropriate text for any guideline on Wikipedia. The editorialising was quickly removed by WhatamIdoing but the initial faulty sentence was retained. QuackGuru then added another statement:

"Cost information may be included in the lead, but this is done on a case-by-case basis"

The reason for this would appear to be to defend Doc James addition of detailed price information in the lead of mainly the WHO essential drugs. It isn't supported by any policy, guideline or consensus of editors on Wikipedia. Indeed, the RFC of two years ago (not 10 as claimed above) rejected the general inclusion of price information in articles. James has found a source that lists a handful of prices from a limited small set of suppliers of a given drug back in 2014 and has extrapolated that to be "The wholesale cost in the developing world" (e.g. Mebendazole). This is a statement that is simply untrue. Nobody has published "The wholesale cost in the developing world". There is a database that contains specific wholesale prices from a very small collection of suppliers who mostly target the developing world. They have got the price information from whoever makes that price information available to them: they don't claim this is actually representative of world-wide pricing or developing-world pricing. There could be huge gaps in that data due to price being withheld or simply hard to retrieve. Perhaps it is likely to be in the approximate ballpark, but no more than that.

Because the source does not perform any statistical analysis on the price, neither can James. But he chooses the smallest and largest price in the database of six suppliers. Picking the smallest and largest value in a dataset is not a typical method used to statistically analyse data and present it to people, because it is prone to giving undue weight to outliers. Performing analysis on a tiny dataset is prone to drawing incorrect conclusions because information is missing. Some of the suppliers in this small dataset could be orders of magnitude larger (and thus more significant) than others, yet we treat them all equally by ignoring all except the cheapest and dearest. That is simply statistical and economic incompetence. The data is certainly now out-of-date as the website has not been maintained for five years. We are told the price in the developing world is between XX and YY. That means we claim to have a reliable source that says the cheapest price in the whole developing world is XX and the most expensive price is YY. But in fact we don't. We have a source that merely gives a price from six suppliers who do not cover the entire developing world. And a price that is 5 years old. And let's not even start on a definition of "Developing country" which may or may not include South Africa, India, China and Russia depending on which measure you use.

James directly quotes these arbitrary prices in dollars and cents. We have in our lead the claim "between USD 0.004 and 0.04 per dose". Let's return to WP:WEIGHT. Do our reliable sources give weight to the lowest and highest prices in the IMP Price Guide of 2014 for this drug? Do our reliable sources quote those prices in tenths of a cent precision? Do they think that the price, to tenths of a cent, charged by German charity Action Medeor International Healthcare to one African country, Tanzania, is important enough to mention in the lead? I hope you agree that is ridiculous. The only reason our lead, as written by one Wikipedian with an agenda, mentions the price in Tanzania by a German charity, is because that's all that James found convenient when web surfing. Not a single one of our reliable sources on Mebendazole mention the price, in tenths of a cent in Tanzania in 2014, in their leads. So neither should we.

Then there is the question of what we even mean by "dose". The article doesn't explain or link. The source gives the price per tablet and also gives a defined daily dose. For example, Mebendazole, the lowest price is $0.0035 per tablet of 100mg and a "defined daily dose" of 200mg. Our article just says "$0.004... per dose". What our article neglects to mention, and most of our reliable sources do mention, is that mebendazole might only need a single dose of 100mg to treat threadworms, though a second dose after two weeks is used if reinfection occurs (which is common). For some other infections, the treatment is 100mg twice a day for three days. Add to that, the advice is often to treat the whole family. Now, we generally don't go into specifics about mg dosage, but it is encyclopaedic that this is a very short and quick treatment (compare e.g. fungal nail infection which might take 6-12 months of treatment daily). Which figure is useful to our readers? The single dose taken three times a day, the 3x combined daily dose, the "defined daily dose" standard "used to standardize the comparison of drug usage between different drugs or between different health care environments" (which is not the therapeutic dose), or the total amount needed to fully treat the condition in the patient, or the amount for the whole family? So, just like wholesale vs retail pricing, we aren't really defining what we mean by dose. Should the lowest price in the lead be $0.0035 tablet in Tanzania, 0.007 per defined daily dose, or give different values for threadworms vs other infections, or total treatment cost?

The article also claims the price in the UK is around $5, citing an FT article I can't read. The BNF says 100mg tablets from Janssen-Cilag Ltd costs £1.34 for a pack of 6 tablets, which is wildly different from $5. The UK retail price is £8 or £9 for a pack of four from two pharmacies I found, which would likely require two packs (£16-18) to treat the family of four with two doses two weeks apart. Why are we mentioning $5 in the UK, when that bears no resemblance to any price whatsoever? It is just wrong.

There is notable commentary in reliable sources about the US price hike. Also this article from 2011 mentions dodgy accounting by reputable charities wrt the price of this medicine.

In summary, we are making patently false and unsupported claims in our leads: nearly every fact presented is just plain false and our wording ambiguous. We are giving way too much weight and precision to prices from an arbitrary and tiny collection of sources, and our major source for such prices has not updated their data for 5 years. And to add to that, our Mebendazole article doesn't mention far more relevant encyclopaedic information such as that just two doses of the tablet, taken two weeks apart, will clear a threadworm infection, or that family members are encouraged to be treated even if they don't show symptoms.

The claim that such information is supported by reliable sources takes a deliberately naive view of how sourcing should influence our article content. I'm sure everyone here knows that people turn up on Wikipedia with claims made by some mouse experiment in such and such a journal. They are perplexed that although we agree that journal is a reliable source for what the experiment did, it isn't a reliable source from which we can make health claims in humans. Similarly, a 5-year-old neglected database of prices from six random organisations is not a reliable source from which we can present the very complex business of worldwide drug pricing to our readers.

Our lead should contain a summary of only the most vital and robust information about the article topic. It is, after all, what is read out to us by our electronic devices and what is translated to other Wikis. Instead we simply have nonsense written by incompetent amateurs who are misinterpreting their inadequate and out-of-date sources. It couldn't really, be much worse. -- Colin°^Talk 21:32, 23 November 2019 (UTC)

Well, there is some precedent for this. It depends on whether you think that the price of a product or service is more like a birth date or more like a criminal conviction. We routinely include bare facts in the name of comprehensiveness even when almost no source mentions them. In biographies, that means that we include people's middle names, birth dates, parents' names, cities of birth, high schools, etc., even when no source actually cares about those facts. In articles about chemicals, we include bare facts such as molecular weight, even though we know that nobody's actually going write an article about how it's so interesting that the molar mass of chlorine trifluoride is 92 instead of some other number. We do this in medical articles, too: if there's no known treatment, then we would usually have a section called ==Treatment== that makes a brief statement that there's no known treatment. We just feel that these articles would be incomplete without this kind of information, and the difference in terms of WEIGHT is whether you mention these things in passing, or if you put a lot of emphasis on them – not whether it's mentioned at all. WhatamIdoing (talk) 02:39, 24 November 2019 (UTC)

Much more like a criminal conviction. A birth date or molar mass is a pure, bare statement of fact. The molar mass of chlorine triflouride isn't one thing in San Diego and something very different in Rio de Janiero; it's just 92, everywhere, every time. If you were born on 1 January 1970, that's your birthday, period, everywhere. The price of a given medicine very well might be different everywhere, and even different depending on how it's being procured or purchased. That's not something we can just slap a number on; it would require contextualization and discussion by a reliable source, not just grabbing a number out of a database. There are cases where reliable sources have extensively discussed the prices of certain medications or treatments, and I'm all for including such well-sourced information in the article, but it shouldn't be a routine practice to add to all or most articles. Seraphimblade ^{Talk to me} 04:19, 24 November 2019 (UTC)

Agree with Seraphimblade. Someone's middle name, DoB, etc are the sort of information one expects in an encyclopaedia and are either correct or not. The price of a drug is just about the most nebulous thing we can consider: where, when, how much, how delivered all cause huge fluctuations. Consider the price of a mango:

• Standard whole fresh fruit. 69p
• Giant whole fresh fruit. £1.80
• Twin pack wrapped in plastic and ripened ready to eat. £1.89
• Dried mango slices, 200g. £4.00
• Mango slices in syrup in tin can, 425g. £1 or 3 for £2.50
• Mango pulp in tin can, 850g. £1.75

And that's just from one major supermarket in the UK in November. Now imagine that I wrote "The price of mango in the developed world is between £0.69 and £4.00" and inserted that into the lead, and edit warred to retain it there and then went and edit warred at WP:MOSFRUIT to ensure the price of mangos was required. The database James found is just a collection of data values from limited sources, just as MySupermarket.co.uk is a collection of data values from limited sources (it doesn't include the price at markets and small shops, just large chain supermarkets). James has engaged in WP:OR to make claims that this dataset represents the lowest and highest prices in the developing world and presented it in a way we don't really know what the price is for.

