Wikipedia talk:Manual of Style/Medicine-related articles

DMOZ/CURLIE

My post above in the lengthy pricing discussion got no response, so separating out here.

MEDMOS (for about a decade) recommended DMOZ specifically as an external link, but that text was removed in 2018 because DMOZ no longer existed. The new {{Curlie}} template, which replaced DMOZ, was never added back in. (Sample [1])

Because this page is fully protected, unless anyone objects, I will submit an edit request to reinstate our long-standing text, but corrected to CURLIE from DMOZ. SandyGeorgia (Talk) 19:04, 11 December 2019 (UTC)

I have no concerns with it being returned. Doc James (talk · contribs · email) 19:36, 11 December 2019 (UTC)

SandyGeorgia, overall I have a big "don't care" about this, but much of DMOZ was undermaintained before it officially closed. Are we sure that the transferred version is actually active enough to be worth recommending? WhatamIdoing (talk) 06:44, 12 December 2019 (UTC)

I suspect that most of us (active medical editors) don't much care one way or the other, but the links greatly simplified our editing. When novice editors add external links to support groups, we can easily point them to the guideline, and to the EL page, and suggest they add the link to Curlie instead. It saves a lot of editing time to provide the kind of information some readers are seeking, and some novice editors add, in one external link. I will wait to submit an editrequest until we have agreement on several items. SandyGeorgia (Talk) 15:09, 13 December 2019 (UTC)

My impression is that there just aren't that many new editors trying to add ==External links== to medical articles these days. I still follow WP:ELN, and I don't think we've had a question about DMOZ/Curlie there for multiple years. WhatamIdoing (talk) 19:09, 14 December 2019 (UTC)

@Doc James, Colin, and WhatamIdoing: please let me know if I should submit edit request (2) as below. We need to get some stuff cleared off of this 800KB talk page. SandyGeorgia (Talk) 14:10, 6 January 2020 (UTC)

My comment above is clear. I am happy for Curlie to be used rather than extensive ELs to charities here etc. Doc James (talk · contribs · email) 14:24, 6 January 2020 (UTC)

I have no objections. I don't think this is important (either way). WhatamIdoing (talk) 16:10, 6 January 2020 (UTC)

Proposal for edit request (2)

Please let me know if there is any disagreement, so we can submit the editrequest and get this section dealt with. SandyGeorgia (Talk) 15:21, 28 December 2019 (UTC)

In the External links section:

• Merge the existing sentence (Normally, however, it is better to link to an external web page that lists such charities, rather than try to provide such a list ourselves.) in to the previous paragraph (If the disease is very rare ... such as a detailed article on the specific topic.)

and re-word it to:

• strike the word very before rare (redundant), and add:
• ... such as a detailed article on the specific topic. It is usually better to link to an external web page that lists such charities, rather than try to provide such a list ourselves. The {{Curlie}} template links to a directory based on the Open Directory Project that contains many such links. For example, on the Tourette syndrome page:

  * {{Curlie|Health/Conditions_and_Diseases/Neurological_Disorders/Tourette_Syndrome/Organizations}}

gives:

• Tourette syndrome at Curlie

Archiving

WhatamIdoing I'm not sure it's a good time to speed up the archiving bot: I haven't submitted the edit requests yet to deal with this section and the next, and the page is protected. How about leaving the archiving time as before, but manually archiving any sections already addressed?

While I'm here, I view this DMOZ/Curlie thing as something that may not help, but doesn't hurt. There doesn't seem to be opposition if we re-instate it. Shall I go ahead and do the edit requests? SandyGeorgia (Talk) 19:28, 27 December 2019 (UTC)

The page is over 500KiB before processing, which is beyond what some people will be able to edit, or even read. This section wouldn't have been affected for another week (even before today's comments). WhatamIdoing (talk) 19:41, 27 December 2019 (UTC)

WhatamIdoing, how about if we do this instead? Leave the archiving bot and numbers as typical, but start a separately named archive for all of the RFC stuff? That's what I've seen done in other cases ... keep all of the RFC stuff in one separate archive, and then we can do that manually, and put a hatnote to it on the top of the new RFC sections. SandyGeorgia (Talk) 19:51, 27 December 2019 (UTC)

That is, leave the bot currently archiving at number 10 with 60 days, but move all of the RFC stuff to a separate Wikipedia talk:Manual of Style/Medicine-related articles/Archive 10b, which can then be a hatnote at the top of the new RFC section, to remind us to archive everything manually together. SandyGeorgia (Talk) 19:54, 27 December 2019 (UTC)

Whatever else, I would prefer not to archive anything that might feed into how we formulate the RfC, until we have the RfC finished. --Tryptofish (talk) 23:29, 27 December 2019 (UTC)

Should I submit the two editrequests now, to be done with these two sections? SandyGeorgia (Talk) 23:32, 27 December 2019 (UTC)

Just noting that I did set the archive time to 14 days from 45 days for now. We are at over 169kb of readable prose here according to XTOOLS which is very large indeed. Right now this page is larger than AN and ANI combined. Barkeep49 (talk) 23:42, 6 January 2020 (UTC)

Treatment/management

What happened to Management as an alternate for Treatment in Wikipedia:Manual of Style/Medicine-related articles#Diseases or disorders or syndromes for those conditions where no treatment (in the conventional sense) is needed? It was long an alternate here and is now gone. WikiBlame is not working, so I can't tell why that occurred. SandyGeorgia (Talk) 01:33, 12 December 2019 (UTC)

It's still being used in articles. It has the particular virtue of not implying "permanent cure" for incurable diseases and chronic symptoms.

It looks like Doc James removed it in March 2017 because (according to the edit summary) some students typed ==Treatment or Management== as their section headings. WhatamIdoing (talk) 06:48, 12 December 2019 (UTC)

Yup lots of students added "==Treatment or Management==" rather than just picking one. This has decreased since that change. I do not care which is used. Doc James (talk · contribs · email) 04:28, 13 December 2019 (UTC)

I'm not sure it made sense to delete something useful from a guideline because students are misusing it; rather, the heading could have been clarified, using the same format that is used for other sections that have multiple possible names. I will wait til we have sufficient feedback on several items to submit an edit request. SandyGeorgia (Talk) 15:06, 13 December 2019 (UTC)

Agree that mentioning management would be nice, else articles like NAFLD may seem like using a wrong layout. Signimu (talk) 19:47, 13 December 2019 (UTC)

Damn, I always remembered I could use either. "Management" should come back IMHO, it i very useful for diseases for which we write that no treatment is known. — kashmīrī ^TALK 21:09, 13 December 2019 (UTC)

Perhaps "Treatment (or Management, especially for chronic conditions):" would be less confusing. I wonder if they made the same mistake with other section headings (like ==Prevention or Screening==). WhatamIdoing (talk) 19:05, 14 December 2019 (UTC)

Edit request pending, so archiving bot will leave this section. SandyGeorgia (Talk) 19:29, 27 December 2019 (UTC)

@WhatamIdoing, Doc James, Signimu, and Kashmiri: please respond to Xaosflux below so we can finish up this section; this talk page is sprawling. SandyGeorgia (Talk) 13:11, 4 January 2020 (UTC)

Proposal for editrequest (1)

Please let me know if there is any disagreement so I can submit the editrequest and we can get this section dealt with. SandyGeorgia (Talk) 14:58, 28 December 2019 (UTC)

• In "Content section", change Treatment: to Treatment (or Management, especially for chronic conditions):

 Administrator note Once a decision has been made, please reactivate the edit request if the page is still protected. — xaosflux ^Talk 15:38, 2 January 2020 (UTC)

Xaosflux the last comment on this aspect of the page was made on 14 December, and no one was in disagreement. I waited two weeks before adding the editrequest. Now the talk page is so large, we want to get a few of these things moved off the page. SandyGeorgia (Talk) 12:22, 4 January 2020 (UTC)

Reactivated. — xaosflux ^Talk 12:34, 4 January 2020 (UTC)

 Done — Martin (MSGJ · talk) 14:05, 6 January 2020 (UTC)

Thank you ever so much, MSGJ-- one thing we can now get off of this 800KB talk page! SandyGeorgia (Talk) 14:08, 6 January 2020 (UTC)

RfC Formulation (Clean Start)

Introduction

Barkeep's Background

A few days ago, Colin quite reasonably asked me for some examples of good RfCs to use as a model. I spent some time today looking into past MOS (and related) type RfCs and also asked a few people with experience closing Wikipedia related RfCs for examples. I am reluctant to share any because I don't know that they will actually help move the conversation forward. What seems to happen is that someone puts forth an idea and it gets criticized for either structure or wording. Much/all of the criticism is fair (and I've done it) but ultimately it means we aren't getting any closer to an RfC. Above Colin expressed frustration with the status quo of the information being included in hundreds of articles at the moment. A few others seem to be feeling this as well. Others are no doubt being frustrated at the inability to add the information in new places. The way past this is to get this RfC completed. Editors of all stripes need to have some faith in our process. The RfC question itself is not the right place to put forward compelling arguments about why pricing is/isn't appropriate. Instead that can happen during the RfC or in some sort of supporting material. If the goal is for the RfC is to solve every pricing related question the whole RfC is going to fail and nothing will be decided. Instead the decision should be made, by the people here who care most, about what's most important. To everyone I remind it is possible that not everything that's important will get decided by this RfC. So what's most important to decide? Some willingness to to accept that important issues won't be decided right away needs to be tolerated in order for there to be any chance of moving this forward and it seems clear that this needs to move forward. If a person's answer to "what weaknesses/compromises can I live with?" is nothing then that person is not going to be able to successfully participate in formulating this RfC. The good news is that no one seems to yet be at that point. The further good news is that multiple people are seeing progress being made. In rereading this talk page it seems like there is some level of agreement behind a single question (that can be answered with a support or an oppose). People seem OK with coming back to the details later. This is helpful because a single question also seems most likely to achieve consensus from the community. If we can't get consensus around a single question I think it could also give us insight into what the multiple questions have to be at this point and we can, if necessary (though I think it might not be) examine different formats for multiple questions. As such I am going to propose the following.

I am suggesting we focus, for now, on trying to perfect a single question about pricing (or whatever your preferred term is). I am also going to ask that people to follow my lead and collapse extended content, leaving only the most important information visible. Say as much as you want, but let's make it easy for people to navigate. Thoughts? Barkeep49 (talk) 21:22, 23 December 2019 (UTC)

Possible Questions

So far the following single questions have been proposed:

A

Do you think that a pharmaceutical drug has one price that can be expressed in dollars and cents, for each region such as US, UK, developing world, and this is information that Wikipedia drug articles should include and can routinely be sourced by editors without original research.
— User:Colin

B

Should Wikipedia articles contain information about the cost of medications?
— User:Doc James

Please take one (or both) of these and wordsmith them to your heart's content. And if you want to explain, at length, why your version is good, or issues you see with someone else's proposal, feel free but again please consider collapsing those comments. Barkeep49 (talk) 21:22, 23 December 2019 (UTC)

Question B does not resolve the issue with the existing content on hundreds of drug articles. We must avoid asking questions that are true occasionally or even quite often, but which then permit something universally. Prices have been added routinely and in a manner that claims a drug has one price and using sources that require original research to present the article text added. This is the practice that either wiki accepts or rejects. -- Colin°^Talk 21:39, 23 December 2019 (UTC)

Colin, do you have a tweak to that formulation? If not, it's hardly surprising that you would prefer Option A considering you were the one who originally crafted it :). Best, Barkeep49 (talk) 21:56, 23 December 2019 (UTC)

Nope. It is a bit like "Should we offer good healthcare to citizens" which, depending on ones politics, could be interpreted to allow anything from private health insurance to socialist state health. And perhaps there should be a bit more input from James. -- Colin°^Talk 22:02, 23 December 2019 (UTC)

• I don't like either A or B (for reasons that I already stated earlier). I'm not going to attempt any further to suggest what a good question would be, but I think that there are basically two "ideas" that need to be incorporated into the single question, and in a manner that community responses will lead to an unambiguous consensus:
  1. Whether drug prices should be widely presented on drug pages, and
  2. What kind of sourcing is needed to support such content.
• I also think that responding editors must be able to see specific examples of what the various options for doing this would look like. (If editors here cannot come up with a specific example of their preferred approach, then that approach does not merit inclusion.) I also think that (obviously) the wording must be absolutely neutral.
  I look forward to seeing specific proposals from other editors that will meet those criteria. --Tryptofish (talk) 22:19, 23 December 2019 (UTC)

