Wikipedia talk:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices: Difference between revisions
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== Initial queries == |
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=== Generics === |
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Thanks for getting this moving, WAID. I am unclear if we are actually restricted to generics? Why do our questions not apply to all drugs? [[User:SandyGeorgia|'''Sandy'''<span style="color: green;">Georgia</span>]] ([[User talk:SandyGeorgia|Talk]]) 03:08, 2 January 2020 (UTC) |
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:If we are focusing on the MSH International Medical Products Price Guide, then it will be mostly generics and drugs from WHO's list of essential medicines. I'm not sure if some HIV drugs are still under patent (and of course some countries have different rules about patents, so produce generics when e.g. the US is still paying the patent price). But the HIV drugs are also a bit weird in terms of supply to developing nations and I think actually there's a better database for prices for those (can't recall right now). -- [[User:Colin|Colin]]°[[User talk:Colin|<sup>Talk</sup>]] 11:42, 2 January 2020 (UTC) |
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::The considerations for small-molecule generics are different from brand-name drugs (including most biologics, even past patent expiration). You'll get some news sources for shiny new things, and the price (and therefore sales) has a considerable effect on the company's stock price, etc. I specified generic because all of these are, and none of those exceptions apply. [[User:WhatamIdoing|WhatamIdoing]] ([[User talk:WhatamIdoing|talk]]) 22:01, 2 January 2020 (UTC) |
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=== Which examples to use === |
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{{u|Colin}} might want to switch out the sample drugs to include one where it's not even clear what the dosage is or what is being treated. [[User:SandyGeorgia|'''Sandy'''<span style="color: green;">Georgia</span>]] ([[User talk:SandyGeorgia|Talk]]) 03:10, 2 January 2020 (UTC) |
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:I'll have a think. Look at [[User:Colin/MSHData]] also. If a third of our drug prices have no suppliers at all, then I think an example of that needs to be picked. Ethosuximide is very much a one-indication drug, though the dose will vary by patient. Carbamazepine's main use is epilepsy but there are also several important secondary indications (and sometimes these, often off-label, indications can actually outstrip the original licensed one, and I'm not familiar enough to know if that is the case here). Mebendazole is just used for parasitic diseases, but there are different treatment regimes for different kinds of infection. So perhaps there are other/different examples to cover the spread of issues with us giving one dose as though there is only one indication and one kind of patient. -- [[User:Colin|Colin]]°[[User talk:Colin|<sup>Talk</sup>]] 11:42, 2 January 2020 (UTC) |
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::I pulled these straight out of a previous page. I don't think that we want to present the most complicated cases. We should start with the simpler cases, and see what information we can get. [[User:WhatamIdoing|WhatamIdoing]] ([[User talk:WhatamIdoing|talk]]) 22:04, 2 January 2020 (UTC) |
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=== What the source says === |
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[[User:WhatamIdoing|WhatamIdoing]], I think there is an initial problem with the "what the source says". We need to back up a bit to see what the source says about the drug, and not just one variant tablet size or formulation: [http://mshpriceguide.org/en/search-results-by-name-2/?searchYear=2014&searchString=Ethosuximide&searchType=Name Ethosuximide], [http://mshpriceguide.org/en/search-results-by-name-2/?searchYear=2015&searchString=Carbamazepine&searchType=Name Carbamazepine] and [http://mshpriceguide.org/en/search-results-by-name-2/?searchYear=2015&searchString=Mebendazole&searchType=Name Mebendazole]. We can see from that: |
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*Ethosuximide is only listed in one 250mg tablet formulation. A wee problem is that if we update the search to [http://mshpriceguide.org/en/search-results-by-name-2/?searchYear=2015&searchString=Ethosuximide&searchType=Name 2015] we get no results at all! Indeed if you look at the chart at the bottom of the 2014 page, you see that there was supplier data between 2000 and 2009 but after that, only 2014. |
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*Carbamazepine initially looks like it has 6 variants, but two are duplicates. So we have a 100mg/5ml suspension, a 200mg plain tablet, a 200mg sustained-release tablet and a 400mg sustained-release tablet. |
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*Mebendazole has 5 variants: A 100mg/5ml suspension, a 100mg plain tablet, a 500mg plain tablet, a 100mg chewable tablet and a 500mg chewable tablet. |
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So we need to be up-front that the source offered options, and the editor chose one of them. We need to be careful the examples don't offer illusory easy answers to picking one of them (such as, there's one variant that has lots of suppliers and the others have none, or that the 100mg and 200mg tablets work out the same price by dose anyway). The existing method for choosing a variant isn't foolproof: the [[diazepam]] article picked the wrong tablet with no suppliers whereas a different tablet size has lots of suppliers. -- [[User:Colin|Colin]]°[[User talk:Colin|<sup>Talk</sup>]] 11:42, 2 January 2020 (UTC) |
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[snip] |