The price of mebendazole is not notable except in the case of the US price hike. Without that hike, the price follows the pattern of any cheap-to-produce out-of-patent pill around the world. Further, it is remarkable for being effective with just a very short treatment regime -- something our article does not mention. Time and again I see WP:MED arguing to include factoids or awful videos but not even getting the basics of a text encyclopaedia right. These embarrassingly bad price statements are present on dozens, hundreds, of our key drug articles, and they are all, every one of them, as wrong in so many ways as a Trump tweet. -- Colin°^Talk 12:34, 24 November 2019 (UTC)

And yet if I added the annual average FOB (~wholesale) prices for imported mangoes according to the USDA to Mango, I doubt that anyone would tell me that was not encyclopedic information and that readers would be mad to discover that they weren't paying US$4.60 to 5.74 per box in the US during 2018 and therefore all information about prices urgently needed to be removed to stop people from thinking that the wholesale price was their local retail price, or that it was terribly confusing to let the experts at the USDA weight conventional and organic, and different sizes of mangoes, and different ports of entry, and different seasons, and the different countries of origin into a single price range all by themselves. I might get complaints that it's only the US (which is fair; 8 of the top 10 mango producers in the world don't export mangoes to the US in any considerable quantity, but that suggests expanding it with a more prices for different countries, not removing the prices that we do have), and I might have to point out that the US grows very little mango domestically, so the import price basically is "the" price, but I don't think that anyone would say that the overall economics of a popular fruit crop are unimportant unless I'm citing a source that talks about those prices in great detail. WhatamIdoing (talk) 16:57, 24 November 2019 (UTC)

• I just set up Wikipedia:Defining data. I intend this to be the start of some guidance about what sort of information should go into articles, seemingly in circumvention of the guidance at WP:NOT, WP:RS, WP:WEIGHT, WP:V, WP:LEAD, and the rest. WhatamIdoing, I think this is what you were mentioning above. Colin, I think you are saying that price is not "defining data", and I am saying that some information about price is defining. Again, I agree - we have great difficulty actually getting this data, but if we had it in sufficiently high quality, then I would like to present it as fundamental. I see price to be as fundamental to drugs as concepts like nationality and century of birth are to a biography. Obviously we need more discussion. Blue Rasberry (talk) 15:20, 24 November 2019 (UTC)
  • Bluerasberry the concept of "Defining data" is interesting. I don't think that wiki projects have always been sensible about what to include in info boxes. For example, WP:MED for years put lots of external database links in info boxes, and I see that is now demoted to a collection at the bottom of the article. Even now it tries to include some rather complex concepts in the infobox. Perhaps a good characteristic of the data we should include in info boxes is whether that data describes something simple and straightforward rather than nuanced and complex. Does it need a lot of explanation? Even so, it can be simple for some subjects and hard for others. The infobox for Measles is fairly straightforward. The Tuberculosis one breaks down a bit with its Frequency datapoint being hard to explain and the value given is probably not what most people would consider (numbers with illness). Infoboxes become downright silly with Cancer and Epilepsy which are really groups of diseases that may have very little in common.

But surely "defining data" is information about a subject that if it were significantly different, it would be a different subject. Someone's DoB, parents, partners, children, occupations and year of death all go to define a person. The defining attributes of mebendazole include its chemical and therapeutic properties. It may also include the company that invented it and may still hold a patent on it. Whether it is licensed in Europe or US. In the UK we might be concerned if it is available only by prescription (PoM) or only from a licensed pharmacy (PM) or widely (GSL). In the US you care much more about price than we do in the UK. Depending on your circumstances and age, prescribed medicines are either free of charge or require a fixed £9 charge for about 1 month's supply. Whether a bottle of pills has a wholesale cost of £1 or £2 or £10 is really only the concern of my pharmacist.

The recent astronomical drug price hikes in the US (and occasionally in the UK) demonstrates in fact that price is very much not a defining characteristic of a medicine. In fact, it is more a representation of the economic systems of countries, and the price regimes their governments do or do not enforce. Has drug company mergers led to decreased competition, have monopoly regulators been asleep? These are not, in fact, questions about a drug at all. The drug price is just a pawn in a bigger game. -- Colin°^Talk 17:10, 24 November 2019 (UTC)

Don't you think that whether the wholesale cost is £2 or £200 is also a matter of interest for taxpayers and policy makers? Perhaps just as it doesn't actually matter whether some politician's birthday is January 1st or January 2nd (although, for better or worse, we do report that level of detail), the exact details aren't that important, but the overall order of magnitude could be important to the healthcare system and its users (not to mention students writing about the drug for school).

Which brings me to the other point: Prices matter to the business end of healthcare. Any individual consumer or taxpayer might not care about the general price range for a given drug, especially since so many of them are generic drugs, but investors should and do care. Are we actually writing comprehensive articles if we're omitting key information about that POV? I notice that s:1911 Encyclopædia Britannica/Tea mentions the early price of tea in England and the then-present estimated capital value of those big businesses, so I think it's fair to assume that some business matters are a proper subject for encyclopedias. WhatamIdoing (talk) 17:24, 24 November 2019 (UTC)

And that's great, and there are places those can be found in many cases (and if it can't be found, well, then it's unverifiable so we couldn't include anything about it either). It's useful is explicitly not an argument for inclusion in an article. Bus, train, and flight timetables and schedules are indisputably useful and of interest to many people, but we still do not include them, both because they're a greater level of detail than is generally encyclopedic, and they often change and would quickly become out of date. That's the same reason we do not generally include prices. Now, with something like the treatment mentioned above, which reliable sources have extensively noted is the most expensive in existence, sure, then we should mention that, in the same context the sources do—its extreme price is part of what's notable about it. But we shouldn't do that for run-of-the-mill drugs or treatments where their prices are not of any particular note. So, while there are exceptions, the general rule of other articles about products should also apply here: No pricing. Seraphimblade ^{Talk to me} 18:40, 24 November 2019 (UTC)

WAID, I just noticed your comment above. My mango comment wasn't made to get side-tracked in to how to price mangoes, but to demonstrate the silliness that I'd found a website quoting a handful of mango prices and had done OR on that to make claims that really aren't true. WAID, we don't have a source for the cheapest price of mebendazole in developing nations. We don't have a source for the dearest price of mebendazole in developing nations. Our source doesn't even claim to represent "developing nations", whatever definition you might use. Nor do we state what the price is actually for. Surely you agree that "what is this price for" is crucial? All our important drug articles make price claims that are simply not true and not supported by the source given. Are you not concerned about that? Consider Ibuprofen:

We can normally take two 200mg ibuprofen tablets up to 4 times a day. The defined daily dose of ibuprofen is 1.2g. So by "dose" do we mean a 200mg tablet, 400mg individual dose, 1200 defined daily dose, or 1600mg maximum normal daily dose?

• Ibuprofen says "The wholesale cost in the developing world is between US$0.01 and US$0.04 per dose"
• The source has "Lowest Price: 0.0046/tab-cap", "Highest Price: 0.0080/tab-cap" (and explains that lowest/highest is just among their 9 suppliers, not "the developing world"). The tablet "Strength: 200 mg". The "Defined Daily Dose: 1.2 G".
• If our dose is a 200mg tablet then "$0.005 to $0.008"
• If our dose is two tablets, 400mg, then "$0.009 to $0.016" (or $0.01 to $0.02 if we round).
• If our dose is defined daily dose, 1200mg, then "$0.028 to $0.048" (or $0.03 to $0.05 if we round)
• If our dose is maximum daily dose, 1600mg, then "$0.037 to $0.064" to $ (or $0.04 to $0.06 if we round).

None of these ranges bear any resemblance to what our article claims. The article also claims "In the United States, it costs about US$0.05 per dose." without saying if that is a wholesale price. The source does not, AFAICS, include any price information whatsoever. Consider the epilepsy drug valproate.

• Valproate says "The wholesale cost in the developing world is between US$0.14 and US$0.52 per day" added by Doc James in 2015.
• The source has one supplier price (IDA) at $0.1486 per 500mg tablet. If we might multiply by 3 to get the 1.5g defined daily dose, it comes to $0.45 per day. The other two prices it lists are buyer prices, for Peru and Sudan. These work out at $0.23 per day (Peru) and $0.79 per day (Sudan). There isn't AFAICS any price or price calculation that gives "between US$0.14 and US$0.52 per day". The price quoted in our article is similar but not exactly the same as two 500mg tablets, but the defined daily dose would be three 500mg tablets.