I think Tryptofish is closer to the mark than the two formally stated questions. · · · Peter Southwood ^(talk): 17:21, 24 December 2019 (UTC)

Both of the formally stated questions do not have simple answers.
My answer to A would be No, but sometimes it could happen, and this is not the only situation in which a price might be of interest, and to B it would be Yes, but not always, and only when it is of encyclopedic value.· · · Peter Southwood ^(talk): 09:06, 25 December 2019 (UTC)

SG's Background

I fully reject B as a non-starter, because we already have policies that answer that question, and to ask it will be an insult and generate a d'oh, unuseful response. Also, it completely glosses over the heart of this dispute, which is NOR and sourcing, and glosses it over to such an extent as to be a misleading way to position an RFC. I partially support A, but it is (as attorneys say) "multiple in form". I would split it. On C, it does not have to be US$, and I tweaked the punctuation, etc. a tiny bit. On D, I took out "should include" because, again, we already have a policy on that and I don't think any of us are arguing that WP:NOPRICE is the problem here, or trying to change NOPRICE. I think we should include our price/pricing distinction in the preamble. And I think if we frame it like this, the responders can give samples in their responses. I believe we do need an example, but no good example has been provided by those who want to use the disputed sources, and if we keep trying to come up with one, we'll be stalled for another month. I would like to see, perhaps Ronz put forward one or two sentences on our price/pricing distinction. SandyGeorgia (Talk) 02:07, 24 December 2019 (UTC)

C

Do you think that any individual pharmaceutical drug has one price that can be expressed in a given currency, for any region such as the US, UK, or the developing world?
— User:SandyGeorgia

D

Followup: What kinds of sources for pharmaceutical drug prices can be cited by editors, without original research, for Wikipedia drug articles?
— User:SandyGeorgia

Thanks for all your hard work, Barkeep49; this amount of effort is beyond the call of duty. SandyGeorgia (Talk) 01:43, 24 December 2019 (UTC)

E

For articles discussing medications, do you think that Wikipedia can, reliably and without original research, source medication prices as used in various regions of the world; and if found, should convert them to a common currency and include in articles?

— kashmīrī ^TALK 02:22, 24 December 2019 (UTC)

I am convinced that the average editor is not capable of answering this question in any useful fashion. Can it be done? Yes, because it has been done in many articles (e.g., multiple articles with accusations about price gouging). Also no, because it can't be done for all of them. And then the poor closer has to tot up the answers, and gets stuck with telling people that !voted yes that they actually meant no, and vice versa. The real question isn't whether it can ever be done; we have done that, and nobody's trying to blank the prices in Martin Shkreli. The real question is under which circumstances we ought to do that. So one answer's clear: No making stuff up or misrepresenting a price just to get something crammed into an article. Another answer's clear: If the price is in headlines all over the English-speaking world for months, then it gets mentioned. But where's the line between those two extremes? WhatamIdoing (talk) 05:53, 24 December 2019 (UTC)

There is no line, it is a grey area that would be undecided in many cases until local consensus was developed for that case. This is a tedious business and generally goes to the most persistent group who will not accept no for an answer. My opinion at present, as a non-expert with no dogs in the fight, is that prices are too volatile and variable to be useful to the reader in most cases, and that the onus is on the person wishing to add a price, to show that the price is encyclopedically relevant in that case. Where a price is considered relevant, I do not think it should go in the lead unless obviously noteworthy in context. · · · Peter Southwood ^(talk): 17:21, 24 December 2019 (UTC)

Peter Southwood, thanks for your comments. I do fear it is hard to create a rule that lays down the law that works in all cases, and perhaps should not attempt to ask for one. The problem with a "local consensus" cop-out is as you say the most persistent group will not accept no for an answer. I wonder if you will look at the drug articles I mention in my collapsed box (Colin's Background) below. Those are examples of the sticking point this RFC is trying to address. They are typical of hundreds of prices in leads of drug articles. I would like a question that answers whether or the article text we have is acceptable. Of course we agree on the question about "Whether drug prices should be widely presented on drug pages" or some variant of that. The second of Tryptofish's question assumes that we have some text about prices and just need to find an appropriate source. But I maintain that the problem with all the drug prices on articles currently is that they attempt to boil a drug down to one formulation, one tablet size, one unspecified indication, one dose and present one price. So before we ask what sources support it, we need to consider if that is even a sensible approach to presenting prices (never mind for now where: lead, body or infobox). Then for sourcing my concern about asking an open question is we don't get decisive answers, and perhaps it is easier to give examples from existing articles and ask folk if that use of the sources is acceptable. I'm sure that would also provoke some people to give alternatives. If we close the RFC with "there is no consensus approach to drug prices, editors should seek consensus per article" then we are back to the RFC of 2016 and the effect of that is that prices were added to all drug articles anyway, and discussions are ongoing to add prices and links to GoodRX on the drug infobox of all articles. Can you think of a question that will resolve whether the text+sources in current drug articles is acceptable to the community? -- Colin°^Talk 19:09, 24 December 2019 (UTC)

Colin so the idea of a baseline (prices are/aren't encyclopedic) doesn't seem helpful to you in this current discussion? Best, Barkeep49 (talk) 19:33, 24 December 2019 (UTC)

"The second of Tryptofish's question (sic)"? I was not asking two questions. I was stating two kinds of issues that need to be addressed. And I wasn't assuming anything. There could certainly be a consensus that drug prices should not be routinely included in articles, and that drug pricing should be discussed only when there are independent reliable secondary sources. To the best of my knowledge, those kinds of sources do exist. --Tryptofish (talk) 21:25, 24 December 2019 (UTC)

Colin, I am still thinking about when and why the price/cost/pricing/whatever of a drug would be encyclopedic information, and when it would not.
When it is not encyclopedic, leave it out.
When it is encyclopedic, a reliable source is necessary, that supports the information included. It is not "medical" information, it is commercial information, so MEDRS does not apply, just regular RS.
It is necessary to specify the context of the information in the article in such a way that the reader understands its scope and is not misled by how it is expressed - the information must be presented in a neutral way, and must be accurate, both in space and time.
The information should be widely valid unless there is an encyclopedic reason to provide information that is limited in space and time. When it is limited in space and time this limitation must be specified/explained.
In many cases the sources may not be suitable for inclusion without some numerical processing. There we run into the risk of original research, and the scope of the numerical processing should be specified to allow the reader to check the math. I think the sources should usually be explicitly stated in the text, as well as being reliably referenced.
We are trying to establish a principle here, rather than to judge specific cases, so I am not convinced that looking at specific cases at this point is either necessary or useful, as it may prejudice fair consideration of the principle. First we establish the principle, then we compare specific cases to the rule.
The local consensus to include is a vexatious issue, as we have editors who do not appear to understand the meaning or process of consensus building, and persist in claiming that they are right in the face of evidence to the contrary, often with a barrage of marginally relevant shortcut policy links rather than logical reasoning and supporting evidence, and frequently accompanied by a group of like-minded involved editors. Closure by an uninvolved neutral third party is a reasonable remedy.· · · Peter Southwood ^(talk): 07:01, 25 December 2019 (UTC)

Kashmiri, I am concerned that unless the original currency and date are quoted, the validity of the claim will be variable over time and partly obscured. There is already a problem with a single quoted price that it generally applies to a specific place at a specific time. In some cases this is relevant, but it is generically not very useful. If converted to a common currency, which one would be used, and why, and how would this be kept current?· · · Peter Southwood ^(talk): 07:50, 25 December 2019 (UTC)

@Pbsouthwood: Yep, but we don't want prices in South African rands, RTGS dollars or Chinese yuans, do we? Also, how do we approach currencies which quickly lose value due to inflation, like the Venezuelan bolívar? Anyhow, I proposed to have the currency component as a part of the question this so that responders have a pause over what voting "Yes" would involve. Maybe it can be reworded, though, although I do think that the RfC questions should touch upon the currency issue. Also, I am toying with the idea that we should somehow indicate that this would prices of pharmaceutical products (i.e., goods) and not prices of the chemical compounds being article subjects, with all the challenges related to different brands, formulations, dosages, package sizes, combination drugs, etc. — kashmīrī ^TALK 18:27, 25 December 2019 (UTC)

Kashmiri, you say we don't want prices in South African rands, RTGS dollars or Chinese yuans, do we? - Why not? Wikipedia is an internationally targeted encyclopedia, what currencies do we want prices in?
Also why specifically prices of pharmaceutical products, not the compounds, and could you elaborate a bit on the challenges related to different brands, formulations, dosages, package sizes, combination drugs, etc? · · · Peter Southwood ^(talk): 19:23, 25 December 2019 (UTC)

@Pbsouthwood: Why not compounds? Because chemical compounds are usually traded by weight or volume, unlike drugs. For instance, Salbutamol is a crystalline powder[2] and is indeed traded wholesale by kilograms[3]. But it is not an approved drug in the powdered form - approved drugs are various products (formulations) that contain salbutamol as their active ingredient: a sugary syrup, NO₂-propelled inhalers (in varying volumes and concentrations), a variety of capsules and tablets (2mg, 5mg, 10mg, normal release, controlled release, etc.); some of them may or may not be approved depending on jurisdiction. I think it would help if the RfC question informs editors about this aspect. — kashmīrī ^TALK 20:45, 25 December 2019 (UTC)

In general, prices change. Whatever prices are quoted should be explicitly linked to the dates and places involved. I do not know how the proponents of including generic/average/median/whatever prices plan to keep them updated. · · · Peter Southwood ^(talk): 07:50, 25 December 2019 (UTC)

Inconsequential formatting change

Kashmiri, in retrospect, I should have re-labeled my suggestions to C and D, to distinguish them from the earlier A and B. If you agree, would you change yours to E (and simultaneously change mine to C and D)? Thanks, I think this will be clearer and allow for other options to come forward without confusion. SandyGeorgia (Talk) 13:53, 24 December 2019 (UTC) @SandyGeorgia: Sure, go ahead, it's only a technicality. — kashmīrī TALK 15:07, 24 December 2019 (UTC) OK, it was me to do it.  Done then! — kashmīrī TALK 15:09, 24 December 2019 (UTC)

Table of Despair

I think that the main question to be settled is how much WEIGHT do we (by default) put on sources about prices (as understood in the dollars-and-cents model, not the general how-many-people-can-afford-that sense). Does it fall into (or near) the category of basic information that User:Bluerasberry calls Wikipedia:Defining data, in which case we need to include something about it whenever reliable sources permit us to say anything at all? Or, alternatively, is this content something that we should normally not include, and only mention when we have especially good sources (e.g., multiple high-quality sources that discuss the price at length). Here are some examples that we might consider:

Caption

Subject	Source type	If we put a lot of weight on prices	If we put less weight on prices	Notes
Insulin	Many long articles in news media and academic journals, including claims of price gouging and people dying because they couldn't afford the drug	In the US, between 1987 and 2017, the wholesale price of long-acting insulin increased from US$170 to $1,400 per vial.	In the US, between 1987 and 2017, the wholesale price of long-acting insulin increased from US$170 to $1,400 per vial.
Valproate	A 2017 peer-reviewed journal article, and some data points in various databases (i.e., independent primary sources)	According to estimates published in The BMJ in 2017 for drugs on the WHO Model List of Essential Medicines, the cost of manufacturing the active ingredient in this drug in India, is approximately a couple of US cents per pill.	(Nothing – this is a single primary source)	The cost of manufacturing the active ingredient is reasonably consistent worldwide. India is the biggest producer of these generic small-molecule drugs. But no retailer or consumer buys just the active ingredient.
Denosumab	An article in a pharmacy industry magazine (independent and possibly secondary)	Shortly after its original approval in 2010, Medicaid's US average wholesale price for a 60-mg prefilled syringe of denosumab was reported at US$990 per dose, with two doses expected each year to treat osteoporosis.	(Nothing here, but maybe something in the manufacturer's article)	Just one dose (of two for this drug), in just one country, at just one point in time, using just one metric (of many).
Golodirsen	An article in a biotech business magazine reporting on an Earnings call (independent and primary)	In the days after Sarepta Therapeutics received permission from the US FDA to market the drug, the net annual cost was estimated to run around US$300,000 per treated patient, assuming the patient was a child weighing 25 kg (55 pounds).	(Nothing here, but maybe something in the manufacturer's article)	No actual sales and little non-business coverage at that point, but high-cost drugs tend to attract attention, so maybe more sources would appear later, at which point it might be treated more like the Insulin example.
Abacavir	A routine entry in a government database	According to the Drug Pricing and Payment database maintained by the US Centers for Medicare and Medicaid Services, the National Average Drug Acquisition Cost for 300 mg pills of abacavir was US$0.77 each in December 2019 in the US.	(Nothing, because it's a primary source)