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We are giving the prices and DDD but not actually helping readers with the maths. This matters because sometimes the DDD is being used and sometimes not. With Ethosuximide, if we multiply the 0.1845 250mg by 5 (1250mg DDD) and by 30 we get £27.67 (not sure where 27.77 comes from). With Carbamazepine, we are multiplying these 200mg tablet prices by 5 to get 1000mg and using that for the daily dose. With Mebendazole, we are actually just giving the price of the 100mg tablet, not the DDD of 200mg. So what do we even mean by "dose"? Since the DDD isn't being used here, it may be worth me explaining to you guys using the [https://bnf.nice.org.uk/drug/mebendazole.html BNF] that you can't read in the USA, which likely focuses on the kinds of parasites we get in the UK |
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*Threadworm infections. |
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**100 mg for 1 dose, if reinfection occurs, second dose may be needed after 2 weeks. |
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*Whipworm infections, Hookworm infections |
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**100 mg twice daily for 3 days |
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*Roundworm infections |
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**For Child 1 year: 100 mg twice daily for 3 days. |
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**For Child 2–17 years: 100 mg twice daily for 3 days, alternatively 500 mg for 1 dose. |
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**For Adult: 100 mg twice daily for 3 days, alternatively 500 mg for 1 dose. |
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So a "dose" could be the 100mg one-off dose, or the 200mg daily dose for three days, or the 500mg dose you take once. How on earth do we cover this? For many youngsters on Wiki, they may only be familiar with ibuprofen tablets and the contraceptive pill, and unaware that medicine dosage and indications for drugs are complex. Maybe we need a little side-box for each drug, that explains things that Wikipedia generally is forbidden to cover like how the dose is recommended for each indication/patient-group. -- [[User:Colin|Colin]]°[[User talk:Colin|<sup>Talk</sup>]] 11:58, 2 January 2020 (UTC) |
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:Hi, [[User:Colin]]. I agree with you overall, but I think this initial RFC needs to focus on the simpler cases of whether the text matches the already-cited source. I would be perfectly happy if an editor says that the cited source discusses one pill size, but there are several other pill sizes, and why was that one size (or that one database) selected? However, the question in this RFC is smaller: we've got a sentence, it's got a source, and are people okay with that particular combination? |
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:Similarly, an uninvolved RFC respondent might notice that there's a typo in the one price, and someone might opine on the subject of whether calculating price per DDD is a routine [[WP:CALC]] or a case of [[WP:SYNTH]]. Editors might have strong views on whether it's important, or on geographical bias, or any number of other subjects. That's fine, and I want to hear everything that's on their minds, but I don't want to push those questions. I'm just looking for a starting point with this RFC. [[User:WhatamIdoing|WhatamIdoing]] ([[User talk:WhatamIdoing|talk]]) 22:19, 2 January 2020 (UTC) |
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=== Buyers and sellers === |
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Wrt wording "One organization said that they sold ... in 2014" should really be "One organization said that they sell... in 2014". We have price data but no evidence they actually sold any. It might be simpler to call these "organizations" "suppliers", especially as that's what the source calls them, and we will end up discussing buyers and suppliers. -- [[User:Colin|Colin]]°[[User talk:Colin|<sup>Talk</sup>]] 11:42, 2 January 2020 (UTC) |
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In the Carbamazepine example, you have focused on the suppliers. In fact, the highest price in the article text ($0.24 per day) is taken from one Buyer (SICA: System of Central American Integration). So, to discuss what's gone on in that article text, we need to talk about Suppliers and Buyers, and should really enlighten readers that for example WHO encourage we take the median supplier price, and only consider this representative of an international price if there are many suppliers. We can source this and if necessary quote verbatim. -- [[User:Colin|Colin]]°[[User talk:Colin|<sup>Talk</sup>]] 11:42, 2 January 2020 (UTC) |
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In the Mebendazole example, the highest price in the article text ($0.04 per dose), comes from one Buyer (South Africa Department of Health) and in a package of 6 pills, not 1000. -- [[User:Colin|Colin]]°[[User talk:Colin|<sup>Talk</sup>]] 11:42, 2 January 2020 (UTC) |
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:On these points: I wrote that they "sold" at that price, because it was five years ago. That's ambiguous, but saying they "sell" at that price also feels wrong (because prices change). |
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:I listed supplier prices because those were the ones used to create the text. There is quite a lot in the source that I didn't reproduce. [[User:WhatamIdoing|WhatamIdoing]] ([[User talk:WhatamIdoing|talk]]) 22:27, 2 January 2020 (UTC) |
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=== Missing links === |
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The bits at {{xt|Additional information can be found at...}} and {{xt|Previous discussions on this subject include...}} still need to be finished. Anyone's welcome to add whatever they want there (or post it here, and I'll add it). I'd really appreciate some help with finding all the relevant things. [[User:WhatamIdoing|WhatamIdoing]] ([[User talk:WhatamIdoing|talk]]) 22:27, 2 January 2020 (UTC) |
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