Honestly, the more examples you look at, the more one wonders if this is some experiment in trolling Wikipedia to include random false facts and see how long the community takes to notice. You ask if our readers might get confused. No, I think here we actually have an editor who is confused, who really hasn't a clue about what they are writing, and has spread their confusion over all our major drug articles. Are any of our drug prices correct? -- Colin°^Talk 18:43, 24 November 2019 (UTC)

Like WAID said, "Don't you think that whether the wholesale cost is £2 or £200 is also a matter of interest for taxpayers and policy makers?" I agree that reporting bus fare and the difference between $0.03 to $0.05 is silly, so let's leave that out because that was never the point. Now you guys say something about uncertainty about whether something is approximately $2 or $200, which is the difference between accessible and inaccessible. Why not communicate this? We seem likely to be able to do so soon with good data and technical capacity, and if people want to experiment with the process now, then why not? Blue Rasberry (talk) 22:21, 24 November 2019 (UTC)

That's...not how any of this works. Wikipedia follows sources. They, not us, should be doing the experimenting. If they decide to go into a lot of detail on the price of certain medication, we follow their lead and do the same. If they don't, we don't either. If we will one day have sufficient data, we will use that data after it exists, not presume one day it will. Wikipedia follows, never leads. Seraphimblade ^{Talk to me} 00:45, 25 November 2019 (UTC)

I think we have two different conversations going on. WhatamIdoing and Bluerasberry are still trying to make the case for including a cost figure and not really engaging on the problem that (a) we don't have sources for what they want and (b) all our major drug articles have incorrect drug cost figures. WhatamIdoing, there are several parties who care about price. You say "prices matter to the business end of healthcare". I return to the question "the price for what?" Clearly our current description of pricing is not actually stating "what" because "dose" is not defined and can be defined in many ways (though defined daily dose would appear to be the relevant one for financial comparison). But for a drug company, that only has meaning when combined with how many doses a person takes (or keeps taking for life), how many people get ill and need the drug, whether other drugs compete or will compete, what competition there is in the market for this drug (either on patent or off patent but nobody else making it), what agreements they already have with healthcare providers that control prices, etc, and whether you want to spend eternity in hell for charging $400 rather than $0.04 for a pill to get rid of threadworms. Our cost information will not help anyone make that decision, and frankly, nor can they be trusted. I think if you want to make the case that cost information should be presented in our drug articles, and describe how it should be presented, then you need to start with an example of best practice. MEDMOS shouldn't be based only on speculative information we might not be able to reliably get, nor based on the very bad practice described above, but on best practice. -- Colin°^Talk 15:08, 25 November 2019 (UTC)

Seraphimblade, the idea of "experimenting" is to experiment with different approaches for reporting what the sources say. For example, would editors be happier with a properly sourced sentence that says "The wholesale cost of generic ibuprofen tablets is usually about a penny each", and leave it to the reader to guess that we're talking about the standard 200mg pill, or would we be happier with a properly sourced bot-controlled item in an infobox that gives the price for an extremely specific definition, such as the "US Average wholesale price (pharmaceuticals) for the Defined daily dose on the specified date"? US AWPs have been reported for four decades for drugs that require long-term treatment, and DDDs are standardized worldwide (that's the point of the DDD, although for ibuprofen, it'd require more than one entry, because there's more than one DDD), so we can source those prices. The "experimental" part here would be deciding whether we'd prefer something approximate in prose vs something precise (we can get the AWP for ibuprofen down to the thousandths of a cent on any specific day, which might be overkill) vs some other approach (e.g., list price at time of introduction, in the ==History== section for a drug). WhatamIdoing (talk) 16:47, 25 November 2019 (UTC)

WhatamIdoing, that's a false dichotomy. The general rule for products is that we do not include pricing at all, and I see no reason to deviate from that here. Exceptions are made in which the price, in and of itself, is one of the notable features of the product, but if it's just something that's sold and no sources talk about the price being of particular note, it should be omitted entirely. So, in most cases, I would prefer to see neither. Seraphimblade ^{Talk to me} 19:38, 25 November 2019 (UTC)

That is simple not correct. We have whole pages on prices.Price of oil Doc James (talk · contribs · email) 21:28, 25 November 2019 (UTC)

Seraphimblade, I'm not sure that the former general rule has as much widespread support as it used to, either in this subject area or in any other. Template:Infobox camera has a parameter for the list price. Template:Infobox battery includes a measure of cost-effectiveness (the amount of energy compared to the price paid by end users). Template:Infobox aircraft type includes the price of an aircraft, and they've clearly put some effort into deciding exactly which price they want to include. Looking at some FAs, Sega Genesis lists the initial or list price for multiple products, plus the clearance price for one of them. 32X has the initial price in three currencies in the infobox. Science Fantasy (magazine) reports the cover price. NeXT names the price for one of their products in the lead. House (TV series)#Distribution tells you how much iTunes is currently charging to buy an episode. If editors genuinely didn't want prices in articles, then I don't think that we'd find it in infoboxes and Featured Articles. WhatamIdoing (talk) 22:00, 25 November 2019 (UTC)

What's found in the articles about the Genesis (and some comparable articles, such as Nintendo Switch) is the original list price. I can see why that might be included, as generally the introductory price of a game console will indeed be discussed pretty heavily by sources immediately preceding and following the launch. I would be amazed to find there isn't a bunch of source material about it. On the other hand, something like the iPhone 11 lacks it (though ironically, it had a spam link for it I cleaned up), because it doesn't even really have a particular price. Sure, there's a list price if you just buy one, but very few people outright purchase at that price; most get them through some kind of deal with their carrier. Additionally, the Genesis article doesn't go into what getting hold of a Genesis would cost you today, so that is a static figure that won't become outdated. Those are all very different circumstances than medications. They're much more similar to the phone—ask ten people what they paid for them, and you'll likely get ten different answers. The same is true of oil prices; that in itself is a notable subject. The subject of medication pricing might also be worth an article if we don't have one; I suspect we could find a fair bit of sourcing for that. But that's different than trying to put current prices in individual articles. Seraphimblade ^{Talk to me} 22:32, 25 November 2019 (UTC)

You said "On the other hand, something like the iPhone 11 lacks it (though ironically, it had a spam link for it I cleaned up), because it doesn't even really have a particular price." The reason it lacks pricing in the article is because you deleted it from the article.[2] QuackGuru (talk) 00:38, 26 November 2019 (UTC)

QuackGuru, you attempted to put it in after I made that comment. Check the timestamps, please. Seraphimblade ^{Talk to me} 07:39, 26 November 2019 (UTC)

Seraphimblade, the original list price for every model of iPhone is listed in the large table at iPhone#History and availability (i.e., the first section). Also, I believe that "deal from your carrier" thing really only happens in the US. Most of the world pays cash on the barrel head for their phones.

It would be trivial to find equivalent sources for the original (US) list price of any new drug. WhatamIdoing (talk) 16:00, 26 November 2019 (UTC)

They certainly are, and with no sourcing to indicate any type of significance. I don't have time to clean up such a large table right now, but I'll correct that once I do. In any case, the correct venue for this, ultimately, is an RfC at WT:NOT. If there's consensus that WP:NOPRICE should be changed or removed, well, then such as it is and we'll go forward with that. But until and unless that happens, that is the global policy on prices and articles, and that rule is "With a few exceptions, don't include them." A local consensus here couldn't change that in any case, so this really is just an academic discussion. If you'd like to work on formulating an RfC, I'd be happy to give my thoughts on wording. Seraphimblade ^{Talk to me} 17:25, 26 November 2019 (UTC)

WhatamIdoing with an iphone the original list price doesn't require any maths or judgement about doses or indications. You say it would be trivial to find original US list prices of any new drug. But all you can find is the price for a product with a bar code: a particular pack size of a particular strength in a particular formulation of a particular brand. I can't just transform that into "price for a drug". Also, "any new drug" doesn't help us with the 99% of our drug articles that are existing drugs. -- Colin°^Talk 17:33, 26 November 2019 (UTC)

The original list price of a MiniMed artificial pancreas doesn't require any maths or judgment about doses or indications, either. It's just an electronic device, complete with bar code. What we recommend about how to describe prices should encompass more than just drugs. WhatamIdoing (talk) 00:20, 27 November 2019 (UTC)

That's very nice, but what we recommend now is "Don't include them". If you'd like to see that change, the aforementioned RfC is still needed. Seraphimblade ^{Talk to me} 04:00, 27 November 2019 (UTC)

See WP:NOPRICE: "An article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention." It does not conclude never include pricing. There is independent sources and there is a justified reason to include the pricing for the IPhone 11 but I believe you violated WP:NOPRICE.[3] There is significant independent press coverage. That is a justified reason. QuackGuru (talk) 12:32, 27 November 2019 (UTC)

International Medical Products Price Guide

The source for most "developing country" prices in our drug articles is the "International Medical Products Price Guide". This is typically expressed in our articles by a statement like "The wholesale cost in the developing world is between US$0.14 and US$0.52 per day." or "The wholesale cost in the developing world is between US$0.01 and US$0.04 per dose" which appears in both the lead and a Cost section. Although cost statements are widespread in our drug articles, particularly the WHO Essential Medicines, only one user, Doc James, added them, mostly in 2015.