All of these examples have been mentioned in the discussions leading up to this point. If anyone feels like any of the examples are misrepresented, please let me know. WhatamIdoing (talk) 05:41, 24 December 2019 (UTC)

Despair sets in; we won't get people to digest this much information. SandyGeorgia (Talk) 05:59, 24 December 2019 (UTC)

I don't have a problem with any of WhatamIdoing's examples above appearing in an article on the drug (assuming that they are correct at face value). I would not expect to see any of them, except possibly the insulin information in the article lead, in which case I would expect a section in the article discussing the price rise and its impact in more detail. · · · Peter Southwood ^(talk): 08:08, 25 December 2019 (UTC)

Colin's Background

I think we have rather forgotten why we are having this RFC. I'm here because MEDMOS got edited to state a medication price agenda, and despite discussion on talk, received further non-consensual edits supporting drug prices in articles. I'm here because I saw the edit war at ivermectin. The article currently says "The wholesale cost in the developing world for the tablets is about US$0.12 for a course of treatment." with a source link that doesn't work. When we look at a fixed link we find the source is the Costa Rica Social Security Buyer price, which is never regarded as an International Reference Price (the median of multiple seller prices is required). We also find that $0.12 is not mentioned by the source nor is the quantity for a "course of treatment" mentioned by the source. This has already been pointed out and no WP:MED editor has joined with me in criticising it nor fixing it since January 2016. Rather than fixing current problems in article text, WP:MED suggest we make it even worse by put prices in the infoboxes. Indeed at Template talk:Infobox drug#GoodRx we have a proposal to include prices and links to GoodRx on all our drug articles. One editor noted "I just realized that since some brands contain multiple dosage forms..." but still wants to pursue it. It is claimed prices are "defining data" suitable for wikidata, despite every evidence to the contrary. The lack of any logic supporting that idea has not stopped it being repeated multiple times. I'm here because valproate currently says "The wholesale cost in the developing world is about US$0.40 per day as of 2015" despite the source not including a price per day and despite the source being a cherry-picked (from 6 record choices) awkwardly large 500mg tablet with one supplier rather than the therapeutically more convenient 200mg table that has six suppliers. This has already been pointed out and no WP:MED editor has joined with me in criticising it nor fixing it since it was added in December 2015. I'm here because we keep pushing wholesale (or retail) official list prices yet also keep mentioning a desire to meet the needs of those who pay out of their own pocket. It has been claimed "The wholesale and retail price vary little from each other" yet WHO remind us that even standard medicines like an Salbutamol inhaler is "virtually unavailable in the public sector of many countries" and "purchased from the private sector, can cost the lowest-paid, unskilled government worker several days’ wages". I'm here because Ethosuximide currently says "The wholesale cost in the developing world is about US$27.77 per month as of 2014" despite linking to a single supplier that only delivers by their own fleet of trucks to the north of the Democratic Republic of Congo (not "the developing world") and despite the source not giving a price "per month" at all. This has already been pointed out and no WP:MED editor has joined with me in criticising it nor fixing it since it was added in December 2016. I hope a pattern is emerging. We aren't having an RFC about some new or alternative idea for prices in Wikipedia articles. We are having an RFC about the actual current prices in actual hundreds of articles. We're having an RFC because of an impasse between two editors. And we're having an RFC because WP:MED has completely avoided making direct explicit criticisms of that text or of fixing any problems in the past three years. WP:MED is clearly not going to fix this and we need input from the wider community and neutral editors to contribute. We need to offer a question that directly resolves this matter, rather than creating new ones. -- Colin°Talk 10:01, 24 December 2019 (UTC) Colin, I am going to put this comment inside your collapsed box, so that honoring the spirit of Barkeep's intent in this new thread, we can stay focused on formulating the questions. But I want to point out: we once had an RFC/U process-- Requests for comment on User conduct. We don't have those anymore. I agree there are behavioral aspects to everything occurring at WPMED, and I regret that not being heard when you discuss policy and provide incisive analysis is causing frustration. It is also frustrating that most WPMED editors are not even engaging this page to help formulate an RFC, while you continue to work towards explaining and applying policy. You are heard. But we don't have Requests for comment anymore for looking at user conduct specifically, and we are where we are. We need to work with what we have. Could you take what I did do with the two questions, and merge them back to your one suggestion while preserving anything of value in mine? SandyGeorgia (Talk) 13:50, 24 December 2019 (UTC)

I think question A (by Colin) is a necessary and sufficient condition for the current text in hundreds of drug articles to be kept. Splitting in two like Sandy proposes weakens this, especially the open question B which may not likely lead to anything other than a random mix of opinions. The problem with a "What kinds of sources" question is that it always depends what you use if for and "for pharmaceutical drug prices in drug articles" is not specific enough. Many people like to view sources as adjectives. So "MSH" or "data.medicaid.gov" or "WHO" or "BNF" will be viewed as "reliable sources" and as "secondary sources" (they aren't the primary source of their data). So I suspect we'd just get comments like "Must use high quality secondary sources like the BNF" without stopping to think that the BNF may list 30 prices from 10 manufacturers for a drug, or even working out what the two prices the BNF list for each record actually mean. I'll try to find some representative article texts later. Essentially we want an "Are you happy with this?" question around existing practice. -- Colin°^Talk 10:21, 24 December 2019 (UTC)

• I'm behind on reading everyone's comments, and busy as well. More than a reminder to myself than anything, with no attempt to create simple questions for an RfC: When are specific prices due mention in an article at all, and when in the lede? How much pricing information needs to be included with any specific prices to make those prices meaningful to the reader? --Ronz (talk) 19:24, 24 December 2019 (UTC)
  • NOTPRICE needs to be supported. The WP:Prices essay deleted/moved. --Ronz (talk) 17:52, 25 December 2019 (UTC)
• So once again, Colin states his support for question A by Colin. Someone please alert the news media. So far, I'm not seeing any single question that adequately covers the two issues that I identified, without being confusing to editors who are coming new to the RfC, or being non-neutral. What comes closest are Sandy's combined C and D, with some further wordsmithing. But alas, that is not a single question. --Tryptofish (talk) 21:33, 24 December 2019 (UTC)

Putting this here at the bottom, to encompass much and good feedback above. Please, people, come on ... take Barkeep's suggestion and put up concrete suggestions so we can start wordsmithing and discussing specifics. Once the proposals are up, we can see the issues and refine. I am at the limit of my wordsmithing ability, and despair has set in; length has again taken over this discussion, and we have nothing concrete. Trypto and Peter and Ronz, give it a go even if you aren't yet fully satisfied with what you might intially propose. SandyGeorgia (Talk) 19:02, 25 December 2019 (UTC)

Thanks, Sandy, but given the responses I've gotten so far when I've previously given it a go, I'm going to sit back and see what others can do. I appreciate the fact that you, alone, covered the things I think need to be covered, in your two C and D proposals, which together seem to me to be the best so far. But, given Barkeep's request for a single question, and given what seems to me to be the predominant opinion of editors here, I think we need to make it into a single question. Without creating new problems in doing so. I'm not seeing any way to accomplish that. --Tryptofish (talk) 23:00, 25 December 2019 (UTC)

Who are "others" that we are waiting for to see what they can do? All of the "Me, too, per editor-so-and-so" !voters, who don't engage to develop consensus? Are you expecting someone new to show up here? It looks to me like we're looking at us, and if *we* don't come up with something, we end up at Arbcom. It should be well evidenced by now that I suck at formulating RFCs, so what are we thinking is going to happen next here? SandyGeorgia (Talk) 23:25, 25 December 2019 (UTC)

SandyGeorgia — It's Christmas day, even if you feel dispair that no one is engaging right now, we need to keep our cool and wait until at least the beginning of January. With the moratorium on change wrt prices, the fact that prices have been included for years, and that this debate has raged for over a month — there is hardly to be any cataclysmic effect of waiting another week or so. Carl Fredrik ^talk 23:41, 25 December 2019 (UTC)

<sigh> ... you are right, CFCF. It happens that, with a big Christmas party behind me, the food done with, and gifts purchased wrapped and delivered, today was the first day I could really finally focus. You are right that today does not have to be the day. My despair is more related to seeing Barkeep try so hard, and getting no results yet ... SandyGeorgia (Talk) 23:47, 25 December 2019 (UTC)

SandyGeorgia, as I noted below to Typto I do think we're getting somewhere. As Carl notes we're in a slow period. But I plan to recollect the various wordings, some of which seem to have more support than others, to see if we can get to a final version (if one doesn't emerge organically). Best, Barkeep49 (talk) 23:51, 25 December 2019 (UTC)

Thanks again for still going above and beyond the call of duty. Lavendar herbal bath is calling my name. SandyGeorgia (Talk) 00:00, 26 December 2019 (UTC)

Well, I've made suggestions, and they have apparently been shot down. And, as I said, I'm not seeing a way forward under the terms we are working with here. --Tryptofish (talk) 23:34, 25 December 2019 (UTC)

I think it's possible we end up with more than one part (and said as much in my extended comments). However, when we started with multiple parts it quickly spiraled out of control and to a place we'd never achieve consensus. I'm hoping by staying smaller it will be easier for us to achieve consensus here on the questions and then to achieve consensus when it's formally putout to the broader Wikipedia community. But yes all this does require on people actively collaborating on wording or else putting forth concrete support for the wording of someone else. This conversation has generated some fresh perspectives so I'm still hopeful we're somewhat moving in a positive direction. Best, Barkeep49 (talk) 23:38, 25 December 2019 (UTC)

Honestly, Trypto, I haven't intended to shoot down or ignore any of your suggestions: they just aren't yet formulated in a way that I can get my arms around them. Because of the history of really badly formed RFCs leading to no conclusions, I think that Barkeep was right to suggest a format in which we could more easily see exactly what the questions would look like, and discuss from there. At this stage of frustration, I could better opine on your ideas if you would put them in the format as A, B, and so on above. WAIDs huge table is where my despair started; while *we* get it, I just don't feel most participants will. We have to stay simple. SandyGeorgia (Talk) 23:57, 25 December 2019 (UTC)

Tryptofish's two part question can be split into two questions. The second question is not relevant unless the answer to the first is "yes", so we can take the first part and ask it, and if the answer is no, the second question falls away. I see the second question as relatively straightforward, as it refers to economic content as opposed to medical content, but it may be that others have philosophical differences about the scope of medical content, and I am happy to leave that debate for another day. I present a modified version of Tryptofish's question. · · · Peter Southwood ^(talk): 06:57, 26 December 2019 (UTC)

• Trying to respond to several points above. User:Barkeep49 "a baseline (prices are/aren't encyclopedic)" question will need to be carefully worded. People have very different ideas about what counts as evidence of encyclopedic. Perhaps worth quoting WP:NOTPRICES here for reference:

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

We have different opinions expressed about what that means and whether we should challenge it. WAID appears to want us to reconsider WP:NOTPRICES for any topic. Others believe WP:NOTPRICES already disallows the "two or three prices in the lead of every single drug article" approach that has occurred. When the above was quoted on 6 December, James wrote "And I agree with that. All the sources being used to discuss prices are independent. And we have sources that justify the importance of pricing information". We have some editors who think prices concerns in national newspapers is what counts as independent discussion and WP:WEIGHT to include. Others claim that multiple drug databases listing prices satisfies WP:WEIGHT and finding some obscure internal memo on the price of X is sufficient discussion, or that general concern about drug pricing is enough to justify the inclusion in every single drug article. So we need a question that cuts through all that to make a clear consensus. If we just end up with a reworded WP:NOTPRICES that is immediately ignored/evaded we haven't achieved anything.