The guide "provides a spectrum of prices from nonprofit suppliers and commercial procurement agencies, based on their current catalogs or price lists. It also contains prices obtained from international development agencies and from government agencies." Its purpose is "to improve procurement of medicines of assured quality for the lowest possible price". It claims "comparative price information helps in price negotiations, in locating new supply sources, and in assessing efficiency of local procurement systems". It cautions "This Guide is intended as a comparative reference only", "The vendors included are not intended to be a comprehensive list of potential suppliers".

There are two types of price in the guide. Buyer and Supplier prices. Buyers are usually government agencies and the price is what they obtained after negotiation, competitive bidding, etc and are not available to anyone else. The buyer prices are indicative only, and can't be used for comparison or reference purposes. Suppliers are organisations who have a warehouse and supply to customers. The prices are further complicated as there are other cost factors to consider when ordering medicines: insurance, transport (air, sea, inland), import duties, unloading costs, handling fee, currency conversion fees, minimum order.

The guide is aimed at the person ordering medicines for their hospital, charity or government department, who is being offered various prices and wants to know if that is reasonable ("for comparative purposes only"). If much higher than the guide prices, then there may be room to negotiate a better price. If much cheaper than the guide prices, questions should be raised about quality.

What the guide does not claim to be is a comprehensive reference of prices in the developing world. It doesn't weigh the prices offered by a huge international supplier as any more significant than the prices offered by a small regional one. For some drugs, formulations or sizes, there may be no price at all, or only one Buyer or one Supplier price.

The guide gives a unit price: per tablet or capsule, or per ml if liquid, or per g if a cream, etc. Each of these will correspond to a particular amount of medicine (often in mg). The actual dose taken by a patient is likely to be unrelated to the unit price: they may take two tablets, measure out 20ml or spread less than a gram on their skin. The guide makes no attempt to related this unit cost to the actual cost incurred by a therapeutic dose or to fully treat a condition. Instead it offers the defined daily dose. This is the "average maintenance dose per day for a medicine used for its main indication in adults". This could therefore be quite different to the dose actually used or when used for another indication. Its usefulness here is in estimating the likely quantity of a medicine that a hospital may go through each day, and thus need to regularly procure. Do I need to buy 10,000 100mg pills a month or 20,000. For some medicines and formulations, the defined daily dose is not available. It also doesn't indicate the duration of treatment.

The guide mostly presents raw data: the package size (100 tablets), the package price ($5.85), the unit price ($0.0585/tablet), the tablet strength (200mg) and the defined daily dose (1.5g). It does perform a little statistical analysis if several prices are available. It gives the lowest unit price, highest unit price, median unit price and high/low ratio. The guide explains that the most useful indicative value is the median unit price. It explains that a simple average (mean) is too influenced by outlier prices. Similarly the lowest / highest prices are themselves most likely to be outliers. The high/low ratio gives an indication of how close or spread the price is. So the most useful price, if we were to present it to readers, would be this median. And it would serve merely as an indication of a typical wholesale unit price available to purchase on the international market.

But a unit price (per tablet or per ml) isn't very useful to our readers, particularly as we don't tell them how many tablets or ml to take. Instead our current wording usually talks of "dose". This is defined to be the amount of drug administered at one time. For ibuprofen, the BNF tells me: "Initially 300–400 mg 3–4 times a day; increased if necessary up to 600 mg 4 times a day; maintenance 200–400 mg 3 times a day, may be adequate". For children, it gives different dose values for seven different age groups. And that's just for the most common indication. Some pills are available in an extended-release formulation, which requires only a once-a-day dose. Other medicines may be designed to take effect rapidly (e.g., buccal midazolam). There are endless permutations of single-dose, three times a day for two weeks, once a day for the rest of your life. As noted above, there is a defined daily dose but that is intended to be used to help the purchasing team know how many pills to order for the hospital, not how much of a medicine a reader might actually use.

Since the guide is based on purchasing a particular form of a medicine, it may actually have many entries for the one drug. For example Valproate.

• Sodium valproate 200mg ec tablet. 100 tablets. Anticonvulsants/antiepileptics. 6 suppliers. 0 buyers.
• Sodium valproate 25mg/5ml liquid. 120ml bottle. Anticonvulsants/antiepileptics. 0 suppliers. 1 buyer.
• Sodium valproate 500mg ec tablet. 100 tablets. Medicines used in bipolar disorders. 1 supplier. 0 buyers.
• Valproic acid 150mg. 100 tablets. Anticonvulsants/antiepileptics. 1 supplier. 0 buyers.
• Valproic acid 200mg ec tablet. 100 tablets Anticonvulsants/antiepileptics. 0 suppliers. 1 buyer.
• Valproic acid 200mg/5ml. 300ml bottle. Anticonvulsants/antiepileptics. 0 suppliers. 1 buyer.
• Semisodium valproate (a drug with equimolar amounts of sodium valproate and valproic acid) -- no information.

So we have 150mg, 200mg or 500mg tablets, and 25mg/5ml or 200mg/5ml syrups. We even have enteric coated and normal tablets. Which of these is "the price"? Most of them have data only for one supplier or one buyer. The drug is used for three main conditions: epilepsy, migraine and bipolar disorder. The recommended initial dose, typical dose and maximum dose is different for each condition. There is no formula to convert unit price to dose.

The International Medical Products Price Guide has not been updated since 2015. I have emailed them to ask why and if there is likely to be a future update. Perhaps they are changing to update less frequently than annually. While the guide provides a lot of data, turning this into information that our readers might use would require a lot of original research and there is no clear algorithm that would take these data values and offer a simple number to the reader. Our source does not give any indication of "dose", nor could it, so we can't quote a price per dose. Although our source does perhaps give a "per day" price (by multiplying the unit price to achieve the defined daily dose), it very much cautions against using this metric for any purpose other than stock control. And our source offers multiple prices for different formulations and no way to choose which is relevant. We could give the median unit price for a 200mg tablet in 2014, but our reader would have no way to interpret what a "200mg tablet" represented for a given condition being treated.

So I think that while this guide is invaluable for its intended purpose, I cannot see any way we can use the raw data it presents in a way that is meaningful to present to our readers of a drug article. It is clear that current use of this source is

• misrepresenting it as a comprehensive reference of developing nation prices
• giving too much weight to the two potentially-outlier values of lowest and highest price
• using the ambiguous term "dose" or "per day", which is not supported by the source, which only gives unit prices
• simply incorrect -- I cannot find examples where the quote prices match the source under any interpretation of the data values

I propose that all use of this source to present the prices in developing nations be removed from Wikipedia. Statements like "The wholesale cost in the developing world is between US$0.01 and US$0.04 per dose" are factually incorrect and misleading in every single word and every single number.

I see similar problems with our prices per dose for the US. These link to Drugs.com monographs which do not actually contain prices. Instead the price is on another page (e.g. diazepam, valproic acid). Those are retail prices "based on using the Drugs.com discount card which is accepted at most U.S. pharmacies." So our lead juxtaposes "developing nation" wholesale prices with US retail prices for a certain discount card holder. And again we have the whole mess of different formulations, different conditions being treated and different pill sizes or syrup strengths and no way to define one and only one "dose". So it seems likely that we should need to remove the US dose prices as well. -- Colin°^Talk 18:22, 25 November 2019 (UTC)

Websites frequently shuffle stuff around. It was present on the page in question when the source was used.[4]

Here we have the "National Average Drug Acquisition Cost"[5] Doc James (talk · contribs · email) 18:33, 25 November 2019 (UTC)

Colin, this particular comment feels like it's more about the application of MEDRS to a specific source than about what general advice to give in MEDMOS. Maybe this particular discussion should be moved to RSN or WT:MED instead? WhatamIdoing (talk) 18:51, 25 November 2019 (UTC)

We could change it to "The wholesale cost in the developing world is about US$0.40 per defined daily dose as of 2015."

But in my opinion "The wholesale cost in the developing world is about US$0.40 per day as of 2015." is reasonable.

So these values are published in a book by WHO. The specific number for valproate comes from the International Dispensary Association Foundation an NGO founded in 1972 that specializes in the delivery of medications to the developing world, so it applies to that area of the world. Doc James (talk · contribs · email) 20:30, 25 November 2019 (UTC)

WhatamIdoing, the problem is that MEDMOS is currently pushing the non-consensus of price/cost into drug articles, whereas MEDRS does not. Price is an economic factor, and not really MEDRS's concern. Perhaps that's why WP:MED is making such a hash of it -- we need some accountants, statisticians and basic maths ability here.

Doc James defined daily dose is explicitly not a useful figure for our readers. See WHO Definition. It exists merely to indicate consumption that affects hospital supplies or consumption in a population. "The DDD is sometimes a dose that is rarely or never prescribed because it is an average of two or more commonly used doses." and "DDDs are not established for all medicines" and "DDD is a unit of measurement and does not necessarily correspond to the recommended or Prescribed Daily Dose". It also corresponds to the "its main indication in adults" -- I have no idea whether the main indication in adults for valproate is epilepsy or manic depression and nor are our readers told. The source doesn't say.

I don't think you are carefully reading what the source does and doesn't include. James continues to talk of a "wholesale cost" as though that is one thing for one drug (e.g. valproate). It isn't. The source gives, for example, an indicative cost of buying bottles of 100 500mg tablets in bulk. There's a different price for 150mg tablets and these are approx 2x more expensive per mg than the 500g tablets. The syrup is even more expensive per mg of drug. These aren't reference prices for "the developing world" but really just indicators from whatever sources they could manage to get that year. So the 200 mg/5 ml syrup only has the Buyer price for South Africa. This isn't a price anyone can buy -- they didn't find any Suppliers with public prices at all. It is the unique price the SA government negotiated and reflects only their contract. And the syrup formulation of valproate is important, as that is the primary form used to treat epilepsy in children.

James, you claim now you used the defined-daily-dose to work out the prices in articles. But as I worked out above, the price you included in the articles does not match that figure. I see you have updated the valproate article. You haven't explained why the figures were wrong before.

What is happening here is a gross over simplification of the issue of "cost". It isn't "developing world" it isn't "one cost" it isn't "lowest" or "highest" and it isn't "per dose" or "per day" in any actual patient and it isn't "one indication/use". A drug has multiples of all these and you are trying to find one number.

WhatamIdoing, this reminds me of Brexit -- all things come back to Brexit in the UK. A slim majority of the UK voted to leave the EU but nobody was told what kind of Brexit we would get. Some promised we would stay in the customs union or the single market, others said we could leave both and still get all the benefits for free. It now turns out that there is no form of Brexit that a majority would be happy with, though it seems like we are heading for a no-deal Brexit in December 2020. You might all wish to include "the cost" as a nice simple figure for readers. But when you actually look at the sources at the fundamentals of how drugs are delivered, indicated, dosed and used, there isn't one cost. -- Colin°^Talk 09:32, 26 November 2019 (UTC)

Colin, we're kind of spread all over the map here, and it might be useful to get a little more precise. Whether any specific source is being accurately represented in a specific article isn't really MEDMOS's concern. MEDMOS, like all manuals of style, is primarily concerned with how you say something, after you've already decided that it belongs in the article in the first place.

The things that should be covered by MEDMOS are things like these:

• Is this something that should normally be included (e.g., similar to side effects; we do not require any sort of extraordinary coverage of side effects to put those in a drug article), or only under certain circumstances (which should be listed)?
• How much precision should be included? The US Medicaid program says that the National Average Drug Acquisition Cost for 250 mg capsules of valproic acid is running between 15 and 25 cents per pill right now, but it reports it to the one-thousandths of a cent. How much do you think is appropriate for most circumstances? Dollars, dimes, pennies, fractions of pennies? The first two significant figures?
• Should costs be presented in monetary terms, or in real-world terms? For example, do you say "Recovery costs US$n in lost wages" or "People can usually return to work after n weeks"? This question is not at all specific to drug costs. Assuming that ideal sources exist, would we rather say that:
  • depression represents a drag of US$n trillions on the global economy, or that
  • it results in US$x in medical costs, US$y in increased morbidity, and US$z in excess mortality, or that
  • depression causes in US$x in medical costs, worsens the quality of life, and shaves y years off the lifespan of affected people?
• When you describe a product or service with significant variations, how do you describe it? There's a lot more variation in laptops than there is in valproic acid, but Laptop#Market Share lists an average sales price. How could we do better?
• Which prices belong where? Presumably, if you're on this kind of list, then it goes in the lead plus elsewhere in the article. But in other cases, where's the best place? Does it depend upon the nature of the information, e.g., with recent prices going in ===Economics=== and original list prices going in ==History==?
• How should prices be described? Consider this business source. WP:MEDPOP approves of the popular press for financial information, and that's what this is: Prosecutors said that Fagron's subsidiary "typically sold the fluticasone propionate for about $160 per gram". It's a generic drug, the daily dose is the same for (almost) everyone, the price only applies to the US, and it's specific to one company. What else would you need to know to describe that price? What about the price for Asfotase alfa, which is only made by one company and whose dose varies by weight [6]? There are a lot of ways to calculate prices for drugs in particular, so which one would you use, and how would you explain it, if you needed to include that information in an article?

Completely apart from the question of whether prices should be in many articles or few, I think we could do some good work here in describing how to write about them. WhatamIdoing (talk) 00:12, 27 November 2019 (UTC)

WhatamIdoing, the discussion on the MSHPriceGuide is ongoing at WP:MED so perhaps that's a better place for it than here. The questions you ask may be valid. But I'm interested in the text in actual articles right now being very very wrong, rather than specifying about how may digits of precision some hypothetical price might be. We have an awful lot of basic "text is not supported by the source" problems at the moment, such as a claim that the price offered by a supplier of Ethosuximide only in the Democratic Republic of Congo is "the price in the developing world". It is all well and good speculating about how we might describe prices, if we can't actually do that given the sources we have. -- Colin°^Talk 09:01, 27 November 2019 (UTC)

• 500mg tablet median cost x DDD = $0.40
• 200mg tablet median cost x DDD = $0.52
• 150mg tablet median cost x DDD = $0.88
• 200 mg/5 ml median cost x DDD = $1.05
• 250 mg/5 ml median cost x DDD = $1.18

James claims the "The wholesale cost in the developing world is about US$0.40 per day as of 2015." But that is just for enteric coated 500mg tablets from IDA Foundation. The price in any other form or for other suppliers or in some developing nations is wildly different, even if we misuse the DDD in the way James wants (which is Original Research). -- Colin°^Talk 09:47, 26 November 2019 (UTC)

Introduction to Drug Utilization Research 2.6 Drug costs lists several cost metrics:

• total drug costs
• cost per prescription
• cost per treatment day, month or year
• cost per defined daily dose (DDD)
• cost per prescribed daily dose (PDD)
• cost as a proportion of gross national product
• cost as a proportion of total health costs
• cost as a proportion of average income
• net cost per health outcome (cost-effectiveness ratio)
• net cost per quality adjusted life-year (cost-utility-ratio)

These are all the possible costs we might consider in the encyclopaedia. James has (apparently, though not supported by any evidence) chosen cost per DDD. Here's what WHO say about that: "For example, the cost per DDD can usually be used to compare the costs of two formulations of the same drug. However, it is usually inappropriate to use this metric to compare the costs of different drugs or drug groups as the relationship between DDD and PDD may vary."'. So my above table showing that 500mg is the cheapest per DDD and the 250mg/5ml syrup is the dearest is a valid usage. But it is only for one formulation and it would be wrong of us to use it to indicate "the cost of valproate" compared with eg. "the cost of carbamazipine".

Problems using the defined daily dose (DDD) as statistical basis for drug pricing and reimbursement: "The defined daily dose is an artificially and arbitrarily created statistical measurement used for research purposes in comparing the utilization of drugs.", "in most cases, the DDD differs greatly from the typical PDD of the drug in question. In some cases, this gap may be exacerbated by the fact that a drug may be prescribed in two vastly different dosages and the DDD represents the average of those outliers." The paper goes on to explain why cost per DDD is a misuse of the metric.

From these and other sources, it seems that presenting a cost per DDD in the lead of our drug articles would be exactly the misuse of DDD that WHO and others caution against. It is an arbitrary unit for doing research into consumption. Presenting this information in our leads is a clear example of why we do not allow original research. -- Colin°^Talk 10:13, 26 November 2019 (UTC)

IDA Foundation sells at these rates to more than 130 LMIC countries. So this represents the approximate wholesale cost in a lot of places.