Can we try not to personalise the ownership of questions either as a reason to negate someone's support for them or to get all defensive about them, though unfortunately to discuss options we sometimes have to label them with a proposer's name. I appreciate Tryptofish's two "ideas" weren't literal "questions". I think we should be free to state concerns about one question or another without having those concerns described as "shot down" or "rejected". One reason I so dislike it when wiki/commons jumps immediately to a vote is that all discussion just gets polarised into adversarial language supporting one's position and rubbishing the opposition -- we see that elsewhere in the MEDLEAD discussion. Sandy's C and D could well work. My nervousness with D comes also to the area User:Pbsouthwood is commenting on: which angle should we approach the problem? I could well be wrong and by asking an open question we get some really good clear advise (personally, I'd be hoping that we'd agree that database sources we use currently are useless to us in anything other than unusual cases, because of all the original research, cherry picking, synthesis, etc). I fear however we may get unclear unhelpful replies where words like "independent", "secondary source" and "reliable source" are used which I hope everyone here agrees are in the chocolate teapot department of unhelpfulness to us wrt the current dispute.

There seems to be some consensus around the C and D questions. I do think it would be useful to include examples, especially of current usage both for the "routine drug pricing citing price databases" and for the "exceptional drug pricing citing some newspaper or commentary source". -- Colin°^Talk 12:37, 26 December 2019 (UTC)

arbitrary edit break

F

Should reliably sourced and unambiguous dosage prices be routinely presented in articles on drugs (medications) in a prominent position (lead or infobox)
— User:Pbsouthwood

Pbsouthwood, can you give an example (current or invented) of such? I don't think I have seen any "unambiguous" (within article text) statement of dose (it has to be inferred from the database record cited, and in the case of some US prices, can't be inferred at all because the source links to a set of 25,000 prices for a given week). Take diazepam for example. It states "The wholesale cost in the developing world is about US$0.01 per dose as of 2014.". Again there are a whole host of problems with this because the source lists only the Buyer price in the Dominican Republic and in Peru, and lists no suppliers at all. This should have run alarm bells for such a huge drug. In fact the 10mg tablet would appear to be uncommonly used (hence no suppliers at all, and in 2015 only Peru was a Buyer) and the 5mg tablet here with eight suppliers is far more reasonable. But what is a "dose". Would someone writing "costs ___ for a 5mg dose" and citing this be "reliably sourced and unambiguous" in your book? The source does not indicate which tablet size to pick or what is a "dose". Nor, for other drugs, does it suggest whether to use enteric coated tablets, or suspensions. The MSH is a "reliable source" for some things (nobody is doubting it is generally likely to be correct about the prices it lists) but not a "good source" for others (the Buyer prices in Peru and DR are not considered representative of the "developing world" according to ANY recommended usage of MSH). Other articles give a cost per day or per month or per treatment. Are they "dosage prices"? By "unambiguous" does one need to include the exact indication too. For example, the BNF gives all sorts of dose options for various indications, many in a range. How would we pick which indication? And if we picked one ("Muscle spasm of varied aetiology") the adult dose is "2–15 mg daily in divided doses, then increased if necessary to 60 mg daily, adjusted according to response, dose only increased in spastic conditions." How does that translate to a "dosage prices" in an article? The BNF prices are here.

Btw, James has hinted he can't access the BNF (other than a paper copy which is very abbreviated wrt price). If others are having that problem, it would be good to know prior to the RFC. A VPN allows you to access the web from another country, and I've used that to access the US GoodRX website for example. -- Colin°^Talk 12:37, 26 December 2019 (UTC)

Colin, I have no example of an unambiguous dosage price, and am not sure I could find one if I looked for it. I consider the issue of medication dosages and pricing as outside of my skill set, and am not a big enough fool to try to bluff my way through. I do think I can recognise several varieties of ambiguity that might come up in an attempt to present such an unambiguous price, and you and others have mentioned a few of them already. My point is that it may be possible in some cases, and that it could be considered by the Wikipedia community whether, if and when it is possible, it is to be accepted as a standard component of an article on the drug. I am taking as a given that ambiguous dosage prices are not encyclopedic and are not acceptable, as being potentially or actually misleading to the reader, which is a MEDMOS issue. It is the responsibility of the editor adding the information to not only provide a reliable source, but also to ensure that the information provided is not misleading. Competence is required, both in researching the content, and in presenting it in an article. I may have the competence to identify a dosage price statementas badly expressed or ambiguous, but it is unlikely that I will ever try to add one. Your example for Diazepam for muscle spasm suggests that in many cases it is not reasonably practicable to provide an unambiguous and useful dosage price, even if restricted to a single market with stable prices. · · · Peter Southwood ^(talk): 16:27, 26 December 2019 (UTC)

PS: BNF is only available in the UK according to the website, so not accessible to me either. · · · Peter Southwood ^(talk): 16:27, 26 December 2019 (UTC)

Would someone writing "costs ___ for a 5mg dose" and citing this be "reliably sourced and unambiguous" in your book?
That price is for 2015, which is not mentioned in text.
The actual price is not mentioned in text. Several are available in the source, which one is actually used is important, and it should be mentioned what kind of price it is. Buyer or supplier, median, mean, or range.
The specific source is one of possibly may, and is not mentioned in text.
5mg dose is unambiguous, but unless the article goes into some detail elsewhere of what dose is appropriate in various circumstances, it is not very useful.
The dosage form (tablet) is not mentioned in text, but I don't know if this is relevant for this drug.
I would call it ambiguous. I have no particular problem with reliability of the source as such. · · · Peter Southwood ^(talk): 17:22, 26 December 2019 (UTC)

F is getting at part of something that must be addressed. This whole dilemma (according to some of us, anyway) is the result of the breach or misapplication of multiple policies and guidelines (NOR, WEIGHT, NOT and LEAD). Some are suggesting that we should revisit guideline and policy (overall, for the case of MEDLEAD for the purpose of translation, and NOTPRICE for the case of medical product pricing per WAID).

I am concerned that our questions must be asked in a way that addresses the NOR aspect of these drug databases, the WEIGHT aspect of whether we should include prices at all, and the LEAD aspect of whether they should be in the lead. If we really have so many core policies being challenged, what the heck. NOR, NOT and WEIGHT are policy; why are WikiProject guidelines and practices challenging policy and why is that not being done with RFCs on the core policies? I am going to end up dissatisfied if we don't have questions that will get us to the core problems. If we still had an RFC/U process for user conduct, we would be asking these questions there. SandyGeorgia (Talk) 14:56, 26 December 2019 (UTC)

Agree that three core policies are being breached, though we have rather lacked WP:MED regulars confirming this, leading us to only speculate why. This is partly why I am reluctant to ask a question that is essentially "Shall we allow several core policies to be broken for drug prices" rather than "Can we do _____ while still following core policy". The insertion into the lead only is an important problem, but perhaps not our first priority. Some have argued that some basic defining data could be in a lead (or infobox) and not repeated in the body. Of course nobody has satisfactorily explained why we should even consider price a defining data, other than to say so in order to justify inclusion in infoboxes or wikidata. The clear example is that drug prices can jump extortionately just because a generic manufacturer is bought out by a rival or decides to drop out leaving only one manufacturer, etc, emphasises that prices can be purely an artefact of the games soulless businesses play. The price of a drug in country YY can change purely because they adopt external reference pricing as a policy rather than cost-plus -- nothing to do with the drug itself. I can't really get my mind round the idea that we could take the dozens of prices on a BNF price page, multiplied by a handful of different indications and patient groups suggesting dose ranges, and condense that down to one entry in an infobox or one sentence in our lead. But that hasn't stopped multiple editors consistently and persistently saying they are fine with it and want to go further. So maybe we need to ask what seems to some of us as obvious, but we shouldn't be asking to be allowed to break core policy. -- Colin°^Talk 15:22, 26 December 2019 (UTC)

So, let's look at F from the perspective of the admin who will have to close the RFC. MEDLEAD is only guideline, so it seemed to be a good small piece to get out of the way early on. We see translation advocates agreeing that guidelines should be ignored for the "greater purpose" of "children in sub-Sahara Africa" (although the overall benefit to anyone, much less children in Africa, is highly dubious, but I digress). We see almost no one engaging the policy/guideline fundamental questions (partly because of the RFC framing, but that is precisely the problem we are facing here, hence the example). And we see a matter too complex and entrenched for average editors to engage.

So, let's consider the answers that F will generate, and how the closer will interpret those? F presumes a baseline understanding of and achknowledgement of reliably sourced and unambiguous dosage prices. We don't have that in this price dilemma. If we did, we wouldn't be here. So, what will the closing admin do with the "ILikeIt", "Me, too, per editor-so-and-so" responses that will not engage the core questions and policies? The RFC MEDLEAD shows we will get "because I like it" responses. We need to be highly specific in our questions about the core policies: NOR, WEIGHT, NOT. With the MEDLEAD RFC, a closing admin can argue that guidelines are flexible and can be ignored. In that case, with respondents not engaging the core questions, we end up with protracted local discussions to determine consensus on individual articles, where one group will argue LEAD and another group will argue MEDLEAD. We end up with articles that cannot be taken to FAC, because you can't please two masters. This is really not a big deal, because essentially no one at WPMED is attempting to write complete articles anymore anyway, and no one is maintaining most of the project's Featured articles.

Unlike the guideline LEAD, on core policy questions, the problem cannot be so easily overlooked. In this case, if we end up with an inconclusive RFC where respondents do not engage policy because we haven't asked the questions with great specificity, what's next? Protracted local disputes end up at arbcom. SandyGeorgia (Talk) 16:22, 26 December 2019 (UTC)

Peter Southwood, I think many article texts are ambiguous. They just say "per dose" or "per day" or "per treatment" and that is "ambiguous" in the sense we don't in-text name the dose or indication or any other factor that influences how much you give, how often and for how long. But suppose we did. Suppose we named a 10mg Diazepam tablet or we stated a full course of X antibiotic at 25mg per day for 8 days. Then the "a" word I have a problem with is "arbitrary". Someone picked 10mg dose and chose a tablet rather than a rectal suppository, and chose an indication for treatment. So while we can certainly make minor changes to improve the article text to be unambiguous and many will argue the sources we cite are already "reliable", neither seem to me to be sufficient to allow what we currently have, even improved with minor tweaks. So I wouldn't want the end result of the RFC to just be "we need to name the dose and formulation in-text".

Btw, I just installed windscribe.com extension onto my Chrome browser. It is free and I get 10gb a month through it. I was then able to select a server in Dallas US and access goodrx.com. I do suggest folk in this discussion do similar for a virtual visit to the UK and have a look at BNF for drug details including prescribing dosages and indications and medicinal forms including prices. I really wish the folk who think we can put this in an info box would look at that -- the infobox would be bigger than most articles. -- Colin°^Talk 17:21, 26 December 2019 (UTC)

Arbitrary is generally not useful to the reader, so I would consider it unencyclopedic. · · · Peter Southwood ^(talk): 17:30, 26 December 2019 (UTC)

Here are the things that I can identify that need to be addressed for F. When we ask editors whether that kind of information "should" be handled that way, we still need to somehow address "as opposed to what?" It's easy for an RfC to close as "yes, it can be done this way" and then have someone come along and assert "but it didn't say we cannot do it this other way" – or for it to be closed as "no, don't do it this way", and someone claims that "my way isn't that, so my way is OK". Also, however we present a question, it's important that we present specific examples of what it would look like in an article, for at least two contrasting alternatives, and that we present editors with concise policy-based arguments for or against whatever it is. --Tryptofish (talk) 18:56, 26 December 2019 (UTC)

Tryptofish, agree that there may be a problem with evading any decision by clever words/interpretation. That is a current concern wrt WP:NOTPRICES for many folk who disagree that drug prices meet that policy requirement for all drugs. If one person says "must use reliable secondary sources" to mean a commentary in a newspaper or journal explicitly talking about the high/low price and perhaps quoting a figure, another person might say "But MSH's prices are secondary sources (they aren't the supplier or manufacturer) and they are reliable". Wrt options, we need to always remember that one option is to not do it at all. For example, there are so many indications, formulations and manufacturers of diazepam that perhaps we conclude that wiki should not emulate the drug databases by trying to list them or nor to falsely condense them down to one price.