Per WHO Defined daily dose "is the assumed average maintenance dose per day for a drug used for its main indication in adults."[7]

So this is the approximate or typical dose in adults.

Additionally $0.40 per day is approximately the same as $0.82 per day.

What it is NOT the same as is $638 per dose.[8]

If these approximates both you I would be happy to switch to "generally less than US$1 per day", "$US1 to 2" "2 to 5, 5 to 10, 10 to 20, 20 to 50, 50 to 100, 100 to 500, 500 to 1000" etc.

Sure there are other numbers we could also provide. And I would welcome you finding sources and doing so. Doc James (talk · contribs · email) 14:42, 26 November 2019 (UTC)

James, you keep mentioning IDA foundation as though somehow that makes your numbers right. IDA isn't even listed as a supplier for all formulations. If you want to just use a single source for pricing, then say "IDA Foundation sell ..." rather than misleading our readers that this represents developing world prices. If the IDA foundation price was all that mattered, then there would be no need for the MSH Price guide.

You are just plain wrong about DDD. Please read what I wrote and linked to.

No, $0.40 is not the same approximately as $0.82 per day. Remember these are wholesale prices. The average daily wage in India is $5.50. So a tablet at $0.40 and a syrup at $1.18 + retail markup are hugely different prices to someone in the developing world. You are just waving your hands about at the moment with this "these are pocket change numbers" comment. It very much looks like you don't care about the actual numbers... perhaps that's why every example I looked at is wrong.

I've no idea what you linked to that was $638 per dose. The link doesn't indicate any drug name. I think we can agree cents are not the same as hundreds of dollars, but if you want to make a point about a treatment being cheap vs extortionate you need a source making that point.

I have looked at lots of sources. James, you are missing the big point. When you say, for example, "IDA Foundation sells at these rates" you miss out the "sells what". What are they selling? They are selling 500mg tablets in bottles of 100 in bulk orders. You have arbitrarily chosen just one formulation of this drug and quote that price. It is as daft as me saying "The price of strawberry yoghurt is 50p". I didn't say how much yoghurt and there is no one size for yoghurt and there are all kinds from Greek style to French set to Organic.

What you want to say "The wholesale price of valproate in 2014 was $...." cannot be said. It makes no sense. You are conducting original research in an area well beyond your competence, even if we allowed editors to do so.

James, there is a reason why none of our sources, in their leads, say things like "The wholesale price of valproate in the developing world is $0.40". They don't say it because it is nonsense. Instead, we have some sources that give raw data for prices for specific product items with bar codes.

I think perhaps we need to open this discussion up to parts of Wikipedia with mathematical competence, rather than just WP:MED. -- Colin°^Talk 15:35, 26 November 2019 (UTC)

When you are interested in having a civil discussion let me know. Otherwise please do not ping me. Doc James (talk · contribs · email) 15:53, 26 November 2019 (UTC)

Restart

Discussion above seems to have gone into the weeds a bit. I believe the best way forward might be to clearly understand the purpose and context of including pricing. For example:

• Increases in the wholesale price of insulin, noted above, are clearly a pressing public health concern and noted by large numbers of sources.
• Variations in costs of drugs between nations may be a matter of public of concern (e.g. salbutamol / albuterol at $30 - $60 per inhaler according to various sources whereas the NHS estimates the annual cost of treatment to the NHS at about £22, with a per-item prescription fee payable by working-age adults of £9 per item). I would suggest this is most relevant on drugs on the WHO essentials list, where there is a notably wide disparity as reflected in independent sources such as news articles.
• The price itself, if it is not exceptional, would not seem to be relevant or encyclopaedic, unless it is specifically called out as extraordinary (e.g. a new cancer drug that costs hundreds of thousands of dollars for a course of treatment but does not yet have a sufficient body of evidence to unambiguously support use - a perennial problem in the UK - or perhaps aspirin, which is pretty much the cheapest drug in the world and is constantly finding new uses).

In other words, it seems to me that we need to show a reason to care about cost: either it's sharply increased or decreased, or there are large and important disparities between nations, or it's called out as extraordinarily high or low. In all cases the key is that sources we normally trust - serious mainstream newspapers, in-depth journalistic reporting by fact-finding TV shows, published journal articles - note the price as being a significant matter. What would people think of using a benchmark expectation of three or more serious sources mentioning the price or one devoted entirely to the price as a significant concern or factor? Guy (help!) 11:43, 5 December 2019 (UTC)

Addendum The questions I think I'd like to be able to answer are:

1. Should we include pricing as a matter of course, or only where it's been discussed as a significant issue by RS?
2. If as a matter of course, based on what part of WP:5P?
3. If we should include as a matter of course, how should we manage the problem of global variation?
4. If we should include only based on RS commentary, what level of commentary do we need?
5. If we include pricing, should it be only from secondary sources or is a primary source acceptable or (because it may be more accurate) preferred?

I think if we have confident answers to these questions, everything else comes out in the wash. Guy (help!) 12:38, 5 December 2019 (UTC)

Guy I fully agree with you that only exceptional pricing is encyclopaedic. This is also WP:NOT policy. And also WP:WEIGHT policy -- if nobody is commenting on the wholesale price of a drug in DRC vs the retail price in the US, then neither should we. James, unfortunately, contests that WP:WEIGHT is supported by database records of raw price data, or by the general concern about drug pricing means it has WEIGHT in every drug article.

However, the only reason this conversation was on this page was because pricing was very recently added to MEDMOS and QuackGuru started edit warring to support James's position of putting detailed prices in the lead. WhatAmIDoing suggested another forum might be better. So it continued at Wikipedia talk:WikiProject Medicine. If you want to start a new RFC on drug pricing, then that may be useful. WP:MED ignored the result of the last one, though. The issue of an RFC is similar to Brexit. The last RFC contained a lot of untruths about pricing sources and wishful thinking about prices being useful, and rather ignored the problem that we don't have sources of anything but raw data, and so require original research to make any statement. As folk say about damn lies and statistics, it is unfortunately a problem that one can make any point one likes about drug pricing merely by selecting the right database records to use. -- Colin°^Talk 12:18, 5 December 2019 (UTC)

Colin, You were doing so well right up to the point that you started attacking other editors again. Could you maybe not do that please? Guy (help!) 12:25, 5 December 2019 (UTC)

Guy I've given an example of behavioural problems and open agenda pushing in a sequence of diffs over at ANI.- Colin°^Talk 13:21, 5 December 2019 (UTC)

Basically, we're just saying to follow existing policy: NOT, POV, OR. --Ronz (talk) 19:17, 5 December 2019 (UTC)

NOT does not apply to medical content. QuackGuru (talk) 19:53, 5 December 2019 (UTC)

I'm afraid you'll find no consensus for that, or are you just trolling? --Ronz (talk) 20:11, 5 December 2019 (UTC)

I'm dying to know what that assertion is based on. – Levivich 21:37, 5 December 2019 (UTC)

@QuackGuru:, could you please explain the comment that "NOT does not apply to medical content"? SandyGeorgia (Talk) 18:04, 6 December 2019 (UTC)

Where does Not mention drug prices? One size does not fit all. QuackGuru (talk) 18:15, 6 December 2019 (UTC)

Your statement was "NOT does not apply to medical content"; your answer does not address that. Also, almost all of NOT specifically addresses topics just like drug pricing, and the idea that the page should list every one of those items explicitly is faulty. SandyGeorgia (Talk) 18:22, 6 December 2019 (UTC)

Where does the WP:NOT policy mention prices? Seriously? At WP:NOTPRICES:

An article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention. Encyclopedic significance may be indicated if mainstream media sources (not just product reviews) provide commentary on these details instead of just passing mention. Prices and product availability can vary widely from place to place and over time. Wikipedia is not a price comparison service to compare the prices of competing products, or the prices and availability of a single product from different vendors or retailers.

– Levivich 18:37, 6 December 2019 (UTC)

I fully agree with Guy and Colin on this. Exceptional pricing that attracted media coverage should be mentioned, but otherwise Wikipedia is not a drug sales catalogue. As I mentioned elsewhere, pharmaceuticals pricing is among the most opaque ones in the world – a medication will have a list price, a reference price, a benchmarking price, the effective price per payer/country, an out-of-bundle price, and many others. They also vary significantly – a drug with a US list price of $1000 and a regional reference price of $800 may be sold for an effective price of $200 or less after volume discounts, risk sharing agreements and/on bundling or capping arrangements. For this reason list prices are irrelevant countries where drugs are purchased by public payers. Listing US retail prices will usually be confusing to the international reader. Again, I'd like to remind Doc James that there is an entire world outside of the simple buy/sell reality of the US! — kashmīrī ^TALK 22:52, 5 December 2019 (UTC)

The World Health Organization states "Data on drug costs will always be important in managing policy related to drug supply, pricing and use." They list a few price metrics including cost per treatment day, month or year and cost per defined daily dose (DDD). Doc James (talk · contribs · email) 03:21, 6 December 2019 (UTC)

WHO doesn't dictate Wikipedia's content. It may be important, but it may not be important enough for what's been done or proposed for product pricing. Nor does it mean it is suitable for presentation in an encyclopedia article.

Best focus on Guy's initial comment and addendum. --Ronz (talk) 04:21, 6 December 2019 (UTC)

It is best to oppose Guy's proposal that is against WHO's position.

WHO confirms drug prices are important. Drug prices is basic information readers are seeking. QuackGuru (talk) 04:33, 6 December 2019 (UTC)

No one is against WHO's position. --Ronz (talk) 04:48, 6 December 2019 (UTC)

Excluding drug prices except in rare cases is saying drug prices are not important. WHO says drug prices are important. QuackGuru (talk) 05:10, 6 December 2019 (UTC)

QuackGuru, no it's not, it's just saying that Wikipedia does not play a role in drug policy. Guy (help!) 09:10, 6 December 2019 (UTC)

Yes, it is saying that drug prices is unimportant. Essential information is drug pricing according to WHO. Excluding essential information is against WHO's position. QuackGuru (talk) 12:56, 6 December 2019 (UTC)

QuackGuru, no it's not. It is saying that drug pricing is important to some purpose other than an encyclopaedic description of the drug. Guy (help!) 14:22, 6 December 2019 (UTC)

• (from ANI) Re Guy's proposal, I think include the pricing only where it's been discussed as a significant issue by RS. The level of commentary should be "discussed as a significant issue by multiple RS"–more than just a mention, and more than just one source treating it in depth. Maybe 2+ RSes giving it significant coverage. The RSes supporting pricing should be secondary, but could be complemented by primary sources in appropriate circumstances. For example, 2+ secondary sources discussing the increase in insulin prices in order to include it in the article, but we might supplement with a primary source to give the most up-to-date price. – Levivich 05:03, 6 December 2019 (UTC)

Being mentioned in a single reliable source is sufficient IMO. There is discussion of prices for every medication more or less but some is easier or harder to find.

For example lenalidomide and bortezomib this WHO text says "Monthly pharmacy costs included in the total monthly cost in the unadjusted analysis were 4101 $US (SD 1931) and 4855 $US (SD 2431) for lenalidomide and bortezomib, respectively."[9] as part of a 6 page discussion of costs.

This is done for all medications added to the WHO Essential medicines list. Doc James (talk · contribs · email) 06:14, 6 December 2019 (UTC)

Doc James, If the price is the primary focus of an independent RS, then I would agree. If it's mentioned as a side issue, then I'd look for more than one. I don't think that's unreasonable, do you? Guy (help!) 09:11, 6 December 2019 (UTC)

User:JzG my thoughts on your questions:

1. Should we include pricing as a matter of course, or only where it's been discussed as a significant issue by RS?
   • WHO states prices are an important aspect of medications and thus IMO we should generally include content on this when covered by a reliable source.
2. If as a matter of course, based on what part of WP:5P?
   • The content is encyclopedic. The cost of a medication is a core part of cost benefit analysis and a key aspect of public health.
3. If we should include as a matter of course, how should we manage the problem of global variation?
   • There are generally three prices ranges globally. That for LMIC and listed as international reference pricing. The US wholesale price of which there are a number but in my opinion the National Average Drug Acquisition Cost from Medicaid is a good source.[10]
4. If we include pricing, should it be only from secondary sources or is a primary source acceptable or (because it may be more accurate) preferred?
   • We have textbooks that list these as well as WHO and the US government. Doc James (talk · contribs · email) 06:22, 6 December 2019 (UTC)

     Doc James, Cost-benefit analysis is not part of Wikipedia's remit, though. We're an encyclopaedia not a textbook or prescribing guide. You and I agree that drugs such as insulin, where costs and cost disparities are identified as a pressing public health concern, should unquestionably be included. But I'm not persuaded that just being on the WHO register qualifies to discuss cost unless other sources do too. Normally I would not expect it to be particularly difficult to find sources discussing cost disparities for essential medicines, given the prices paid in the US compared with other countries. If there's evidence that price, specifically, is a focus of RS coverage for a substantial proportion of the WHO list then I'd be more inclined to support your position. Can you show that? Not price books or anything else, but actual RS coverage showing that costs of WHO essential drugs are considered independently significant? I suspect this does exist and we may be able to word a consensus position for the WHO essential list. Guy (help!) 09:18, 6 December 2019 (UTC)

   user:JzG As I mentioned above we have a 6 page discussion in a WHO document of the price of lenalidomide and bortezomib among others. Would you consider that to be suitable for showing notability? Easier to get this information for newly added medications to the list as documents for when older medications were added are harder to find. If we limit cost discussion to only those picked up by the popular press we will end up with primarily US prices for new medications. And our content will become more a US perspective. Doc James (talk · contribs · email) 20:38, 6 December 2019 (UTC)

• The price of all things is important to somebody. I can find sources or indeed highly authoritative reports from respected bodies that say the price of ____ is important. Food, heating, housing, travel, clothing, broadband, alcohol, pet food, kitchens and bathrooms... I don't think the argument that the WHO say prices are important or even that some authority considers the WHO List of essential medicine prices to be important is actually a valid argument for including in an encyclopaedia. Someone mentioned Wikipedia's place in the information<-->knowledge spectrum. The problem with James's sources are they are raw database records. They tell you that a pack of 60 5mg wonderpam-sodium enteric-coated tablets from DrugMaker corp on the week ending 06/12/2019 cost $xx [insert some country-specific definition of an arbitrary "wholesale" price here]. What James has tried to do and claims we can do, is give 'a price' for 'a drug'. We can't. Above it is claimed "Drug prices is basic information readers are seeking" but read kashmīrī's comment above about all the different concepts of "price" in the US. James claims we can use the BNF for UK pricing. It is no better. It gives several prices for each specific thing with a bar code you might get from a pharmacy. It lists two prices, not one, one of which is indicative of what a pharmacy might pay, and the other an indication of what the NHS would refund the pharmacist -- but that explanation hugely hugely oversimplifies the actual pricing. These prices depend on whether the drug has several generic alternatives or only one supplier, whether the GP wrote the brand name on the prescription or not, they vary depending on supplier shortages, which are not uncommon. They vary in dose size, formulation, coatings, etc. I'm afraid the claims "we have ...." sources that would provide an easy "the price for wonderpam is $3 a day in the US" do not stack up to scrutiny. We have raw data and way way too much original research needed to even begin to simplify the price, and no one concept of "price" from country to country. -- Colin°^Talk 11:37, 6 December 2019 (UTC)

  Colin, it's a great argument for an article series on medical costs in $COUNTRY, though. Guy (help!) 14:25, 6 December 2019 (UTC)

  I love this argument. Why don't we add national prices to articles on cement, timber, steel, copper, gas, electricity, agricultural land, university tuition fees, public transport, bread, housing, postal services etc.? For sure there are UN sources that list many of these prices as highly important in some area of human activity. Why stopping at drugs? Let's make Wikipedia a registry of Very Important Prices! — kashmīrī ^TALK 17:49, 6 December 2019 (UTC)

• Reliable sources do say it is important and reasons have been given for including them. Prices of the same drug vary in different countries.[11] Drug price monopolies raise drug prices.[12] QuackGuru (talk) 12:56, 6 December 2019 (UTC)

  QuackGuru, also true of cars. You are framing opinion as fact and not citing policy to support it. Guy (help!) 14:19, 6 December 2019 (UTC)

  I cited sources that support it is important. That is framing a fact as a fact. QuackGuru (talk) 14:22, 6 December 2019 (UTC)

  QuackGuru, see WP:ITSIMPORTANT. You cited sources that say it's important to drug policy. Wikipedia has no role in that. Guy (help!) 14:26, 6 December 2019 (UTC)

  Drug prices fluctuate and there is a controversy over the increasing drug prices. QuackGuru (talk) 14:30, 6 December 2019 (UTC)

  QuackGuru, which is either significant or not depending on the importance of the drug, the amount of the increase, and other factors. And we establish that from reliable secondary sources about the drug specifically. What we don't do is to decide that because prescription drug prices in the United States is an important topic, so the price in the United States is important to every drug. Guy (help!) 14:50, 6 December 2019 (UTC)

  Drug prices vary globally for the same drug. This has led to a controversy. Therefore, it is important to include the differences in drug prices. QuackGuru (talk) 14:56, 6 December 2019 (UTC)