At the other end of availability, look at Terbinafine. Peter Southwood, you mention above whether "dosage form is relevant for this drug [diazepam]". It certainly always affects the price, so picking one form or table size can hugely affect the price quoted. Different forms are required for different patient groups/ages and indications. The most amusing I just found was Terbinafine. We cite a source commenting (as an aside) that the price for a 12-week treatment fell from $547 to $10 after the patent had expired. Is that price drop notable or typical? Anyway, the point is the source is talking about a lengthy oral (tablet) treatment for nail fungus. But we also, in the previous sentence say "The wholesale cost in the developing world is about 2.20 USD for a 20 g tube" which isn't for nail fungus (the cream isn't effective) but for athletes foot or other itchy skin, which typically clears up in days, not months. So we are being very ambiguous and the juxtaposition is very much against policy. But also importantly, the source from 2014 doesn't list any Suppliers at all and only one Buyer (an organisation representing 9 Eastern Caribbean states). And MSH doesn't have any entry for the tablet. The only reasonable conclusion is that Terbinafine cream or tablet are not generally available from suppliers to governments in the developing world, yet we are so desperate to give a price that we quote any old garbage database entry we find and claim falsely that this represents "the wholesale cost in the developing world". Mostly, we should pick the "say nothing" option, and our questions should allow for that. -- Colin°^Talk 09:11, 27 December 2019 (UTC)

Yes, we agree about that. I think there's a world of difference between taking terbinafine orally, under an MD's supervision and perhaps monitoring liver function, versus using an over-the-counter cream for an itch. --Tryptofish (talk) 23:26, 27 December 2019 (UTC)

NOR vs DUE

I really think this is important: NOR is not DUE.

Deciding which entry to cite in a database is not a NOR violation. It's (possibly) a DUE violation, but an accurate description of the content published in a reliable source is never NOR. This means that if you look up wonderpam in The Database, and it says "100 mg pill – generic – Specific Price Type – US$0.10 – December 2019 – UK", then writing "According to The Database, the Specific Price Type of a 100 mg pill of generic wonderpam was US$0.10 in December 2019 in the UK" is not original research. That's actually what the published reliable source said; therefore, that's not NOR.

Now, while that statement is not a NOR violation, NOTPRICE suggests that it's also probably not something that we want. It's possibly unencyclopedic, and it's very likely UNDUE emphasis (why that one size, that one date, that one country?), even though it's not actually original research. I don't think that we'll get a sensible RFC response if we go to editors and say "He copied this information straight out of a single reliable source – that's a NOR violation, right?" NOR means "material—such as facts, allegations, and ideas—for which no reliable, published sources exist". If you're copying it straight out of a single reliable source, then it's not NOR. IMO we need to stop talking about NOR (which is either not a problem at all, or is a problem that can be fixed by copyediting) and focus this discussion on DUE.

"Focusing on DUE" IMO means that we ask editors how much emphasis we should put on this subject. "How much emphasis" is partly subjective. Yes, you have to have the sources, but if something is "always" DUE, then you can/should write a weak claim from whatever source you can get.

We need to know whether editors want minimal emphasis (in which case, we remove a number of existing statements, or at least move them out of the lead), or whether they want significant emphasis (in which case, MEDMOS can provide information about how to write non-NOR statements), or something in between.

It would be good to educate the respondents about how complex the subject area is, but if they want significant emphasis on this, then the feasibility of implementing their goals in any given case is not the primary factor in writing our advice. After all, we put a huge amount of weight on the dates and locations of people's births, even though we know that can't source birthdates and locations for every single biography. Putting a huge amount of weight on it just means that if you've got any source at all, even if it's just one unimpressive primary source, then you include whatever you've got, with whatever WP:INTEXT attribution and careful description that allows readers to understand the limits of the source.

When this started, I gave a pair of examples in MEDMOS:

• 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.

If editors want prices at all costs, we could add one that shows how to respect NOR while still including database-derived prices:

• Y Do this: "Prices vary according to dose, location, and other factors. As an example, according to Named Database, the government of Costa Rica paid US$0.10 per 100 mg pill for generic wonderpam in 2015."
• Y Do this: "Under the affordability model published by the World Health Organization and Health Action International in 2008, a medication is affordable if a month's treatment costs less than seven days' wages for the lowest-paid unskilled government employee. In the WHO/HAI database, generic wonderpam is classified as an affordable medication."

We could also add an example from news media:

• Y Do this: "Shortly after its original marketing approval by the US FDA in 2010, Business News estimated the manufacturer's list price of Wonderpam at US$1,000 per day in the US."

I know those statements can be sourced for some medications without transgressing NOR. IMO what we need is to know whether editors actually want us to do that.

With that in mind, I think that the question to ask is:

G

How much WP:WEIGHT should be put on the prices of pharmaceutical drugs?

This question can (and IMO should) be followed by examples (the despair-inducing table) and explanations (the impossibility of finding the One True™ Price for a drug that sells in 190 countries in six different doses and four common formulations under at least 90 brand names) and alternatives (we could skip dollars-and-cents and instead try to source a comment about affordable/expensive), and comparsions to similar subjects (e.g., how NOTPRICE is applied to other products), but I think that this is the most basic question to ask.

I do not think that we should be asking a yes/no question. I think editors should be encouraged to respond with both an overall view related to inclusion (e.g., always include, usually include, usually omit, only include under extraordinary circumstances, only for generic drugs, only for WHO Essential Medicines, only for drugs under patent protection, only for drugs with unusually high prices – whatever editors actually want) and with an idea of how to include (e.g., brief mention in the lead vs a whole paragraph or section, current prices vs original prices, etc.). WhatamIdoing (talk) 19:14, 27 December 2019 (UTC)

I do think we should give some serious attention to presenting the RfC in such as manner as to not conflate policies. But I also think that there is a serious need to keep things simple, rather than tl;dr. If we ask "how much weight?", there will be the issue of how to answer the question. How does one define "a lot of weight" versus "not much weight"? --Tryptofish (talk) 23:23, 27 December 2019 (UTC)

I'm still not seeing a simple RfC coming from all this.

Having information in the lead, an infobox, or in the article body are issues of weight. Presenting information in inappropriate context can be NOR, NOT, or POV issues.

I think this examples of what to do and not do are very valuable in moving us to some consensus, and giving proper guidance to editors who are trying to address these problems in articles. --Ronz (talk) 23:56, 27 December 2019 (UTC)

I, too, am still not seeing a simple RfC here. I also think that concrete examples are very useful – not only to what we are working on here, but also potentially to be included in some way in the RfC. I'm willing to be a bit flexible with regard to covering every issue, even every significant issue (infobox versus body text, for example), in the interests of a manageable RfC, but I also think increasingly that we will just be spinning our wheels if we keep trying over and over to craft a single question. --Tryptofish (talk) 23:53, 28 December 2019 (UTC)

WhatamIdoing, sorry but I think you are totally wrong, because you keep having a strawman argument about fictitious possible price/cost/affordability statements some fictitious article might contain. We aren't having an RFC because of fictitious possible article text. Of the 500+ drug articles that currently display prices, all of them required original research to make the statement they do. When we chose one unnamed tablet to represent "the cost", that was indeed original research and when we multiplied by a "dose" that was also original research. Have you looked at the medicaid source links? They cite a "prices for week xx in 2018" database of tens of thousands of records. You need to then, by hand, filter the results to the drug the article is about and then you need to look at different formulations and tablet sizes and try to reverse engineer which one was picked to get $50.45 a month or whatever we claimed. And of course the medicaid site doesn't mention a dose at all, so no "intelligent reader" could possibly work it out from that source -- the very definition of original research.

And we also made claims that are not supported by the source at all, like "the wholesale cost in the developing world" citing one buyer price in Costa Rica, or claiming the price ranged from $x to $y when that is also not supported by the source. None of actual articles formulate the price statement like you did. If they did, then you could indeed make the argument that it was undue weight to mention one tablet size from one drug manufacturer in one country. But they don't and the difference is not solvable, as you put it, by "copyediting".

We nearly always give a price per dose, per day or month (which also require picking a dose) or per treatment (which requires an indication and dose). But we always don't mention what that dose is nor do we mention what the indication is. Terbinafine was one example above, Aciclovir another I spotted today, where the article does not state whether the costs are for a cream for cold sores or a tablet for shingles or post-transplant infection of cytomegalovirus. Yes there would be a WP:WEIGHT problem with explicitly giving the price for just one indication, and there would be a WEIGHT problem if we were explicit about the formulation/supplier/etc we used for our maths. But we aren't even specifying the indication, never mind the other things, so our problem isn't WEIGHT but just being dishonest with our readers in claiming there is One Price. The "we could be as specific as The Database is" argument is a false one to make and knock down, because nobody is proposing it. As you say yourself, just giving an example of all the permutations should be despair-inducing. We need to also remember MEDMOS prevents us from stating drug dose information in articles (for good reason) so we can't even explain to our readers why we picked the 250mg tablet.

WhatamIdoing, I have complained about the horrendous problems with the lead text in 500+ drug articles, and I think an RFC that appreciates the problems with that text will result in all those lead prices sourced to databases texts being removed from all 500+ drug articles. Please, the RFC must resolve the conflict over existing article text, not generate imaginary conflicts with imaginary texts. I don't think your WEIGHT question resolves this conflict at all. It isn't even in my mind a sensible question to ask. WP:WEIGHT is determined by reading the body of literature on the article topic, not by Wikipedians expressing a personal opinion. -- Colin°^Talk 12:54, 28 December 2019 (UTC)

IMO, all of this is original research (not simple math). Let's not archive those sections yet. SandyGeorgia (Talk) 14:26, 28 December 2019 (UTC)

Help me out with this, User:SandyGeorgia and User:Colin. You've been consistent in thinking that it's NOR. If you're looking at a database record in a reputable, WP:Published database that says this:

"wonderpam – 100 mg pill – generic – Specific Price Type – US$0.10 – December 2019 – UK"

and someone uses that to write:

"According to The Database, the Specific Price Type of a 100 mg pill of generic wonderpam was US$0.10 in December 2019 in the UK"

where exactly in that sentence do you see "material—such as facts, allegations, and ideas—for which no reliable, published sources exist"? Or would this be fine (in NOR terms – I still have my doubts about it in DUE terms), and the problem is "merely" that none of the articles using this sort of source are following this model? WhatamIdoing (talk) 17:23, 28 December 2019 (UTC)

• WhatamIdoing, I'm working on a page that lists pretty much all the price statements I can find on our drug articles. Today or tomorrow I'll have something I hope. I think that should give us all a clearer idea of what is on Wikipedia and perhaps spark some suggestions about good things and maybe we can clear up some bad things. I strongly suggest you follow my suggestion above about getting a VPN for your browser and travelling over to the UK to have a peek at the BNF. It is easy to turn the VPN on and off and to travel to nice places. The BNF link for Colecalciferol aka vitamin D3 has 216 formulations/manufacturers listed. And that's only for manufacturers that supply the NHS, Amazon list a bazillion other options too. From what I've seen so far on wiki, a minority of articles mention a formulation/strength for a price, rather than the OR step of quoting a price per dose/day/month/treatment seen in the majority, but even those aren't making claims fully supported by the source. Rather than discuss imaginary databases, can you use one of our actual drug sources and see if you can come up with text you think avoids NOR and only has DUE issues. -- Colin°^Talk 17:47, 28 December 2019 (UTC)
  • Colin, thanks for this question at the end. This MOS guidance is about what we should be doing. This doesn't mean it always will be done, but does give editors who change content in that direction a basis for doing so. In my own area of content expertise, books, the MOS discourages sections about characters. Yet I frequently find character sections and when I do I normally just remove them referencing the MOS. The same will likely be true here. After the RfC there will be guidance about how price/cost should be used but it will still be up to editors to make that happen (both with existing and new content). Best, Barkeep49 (talk) 18:00, 28 December 2019 (UTC)
  • (edit conflict) Colin, I've done that. Remember the despair-inducing table? Those all have real-world sources behind them. I usually aim for obviously "model" sentences in guidelines, but if you want to see one that has real-world drug in it, with a real-world database cited, then that sentence could just as easily say "According to the Drug Pricing and Payment database maintained by the US Centers for Medicare and Medicaid Services, the National Average Drug Acquisition Cost for 300 mg pills of abacavir was US$0.77 each in December 2019 in the US.[4]" What I want from you is to know whether this model (which does not appear to have been used in any articles yet; I know) is, in your excellent judgment, a violation of NOR. I grant that it may have other flaws (e.g., DUE and NOT), but right now, I just want to know whether you believe that sentence, from that source, is a NOR violation. WhatamIdoing (talk) 18:10, 28 December 2019 (UTC)

• While a model statement might be a good idea in a guideline, we have historically had a problem throughout the price debate of claims being made about sources providing information that they don't. For example, it has been repeatedly and falsely boasted that the MSH database is a source of external reference pricing when in fact our up-to-date sources on that topic do not claim its use (instead, a basket of prices from specific countries are used). While the MSH records are no doubt generally reliable for what they are, if you ask me, I would say that it is not a reliable source for prices for "the developing world" because its records are extremely patchy. There is a reason why when WHO use it for price comparison studies, they restrict themselves to 18 common drugs at very specific formulations and strength -- those are ones they can be sure have a healthy set of supplier data.