• (Saw this on ANI). Not my area of expertise, but I just wanted to challenge the argument that because the WHO considers that "Data on drug costs will always be important in managing policy related to drug supply, pricing and use" it does not follow that "Data on drug costs will always be important in informing a reader of an encyclopaedia article about a drug" which is our remit. We might decide it is, we might decide it's not, but as (hopefully) our articles will not be used to manage policy re drug supply, pricing and use, we should consider things by our own requirements. Scribolt (talk) 13:58, 6 December 2019 (UTC)
  • Indeed it is framed that "WHO say X therefore Y". For example James says "[WHO] list a few price metrics including cost per treatment day, month or year and cost per defined daily dose". Yes they do list them, but that doesn't mean they recommend them, or that one has to be very careful when using one. For example the "cost per DDD" is extremely contentious and WHO warn that DDD is essentially an arbitrary number for population studies. They say "the cost per DDD can usually be used to compare the costs of two formulations of the same drug. However, it is usually inappropriate to use this metric to compare the costs of different drugs or drug groups as the relationship between DDD and PDD may vary." (PDD is the prescribed daily dose for an individual with a particular condition). So you can use the arbitrary DDD to do some maths to compare that a person needing 100mg DDD with two 50mg doses a day would in the UK cost the same as someone taking 100mg once a day (because the few UK prices I've seen seem proportional to dose -- not claiming that as a fact) whereas in the US it would likely be twice as expensive (again, based on my experience with US prices being the same for various sizes, though with some odd values here and there). Of course all I just did is original research and just because WHO say an expert performing Drug Utilization Research (the source James cites) could do that sort of maths, doesn't mean that Wikipedians can or should. -- Colin°^Talk 16:28, 6 December 2019 (UTC)
• Guy, you might be starting to realise that there are two sides to this who are completely talking past one another. One side is trying to frame an argument based on polices, on what individual drug articles might warrant, and what they might reasonably expect editors to be able to say based on very limited sources, and an appreciation of just how complex the issue of cost is. The other side is framing their argument based on a political agenda against Big Pharma secrecy, price extortion, etc, based on feelings around drug costs in general, and never budges from considering that cost is a simple basic thing all readers want to know. It is like placing a Brexit party MEP in the same room as a Lib Dem MEP. Each have totally separate value-systems when it comes to emotion/truth/fairness/equalty/etc,

Further, as we know from Brexit, the Devil has the best lines. A punchy dishonest/misleading soundbite zings whereas you need a five-paragraph BBC Fact Check web page explaining why, in fact, it isn't as simple as that and no there never were going to be 40 hospitals or 20,000 police officers. The Truth is complex and messy whereas Lies are simple and easy. I don't have a solution for that.

If we keep talking past each other, as has happened with me and James, and with Ronz and James, then we will not achieve consensus, and any poll in the end will just becomes a numbers game. It may result in another no-consensus result, and it may once again result in a problem where one side says things the other side regard as patently false or obviously irrelevant. Further, a poll merely asking "should all our drug articles have prices", still doesn't solve the problem of which prices and how do we get them without original research or relying on now defunct websites or over-simplifying. When you have editors who are totally happy with juxtaposing wholesale prices from 2015 with retail prices from 2019, the problem is bigger than "should we have prices". Like politics, it is all well and good if a majority want the moon on a stick, we need some agreement on what those drug prices might look like, and acceptance that the methodology used to get them passes our fundamental policies. I don't think that has been demonstrated yet, not even close. -- Colin°^Talk 16:28, 6 December 2019 (UTC)

Regarding the importance of pricing: Where is it covered in depth in Wikipedia? Medication costs, Prescription drug prices in the United States, Prescription charges. I expect there are more. There seems to be some disorganization and outdated links currently in articles. Regardless, we clearly think pricing is important and are treating it so. --Ronz (talk) 17:58, 6 December 2019 (UTC)

Thanks for the restart, JzG. I went away over the US Thanksgiving holiday, and lost track of the discussion here (will not try to review the content added since I last weighed in, and appreciate the restart). Colin, henceforth please let the bigger problems speak for themselves (ala ROPE); I believe they are self-evident. I agree with JzG, Colin, Levivich, Ronz, and Scribolt (because their positions address Wikipedia policy). I also agree with Kashmiri (an unusual position for me). I disagree with Doc James and QuackGuru (because those positions do not encompass policy). I also submit that with so much dangerously defective information on Wikipedia, WPMED should get back to working collaboratively to improve content rather than focusing on adding information that is not policy compliant. SandyGeorgia (Talk) 18:13, 6 December 2019 (UTC)

MEDRS is not policy. It is a guideline like this page. QuackGuru (talk) 18:17, 6 December 2019 (UTC)

Lead

I have removed some additions to the lead section. MEDMOS needs to stick to dealing with medicine/health article issues and not become some fork of standard guidelines. We already have guidelines on lead sections and on making technical articles accessible, so no need to add more. Given that "people don't read the manual", the shorter and more to-to-point this guideline can be, the better. As an aside, there is more skill involved in making an article accessible and engaging than just replacing words with more basic simple words. -- Colin°^Talk 10:16, 12 November 2019 (UTC)

Disagree. Having these basics here is still important. Doc James (talk · contribs · email) 18:19, 21 November 2019 (UTC)

Colin, do you think the other guidelines on lead sections and making technical articles accessible do a good job of making it clear that those guidelines also apply to medical articles? If so, can you point me toward the guidelines you referred to, please? I would like to have a look. Thanks! I do think that is important. Many analyses of Wikipedia medical articles have found them to have too much jargon, which can be confusing to our readers. I do agree that the lead should be kept fairly simple (target is ~8th grade reading level) and we can go into more depth in the later parts of the article. TylerDurden8823 (talk) 20:13, 21 November 2019 (UTC)

A level of grade 12 is more realistic and what we appear to be managing for the leads.[13] Doc James (talk · contribs · email) 22:35, 21 November 2019 (UTC)

Doc James, you restored the lead text you wrote prior to attempting to achieve consensus and prior to posting your above "Disagree" comment. You are simply edit warring. As I made clear in my above comment, there is nothing James has written that is specific to medical articles. The same is true of any potentially complex topic on Wikipedia. We do not fork such guidelines. I really don't think James is in any position to lecture others about good writing technique. If it isn't specific and relevant to health/medicine, it does not belong here. If someone is including a "Reader Native Language by Language" chart in MEDMOS, then you can tell they are desperately trying to make point to meet an agenda, rather than stating something that has Wikipedia-wide consensus. Let's leave the advice on writing leads to the whole Wikipedia community, where those who are actually competent writers can craft competent guidelines. -- Colin°^Talk 21:49, 23 November 2019 (UTC)

I support Doc's changes with regard to the lead material. I don't see an issue without spelling out those aspects in this guideline. Flyer22 Reborn (talk) 03:38, 26 November 2019 (UTC)

Coatracks and tangents

I've removed the section on Coatracks and tangents. There is nothing specific about editors using a coatrack or going off on a tangent. Surely better if we can point to existing general guidelines on WEIGHT or sticking to the article subject. Are there specific issues here that frequently occur in medical articles and have a medical specific argument against/for. -- Colin°^Talk 10:57, 12 November 2019 (UTC)

These changes are mostly a question of whether you want "no duplication" or "one-stop shopping". Both approaches have value. "No duplication" is less work for people who maintain and de-conflict pages like this. "One-stop shopping" is more effective for someone who's trying to teach someone how to edit. I don't have strong views myself about which approach this page should take. WhatamIdoing (talk) 15:26, 14 November 2019 (UTC)

Abortion - definition conflict with Unsafe Abortion

Hi!

There is a discussion that I am participating in over at Talk:Abortion#Viability focused on the conflict between the definition of "abortion" as "the ending of a pregnancy by removal or expulsion of an embryo or fetus before it can survive outside the uterus" (status quo, Abortion) and the definition of an "unsafe abortion" as "the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both" (status quo, Unsafe abortion). Under the current use of these two definitions, Wikipedia's answer to "what makes an abortion risky" completely overlooks the well-known increase in risk as a pregnancy progresses week by week.

I believe that the article Abortion is worse than it would be if we followed the suggestion to allow that a late termination of pregnancy (i.e. one after viability) were included with the definition of abortion, because it would give a much more informative answer to the average Wikipedia reader's straightforward question, "what makes an abortion risky?". 170.54.58.11 (talk) 20:27, 22 November 2019 (UTC)

Yes, I notice that you've been arguing this unsuccessfully for some time on the talk page. Guy (help!) 14:16, 6 December 2019 (UTC)