So, back to your example. I clicked on the link and didn't see any mention of abacavir on the page. This may itself fail NOR requirements, because our dear intelligent reader has to figure out how to use the database, and it really isn't obvious. One might be tempted by the big [Search] box on the top, but that would be a mistake. So I click on the [View Data] button. It returns the first 100 rows out of 7,673,560! By a complete and lucky chance, abacavir is on this first page. But you and I both know that wouldn't generally be the case. So the reader has to figure out to insert "abacavir" into the [Find in this Dataset] box. Initially I got side-tracked by the [Filter] button but that led down a rabbit hole. (It isn't always the wiki article title you need: if you type "valproate" into the box, you'll get nothing). It isn't clear to me why I get 13 rows for the 300mg tablet for 12/18/2019 but at least they all have the same price of $0.77418 each. I don't know if that amount of manual-intervention and learning-how-to-drive-a-database is permitted for our sources? But assuming it is, then I would accept your article text does not breach NOR. Our current text, though, is in a galaxy far far away from that sort of sentence, and I sincerely hope nobody would want to write that in a lead. -- Colin°^Talk 18:39, 28 December 2019 (UTC)

Learning how to drive a database is permitted for sources. We may still have hundreds of probable NOR problems in articles right now, but we've got an agreement that something could be done with databases. I'll go add this to the Table of Despair. That database is probably not a good indication that including it is obviously DUE, right? So it'd be included if we put lots of weight on it, and not if we take a more stringent NOTPRICE approach. WhatamIdoing (talk) 18:52, 28 December 2019 (UTC)

It is worth pointing out that Abacavir currently says "The wholesale cost in the developing world as of 2014 is between US$0.36 and US$0.83 per day. As of 2016 the wholesale cost for a typical month of medication in the United States is US$70.50".[5][6] The DDD on the MSH site says 600mg daily dose, as does my BNF and Drugs.com. So that's two 300mg tablets a day as the developing world prices agree. But the US price of $70.50 is approximately the $70.35 I get by multiplying a 300mg tablet price of $2.34487 by 30. The actual 2016 US monthly price should be $140.69. (Why we have one price per day and another per month is beyond my understanding). Leaving aside that neither MSH nor Medicaid state what the typical therapeutic dose is, for us to do original research on, this is just mathematical incompetence. And it is very typical. I am repeatedly seeing prices citing the BNF that assume a pack of 28 tablets is a "month's cost", totally ignoring that a patient might taken more than one tablet a day. So, the evidence does rather suggest that disallowing original research is a jolly good idea, because we are crap at it. And then we see that the price hasn't been updated since 2016. As your citation shows, the equivalent price in 2019 for 60 tablets would be $46.45, which is about $100 a month less. No small change that, but nobody it seems, is interested in either the price in 2016 being right, or giving the right price for 2019. -- Colin°^Talk 21:40, 28 December 2019 (UTC)

@WAID, I'm not ignoring this, just really needed to back off here for a bit and let you all take the lead. I've got my own Table of Despair, that is awaiting your feedback. @Colin, add to all of this the prescribing practices I see in the free clinic for migrant workers without insurance. If a pill can be split, and is less expensive in a higher dose, the physician prescribes the higher dose if the patient appears competent to be trusted to split it. If the drug is on the 30-day $4 list, or the 90-day $10 list, they prescribe whatever is cheapest, even if splitting is needed, and even if they are only saving $2 on 3 x 30 vs. 90 days. SandyGeorgia (Talk) 22:25, 28 December 2019 (UTC)

Colin, I wouldn't be surprised if there were any number of accidental errors, but the goal here is to write advice on how to do it right. The fact that it's currently not right in many articles may be a disaster, but it's a nearly irrelevant disaster. Once we get some decent advice together, we can sit down and apply the advice. If we try to fix all of that before getting an agreement about what the right approach is, we might end up making the articles a different kind of wrong, rather than really fixing them. WhatamIdoing (talk) 06:02, 29 December 2019 (UTC)

WhatamIdoing, Abacavir is an interesting example for another reason. We can eliminate OR by stating a price for one thing -- with a barcode -- but then you argue the problem is DUE because there are multiple (dozens, hundreds even) of possible things with barcodes we could pick. But from my reading of most HIV pills, they tend to have one dose that everyone takes, and a limited range of suppliers. So the Abacavir 300mg pill in the Medicaid database is the only size in that database. It could then be argued that we could give the price of a 300mg tablet in the US. But we know the dose is 600mg, taken once or twice a day, and we can't tell the reader that because we aren't allowed to give dosing advice on Wikipedia. So the price of a 300mg tablet is fairly meaningless to our reader -- they don't know what to do with that information. That's probably why nearly all our price statements in articles give a price per day/month for an unspecified indication and unspecified dose and unspecified tablet size. So even in the few occasions where a particular tablet size is not undue, using the "price of a XXmg tablet" approach is not likely to be encyclopaedic. (Btw, the BNF has three suppliers for the 300mg tablet pack of 60: £177.60, £177.61 and £208.95 for the brand-name, as well as a 20mg/ml oral solution at £55.72 for 240ml, so darn the BNF for offering options!) -- Colin°^Talk 12:40, 29 December 2019 (UTC)

In terms of presenting this question, I think it needs a bit of explanation. The straight-up question is "How much weight?", but after that, some explanation is necessary. One way (of many ways) might be to explain the context, and then offer some considerations. It could look something like this:

All Wikipedia articles should present information with WP:Due weight. Generally, this means that the more our reliable sources talk about an aspect, the more attention that aspect should get in the Wikipedia article. However, there is some information that is considered so important that it is included whenever possible. For example, in a biography, we include information about the subject's birthdate whenever possible, but we normally mention the subject's hair color only if reliable sources dwell on the person's appearance.

Drug pricing and affordability is a significant area of discussion in reliable sources, but this discussion is almost always held at a general level, and does not extend down to individual products. The prices of individual pharmaceutical products vary so widely by place, time, dose, and other factors that general claims, such as "the price worldwide" or "the price in developing countries", are almost always incorrect. It is, however, frequently possible to source a statement about what a particular metric yields for the price of a particular size of a particular drug from a particular manufacturer in a single country on a given date.

Editors who work on medicine-related articles have recognized that much of the information about drug prices currently in Wikipedia articles is not an example of our best work. Much of it is outdated or otherwise incorrect. We want to fix it, but we have not been able to agree on the best approach yet. On the one hand, the cost of a drug affects whether people can get it at all, so some editors believe we should always include whatever we can source. Other editors believe that pharmaceutical drugs should be treated like any other manufactured product, and that means no prices unless we have multiple reliable sources discussing the price of that particular product in depth (as we do for some, usually because of very high costs). Editors fall across the whole spectrum from maximizing inclusion and prominence, through the middle grounds, to the opposite side of including as little price information as possible. All of us want to know other editors think, so we're asking you: How much weight should we put on drug prices?

To explain some of the positions, a few editors have offered background information that may be useful to you. We hope that you will join us in a conversation about the best way to handle this subject area.

(Collapsed – It's incredibly important) (Collapsed – You wouldn't believe how complicated and useless this is) (Collapsed – The middle road is WHO/HAI affordability, not prices) (Collapsed – People should care about pricing, not prices) (Collapsed – Where and how we mention prices matter more than whether we do) (Collapsed – What we could actually source is unencyclopedic) (Collapsed – Whatever other ideas/positions/recommendations I've forgotten)

My suggested "collapsed" sections could be written by different people, in the hope that editors would read more than just the headlines. Yes, it's long. That's not necessarily a showstopper. The important question is, if we asked this, do you think that we would get responses that would help us figure out how to clean up these articles? WhatamIdoing (talk) 06:53, 29 December 2019 (UTC)

I think we already know how to clean up these articles. And I don't think we can craft an RFC that will prevent this from happening again after the RFC closes. I am unsure if any of the very well-crafted text above should be positioned as referencing editors (plural) representing ranges of differing opinions, because that gives the equivalent of UNDUE weight to a very minority position that has led all of us to all of this effort to attempt to formulate an RFC, where we used to have an RFC/U process for these kinds of issues. Speaking relatively, I don't think it matters in terms of the respondents how we phrase the questions: we will generally get, "me, too, per editor so-and-so responses". That is why we are where we are. WAID, you are seeing this through your own lenses, as an editor who carefully reads and contemplates issues. Most RFC respondents won't do that as you do. It is a timesink to try to figure out how to phrase a response that will generate contemplative responses; we need to phrase an RFC that will generate something useful to the closing admin knowing that we will get irresponsible responses from people who don't read or digest or contemplate the problem. I am not sure those two sets of potential questions intersect. SandyGeorgia (Talk) 11:45, 29 December 2019 (UTC)

I shall think about it. I fully agree with your Wikipedia:Polling is not a substitute for discussion link and am not convinced voting is going to bring sufficient light here for all the reasons wiki has documented about why it is evil. The "It is, however, frequently possible..." sentence really isn't true. I think part of the problem has been upside-down thinking about our sources. We have an article topic, and what appears to be a database of thousands of product prices, and we type the topic into the search box. We get the price of a random sized pill in north east Democratic Republic of Congo in 2015. Or we get the price of a 20ml cream paid by the government of Sudan in 2014. It really isn't "frequently possible" to source drug prices at that level of precision for any given country or any given supplier/manufacturer. The MSH database is really way too sparse to be generally useful, yet I have seen it used desperately for everything including sanitising hand rub and chlorine bleach, which are both not even pharmaceutical supplies. The Medicaid database has average prices, not prices for a given manufacturer, and the drug descriptions can be so terse it isn't always easy to know what formulation is included. There is a suspiciously low range of pill sizes in that database compared to e.g. BNF or Drugs.com, making me suspect it only includes common ones or, worse, only the ones it got price data for. The BNF is almost the opposite in richness of price information, but we do need to bear in mind it is only concerned with drugs a doctor can prescribe on the NHS and are available via pharmacies. The wholesale price of drugs/products that are (also) available over-the-counter at a pharmacy or supermarket cannot be determined by citing the BNF. The BNF also fails to point out when drug prices are increased due to availability issues, or massively discounted due to (often confidential) agreements with the NHS on expensive new drugs. Also "frequently possible to source a statement " tends to suggest that doing so is actually a valid thing that makes sense and doesn't break policy. The 200+ prices for Vitamin D3 would suggest it really isn't "frequently possible" at all. So while we can get some arbitrary prices for mostly random countries or suppliers, it think it is dangerous to suggest that could reliably form a "statement" rather than merely form a piece of data that an editor may then wonder what to do with.

The "Much of it is outdated or otherwise incorrect." is really "Nearly all of it is incorrect and misleading, and most of it is many years out of date, often citing a source that stopped being updated in 2015". It would greatly simplify any RFC if we could simply get prior agreement that the MSH database is not fit for our purpose. It was fine for the 18-50 products that WHO/HAI studied in their global price analysis projects a decade ago, but pretty useless otherwise.

I think the "WHO/HAI affordability" has, with all good intentions, been rather over-egged as a solution. It is a historical project from 10-15 years ago. Look at the database of prices and expand all the countries. You get random dates of when a survey was done, mostly from 2001 to 2008 but a handful as recent as 2015. I wonder if it is not a coincidence that the MSH database stopped being updated in 2015. If you expand the Affordability tab to see all the drugs they have surveyed, you will find just 50 medicines (some in a few formulations/strengths). And if you consult the table of results, you see what we have noted previously, that many popular drugs are simply not available through the government health system and can only be purchased privately at extortionate retail prices. Those prices bear no relationship other than a tenuous much-greater-than the wholesale price. It is hard to understate how misleading and wrong our "developing world" prices are.

I agree with Sandy, that we must be careful not to claim one editor with strong views and who added nearly every single drug price to over 500 articles, is "some editors". We are here because that editor persistently resisted challenges to the text added, and because WP:MED failed to intervene in any meaningful way. WhatamIdoing, I have every confidence you can think wisely about the sources and could, if so inclined, add some excellent price information where and when it is justified to do so. When Sandy says "I think we already know how to clean up these articles" that means those currently participating here and it is very obvious who are not participating. Is this really a content problem we don't already know the answer to and need to ask the community, or actually a user problem that should be dealt with another way? -- Colin°^Talk 12:28, 29 December 2019 (UTC)

We are here because too many editors are not like WAID, and because in WPMED discussions that led to these impasses, the idea that Wikipedia:Polling is not a substitute for discussion was not in evidence. I appreciate WAID's care and consideration in crafting text and responses, but I fear we may be missing the obvious underlying tensions when we expect editors will engage extended commentary or discussion aimed at developing sound consensus. They won't (hence my reference to the table of despair). SandyGeorgia (Talk) 13:57, 29 December 2019 (UTC)

I think we are here because editors at ANI told us to start an RFC about "the question of drug pricing". My preference is to write the RFC in a way that results in improving this guideline, but SandyGeorgia's alternative (below) is also responsive to that direction. WhatamIdoing (talk) 21:41, 29 December 2019 (UTC)

I think it is useful to have different editors write different explanations, although there also will need to be some general discussion of it here before the RfC goes live, in order to have a consensus that views are being presented fairly, as opposed to being lopsided. But I think we have to be extremely careful of tl;dr. I'm not sold on the idea that the solution to making "how much weight" clear is to write a lengthy introduction to explain what we are trying to ask. Instead, I think it needs to be as clear as possible what responding editors are supporting or opposing. If we do have different editors each presenting different views, I could see an RfC where we do that, but without identifying views by editor names, and ask the community to support or oppose those views. It really looks to me like we have essentially two conflicting views that were laid out at ANI, one favoring widespread presentation of pricing, and one insisting on caution instead. In that way of looking at it, we really are not asking how much weight to put on prices, so much as how widely prices should be included. --Tryptofish (talk) 23:15, 29 December 2019 (UTC)

Start over again

SG's attempt at a new start over, abandon hope all ye who enter here

IMO, the reason we are unable to formulate an RFC question or questions is that the task we are undertaking is the wrong one: we are attempting to formulate a general RFC to address what is in fact a very specific dilemma relating to very specific databases, when the answers to our sourcing and content dilemma are already addressed by policy. We have no other example anywhere, after weeks of discussion, of any other instances of drug pricing in articles presenting a problem. There has been no problem except the database-style sourcing. We are attempting to generate questions that will get respondents to read and respond to what is (should be) a policy question, but we will get "because I like it" responses that will give us nothing useful as result. That is why we are here. Everyone who has participated in this discussion knows how to add price data according to WP:V, WP:NOR, WP:WEIGHT, WP:NOT and WP:LEAD. Why don't we forget all the general questions we are trying to ask to solve a non-existent general problem, and instead just get straight to the specific problem? Put up one example of database-sourced text (I have repeatedly asked the database advocates to give us the strongest example, and none has been produced) and simply ask if this text is supported according to policy, V, NOR, NOT, WEIGHT, LEAD. Then each respondent will lay out arguments of why it does or does not breach each policy. We are spinning our wheels trying to solve a non-existent problem, as if this has been a generalized problem across all drug articles. We have one problem only; over 500 articles using a database to source text. SandyGeorgia (Talk) 12:57, 29 December 2019 (UTC)

• H

  Do these examples of pharmaceutical drug prices comply with Wikipedia policies on verifiability, due weight, no original research, and what Wikipedia is not? If so, should this text be inserted into leads of articles?

• Ethosuximide: The wholesale cost in the developing world is about US$27.77 per month as of 2014.[7]
• Carbamazepine: The wholesale cost in the developing world is about US$0.07 to US$0.24 per day as of 2015.[8]
• Mebendazole: The wholesale cost in the developing world is between USD 0.004 and 0.04 per dose.[9]

But the examples need to be varied to included the other drug databases, and the other kinds of problems presented; I pulled these samples from one section above, but the three of them were to demonstrate one issue. The other kinds of examples should be give in place of two of these. SandyGeorgia (Talk) 14:23, 29 December 2019 (UTC)

Multiple examples of the same problem are useful, in that they demonstrate that the problem is not isolated. If we assume that Wikipedia:Nobody reads the directions, then it might be more effective to provide an explanation of the source in the RFC question, like this:

Ethosuximide:

What the lead says: The wholesale cost in the developing world is about US$27.77 per month as of 2014.[10]

What the source says: One organization said that they sold 250 mg tablets for US$0.1845 each (100 tablets per package). This organization only sells drugs only to government-recognized healthcare organizations in the Democratic Republic of Congo. The defined daily dose (a complex statistical concept; not necessarily the dose any person takes) is 1.25 grams.

I don't think that "if so, should it be in the lead?" is necessary. WhatamIdoing (talk) 21:55, 29 December 2019 (UTC)

I like the general approach here. I think it's much better than trying to ask a single question. What we could, in effect, do is to ask the community: do you support doing it this way, or that way? If we work on making something along those lines as clear and concise as possible, I think that would be the path to getting an RfC that results in an outcome that actually means something. --Tryptofish (talk) 23:18, 29 December 2019 (UTC)

I think this is a decent formulation, though we are presuming all respondents will both check the sources, and know what they are and how to interpret data from them. I'm not certain that will be the case, especially if the RfC is widely publicized. Seraphimblade ^{Talk to me} 03:48, 30 December 2019 (UTC)

Could a neutrally written background accomplish some of this? Best, Barkeep49 (talk) 05:12, 30 December 2019 (UTC)

Yes, if everyone could come to agreement on how to describe what they are, how they gather data, etc., that could be very useful knowledge for those who comment in the RfC. Seraphimblade ^{Talk to me} 07:06, 30 December 2019 (UTC)

This concept of how to address ask the RfC seems to have some traction. Pinging participants from the past week: Colin, Kashmiri, Pbsouthwood, CFCF, and Ronz. Best, Barkeep49 (talk) 05:12, 30 December 2019 (UTC)

I had wondered a similar thing to Sandy's idea: that we take each of the four(?) price-database sources and look at how they are being used and then together reach an agreement about the problems with them, what could be said using them, and what shouldn't be said using them. I actually remain optimistic that much of that analysis/discussion/conclusion could simply be done if we get a good-faith article-experienced bunch of editors to simply work together. All the previous discussion on specific problems felt like it was only me and James and that didn't work for various reasons. I'm not rejected the idea of an RFC, but it would be great to clear away a lot of the crap first, and there really is an awful lot of pretty straightforward crap we could eliminate IMO quite quickly, and focus an RFC on asking the community about price statements that are actually source->text honest and policy-legal. I would be much more confident that such an RFC would be successful in its goals (and to be honest, presenting all the awful prices to the entire community right now would IMO seriously dent WP:MED's credibility).

A mix of family priorities, the latest Star Wars film, and going back to work mean I've not yet finished some of stuff I was working on that demonstrate current text and current problems. I do hope I get a chance to put them up very soon. I think then it will be good if we can all see an honest full selection of drug prices in articles (rather than anyone accuse of picking a hard/easy example) and also quite a number of drugs where the price is genuinely notable and editors could make a really good effort to polish some excellent guideline text on how to present that to readers.

Barkeep49, could we have some kind of moderated workshop to focus on e.g. one source at a time. Advertised to the community. We want participation from wise owls or diligent investigators, rather than just ask for a big mob to vote all at once. I don't think we require medical experts at all, so please nobody rule themselves out on that regard. This is really straightforward source->text analysis. The only kind of ability I can see being useful is an appreciation of statistics to the degree that one can't make general statements from few data-points and to identify the weaknesses in one's data. But that is elementary stuff. We could do this workshop on this page even, and do one source at a time. I would certainly like all the current participants to help, but there is one obvious name who is not currently engaging in discussions, and who's participation is essential. --Colin°^Talk 10:06, 30 December 2019 (UTC)

I think this idea has potential, and I am willing to invest some time in it if and where I think my contributions will be helpful. If we are looking for a moderator, I propose Barkeep49. · · · Peter Southwood ^(talk): 16:15, 30 December 2019 (UTC)

Despair recedes ! SandyGeorgia (Talk) 16:20, 30 December 2019 (UTC)

But, as we present the different examples from the different databases, we should keep in mind that there is another outstanding issue: in spite of all of this discussion, we still have editors contemplating adding goodrx.com prices to infoboxes. SandyGeorgia (Talk) 16:27, 30 December 2019 (UTC)

One can only deal with so much madness at any one time :-). --Colin°^Talk 17:24, 30 December 2019 (UTC)

Adding prices to the infobox falls short of the community endorsed prohibition on adding or removing this information and you can feel free to point editors to that discussion in removing the prices/costs. Best, Barkeep49 (talk) 20:19, 30 December 2019 (UTC)

I, too, am feeling increasingly optimistic about this direction that the discussion is taking. One aspect where my own understanding is rather poor, and it would be helpful to me to better understand, is one of how many different competing opinions there are. In other words, are there really one group of editors who like Source A, but not Sources B, C, and D, a second group who like Sources A and B, but not C and D, a third group who like Sources A, B, and C, but not D, and so on? It kind of looks to me (but please correct me if I'm wrong) that it's not like that. It looks to me more like there are basically two "camps" that were in conflict at the ANI discussion: one that likes several of those sources and likes widespread presentation of drug prices, and another that opposes the sources that the first "camp" likes on the basis of things like NOR and opposes widespread presentation. So if – if – I understand that correctly, we might not need to evaluate Sources A, B, C, and D individually, but instead treat them as a group for RfC purposes. --Tryptofish (talk) 23:18, 30 December 2019 (UTC)

It's not useful to try to determine consensus based on "Me, too" or "BecauseILikeIt" declarations at ANI or anywhere else, and it's that sort of !voting rather than discussing that has plagued WPMED discussions. The answer to your question is elusive, because no one who may support these database prices has fully engaged this discussion. How are we to know if that means there is no defense of the sourcing used, or something else? The RFC needs to show sufficient examples and be phrased in a way that the closing admin can judge responses that engage policy (or not). SandyGeorgia (Talk) 23:29, 30 December 2019 (UTC)

Thanks, that makes sense. Would it be correct to say, conversely, that there are editors who would consider an entire group of such sources inadequate? --Tryptofish (talk) 23:33, 30 December 2019 (UTC)

I can only speak for myself. I see violations of V, NOT, NOR, WEIGHT or LEAD in every example given. I have asked for a best example of how to use these databases; none surfaced. SandyGeorgia (Talk) 23:36, 30 December 2019 (UTC)

Actually, that's not entirely true. WAID gave hypothetical, "if we believe this", "then we'll do this" examples. SandyGeorgia (Talk) 23:38, 30 December 2019 (UTC)

Tryptofish, pretty much all the drug-database-sources->wiki-text have fundamental original research and/or weight and/or competence and/or source-honesty issues. I don't think good-faith impartial editors should find any of that contentious. It is possible that a workshop can identify if there are any limited ways those sources could be used properly. The conflict stemmed from a lack of follow-through from "you can't do this because it has X/Y/Z wrong" -> "ok, I won't do that". Is there actually any camp that still claims a database result-set listing no suppliers whatsoever for a product should be used to make claims about "the developing world"? Is there actually any camp that still claims that a source that gives prices for many formulations and specific pill strengths but does not give any therapeutic dose or recommended tablet strength or treatment duration cannot be used to make claims about "monthly cost" or "cost of treatment"? Is there any camp that claims Wikipedia should continue to use a source that stopped being updated in 2015? Etc, etc. Camp B seems to have gone rather quiet. -- Colin°^Talk 23:46, 30 December 2019 (UTC)

(edit conflict) As you can probably infer, where I'm going with this is that I'm looking for ways to simplify the RfC structure (without ruining it, of course). Would it be appropriate to render this as: one perspective is that the sources all flunk policy, and the other perspective is that the sources can be OK subject to certain caveats? Adding after ec: so from what Colin says, that may perhaps actually be the case. I've become increasingly aware of that lack of responsiveness during my brief involvement here. In one fish's opinion, if editors don't engage, they are entitled to one last alert before the RfC goes live, but if they still don't respond, then they lose out on determining the parameters of the RfC. --Tryptofish (talk) 23:55, 30 December 2019 (UTC)

All of those suggestions seem to be leading. The problem is how to strike a balance between my "Is it in sync" (which got responses that didn't engage at all, rather "Me, too'd", and only later read each point to change their position), which attempted to not lead at all, and providing more text without leading?

As to editors who aren't engaging an RFC formulation they know is underway, and have forbidden pings and talk page posts, I'm happy leaving notification decisions to Barkeep. SandyGeorgia (Talk) 00:02, 31 December 2019 (UTC)

Hmmm... I'm just thinking out loud here, but: It sounds to me like it would be pretty feasible for the editors who are participating actively here to articulate arguments against all of the sources in question. The dilemma is how to formulate the RfC with respect to perspectives that support some or all of the sources. I'd like to avoid making the RfC creation process more difficult than it needs to be. --Tryptofish (talk) 00:24, 31 December 2019 (UTC)

I've been regularly pinging people who appear to be engaged with the process while respecting those who, for whatever reason, have stopped participating. I think to Trypto's point we're close to being ready for a ping to WT:MED that could invite people who haven't been participating to join in before the RfC. Ultimately if editors who have a certain position choose not to help formulate the RfC they lose out on the chance to structure the debate but obviously not the chance to weigh-in during the RfC. I do think we the end RfC will be better if editors who end up with contrasting thoughts at the RfC help formulate it, but as a volunteer project we move forward with the volunteers who are willing to spend the time. Best, Barkeep49 (talk) 00:38, 31 December 2019 (UTC)

I agree, and I think a message to all interested editors at WT:MED (perhaps what you meant by a "ping") is entirely appropriate. --Tryptofish (talk) 23:59, 31 December 2019 (UTC)

I think we can simplify SandyGeorgia's proposed question:

I

These examples of pharmaceutical drug prices have been taken from the leads of some articles. Do they comply with Wikipedia policies on verifiability, due weight, no original research, and what Wikipedia is not?

It could have a line about "If you think this needs to be improved, then what changes would you advise?" Editors could then provide their specific opinions (like explaining the contents better, moving it out of the lead, using it as an external link, not including prices at all, or whatever else they think).

On a related point, I'm not sure that addressing "all of the sources in question" in a single RFC is a good idea. The inherent problems with the NADAC database are fewer than the inherent problems with the MSH database. I think we are better off asking about one set of problems, and then having another RFC on another source later (if necessary). WhatamIdoing (talk) 01:02, 31 December 2019 (UTC)

I like it. <oops ... yes, I said that>. SandyGeorgia (Talk) 01:50, 31 December 2019 (UTC)

I like the idea of presenting the community with specific examples of article content, and asking whether they approve or disapprove. I think specific examples are much better than asking about generalizations. I'm weighing, however, how best to pose such a question. A bit higher up in this talk section, Sandy quite rightly pointed out the issue of not making any aspect of the RfC a "leading question". With respect to I, I could imagine editors coming to the RfC would surmise that we would never open an RfC asking about policy compliance of selected examples from leads unless there were a significant concern about policy violation. Another point that occurs to me is that I think we want to get community feedback about how widely drug prices should be included on pages, and it seems to me that any consensus derived from this question would only be applicable to lead sections. The "what changes would you advise?" approach could also lead to a very large number of proposed changes without leading to a consensus about which changes are the best. --Tryptofish (talk) 00:17, 1 January 2020 (UTC)

I would like a bit more time to prepare some data pages like I've linked below. There's also a couple of wiki articles on price-related topics that still need a bit of work. I'm keen that we present real data rather than appear to cherry pick. As Sandy notes below, for many of the sources, other editors will not easily grasp how on earth the price was derived from the source. It has taken a while for us to figure this out (while picking jaws up from the floor at the amount of original research and arbitrary choices made). WhatamIdoing you ask "Do they comply...."? Is there anything about this that the group here currently discussing prices disagree on or don't know the answer to? I still think a workshop could be a better approach to tackle and resolve the basic stuff that isn't opinions about what is or isn't encyclopaedic or what does or does not belong in a lead. Those are questions we could ask an RFC, but there are basic mistakes with all the texts & sources that really we don't need to ask the community. Do we? Having an RFC to resolve issues with what one editor alone has written and defends is a bit weird if you ask me. If you ask the above question, it is admitting that WP:MED has no competence to discuss, reach consensus and write honest source-based facts about drug prices. That it hasn't a clue whether the prices in the articles are good or bad and needs some help from Pokemon editors and Historical Fiction writers. And while I think that has been true, that WP:MED has been incompetent here and has failed to address or even examine the problem over many years, it doesn't need to be. -- Colin°^Talk 14:24, 31 December 2019 (UTC)

Colin, how I wish that this all could have been resolved through discussion. However, past attempts at discussion left you frustrated because a number of editors showed up to disagree with you without engaging you on the merits of what you were saying. And then the discussion to the extent it did happen became heated - in part because of comments like "Having an RFC to resolve issues with what one editor alone has written and defends is a bit weird if you ask me." which takes a jab at an editor (who while unnamed is clear to us who've been following this) and which could have been omitted without diminishing the larger point. The broader community decided that the way forward was through the RfC process, a way of gaining binding consensus. Any consensus reached without an RfC will need to include the consent of editors not currently participating in the discussion but who are invested in the outcome. Unless those editors choose, voluntarily because this is Wikipedia and we all have options afforded to us by being volunteers, to agree to that consensus then it will need to go to RfC. I wouldn't say that the chances are 0 of finding consensus without an RfC but they are slim. And if we can't get to an RfC then the only option is to focus on the behavior issues first (through ArbCom) in hopes that this then creates an atmosphere where consensus can be found on the content question. And even then we still might end up with an RfC. Best, Barkeep49 (talk) 17:43, 31 December 2019 (UTC)

Barkeep49, because we have to so carefully choose our language here, I want to be certain I am understanding. Are you saying that, if the editor(s) who made all of these edits were to voluntarily withdraw them (although that case appears unlikely), then an RFC could be avoided? Or are you saying an RFC has to proceed regardless if any pings to editors not participating result in a chance in stance? The time we are spending on this (and related) is what continues the despair. Regardless of the outcome of either RFC, I am unsure we will have changed the overall picture with all of this effort; I would rather be improving content (eg Epipen). SandyGeorgia (Talk) 17:50, 31 December 2019 (UTC)

SandyGeorgia, if the editors who are members of the WikiMed Project and who have, in a variety of venues, supported inclusion of prices/costs where you (and others) have not, agree to standards about where and how to include prices/costs then no RfC would be needed. This could happen even if they don't voluntarily withdraw them - though if they were to voluntarily withdraw them that would be an even stronger indicator of support for the consensus (but is as you point out not likely). I think it unlikely that that consensus can be reached without an RfC. Not impossible but unlikely. And hopefully, at the end of this, we have standards that let us focus on improving that content because I agree that improving content is multiple more rewarding than this :). Best, Barkeep49 (talk) 18:12, 31 December 2019 (UTC)

Thanks for the clarification, which clears up my uncertainty. SandyGeorgia (Talk) 18:16, 31 December 2019 (UTC)

My view on the "Do we hafta?" question is even more restrictive than Barkeep's. ANI said that nobody gets to touch that content until there's been an RFC. Fine, let's have an RFC (or several). The fastest way through that restriction is probably having an RFC that says "Is this stuff okay, or not?" Fine details, like what ought to go in MEDMOS, can be handled later. WhatamIdoing (talk) 23:39, 31 December 2019 (UTC)

I've posted a reminder of this discussion at WT:MED#Plans for RfC about drug pricing. --Tryptofish (talk) 22:12, 3 January 2020 (UTC)

Existing Prices

I have created User:Colin/ExistingPrices that is an automated extract of drug prices from drug articles. I got the list of drug articles by looking for external links to the MSH price guide, the Drugs.com price pages, the Medicaid NADAC pages, or referred to the BNF. It isn't all the drugs, but it 530 is good sized sample. I then extracted lines containing the word "price" or "cost" and did a bit of hand-editing on the result.-- Colin°^Talk 17:24, 30 December 2019 (UTC)

User:Colin, would you please change that to put a plain <references /> tag at the end of each ===Example===? I'm pretty sure that a simple regex find-and-replace across the page would do it, but I wasn't able to figure out the right combination. The main ref tag was updated to auto-limit itself to only the stuff in between the current one and the previous one, so that will get us the refs in each section (so people are more likely to look at them) without exceeding the template limits. WhatamIdoing (talk) 20:01, 30 December 2019 (UTC)

WhatamIdoing, with Colin's indulgence (and at the risk of taxing my poor Mac with the copy and pasting I did), I have  Done this. Best, Barkeep49 (talk) 20:35, 30 December 2019 (UTC)

Thanks Barkeep49/WhatamIdoing. I didn't know you could have multiple reference groupings. -- Colin°^Talk 23:14, 30 December 2019 (UTC)

The mw:Editing team worked on Cite.php a couple of years ago. This was one of the happy results. Another is automatic display in 30em columns (at wikis where this is enabled, including this one), although that somehow broke last week (and will remain so until next WP:THURSDAY). WhatamIdoing (talk) 00:50, 31 December 2019 (UTC)

I have also created User:Colin/MSHData which lists every MSH Price Guide reference along with the data year cited and the number of suppliers and buyers. In the WHO/HAI price survey methodology, how representative reference prices are depends on the number of suppliers quoting for each product. Because of this, they focus on a small set (14 or 18 products) that have good supplier data. We can see that 30% of our drug citations have no suppliers at all, yet we claim a price in "the developing world". A further 28% only have one or two suppliers, which makes the claim to be representative of "the developing world" a tenuous one. The majority (58%) of our MSH citations for "the developing world" refer to fewer than three suppliers. While some suppliers are international in scope, many target a single country or even just one part of a country. Nearly all (92%) of our MSH prices are from 2014, five years ago. The remainder are from 2015. The guide used to be updated annually but has not been updated since 2015. -- Colin°^Talk 23:14, 30 December 2019 (UTC)

Colin, let's assume everyone coming to the RFC is going to access this data, and do what I did: check meds they know. I checked the most commonly prescribed at the clinic where I volunteer. First, readers trying to understand this data are going to get incredibly frustrated, because it is so hard to find what one is looking for in those sources, and then when one figures it out, it's unbelievable.

• Levothyroxine claims "In the United States, a typical month of treatment costs less than US$25" based on an old hard-print source I can't access. That information is not very useful, so sure does not belong in a lead, but this is crazy. Levothyroxine is on every $4/30-day and $10/90-day list. Walmart sample. Everyone gets 90 days (you take it for life, why get 30?). It's $3.33 per month ... <sheesh>. Inserted into the lead three years ago.

• Chlorthalidone claims "In the United States the wholesale cost is about US$13.50 a month", based on NADAC. So, the average reader goes to that source, finds a bunch of gibberish, and finally figures out that some real person, seriously, took the wholesale cost for a 25-mg tablet and multiplied the 0.45 cents per tablet x 30 for a monthly supply.[11] But the standard dose for chlorthalidone for high blood pressure is 12.5 mg. Since it only comes in 25 mg tablets, it has to be split. How much of this kind of error do we have? Do we have no drug editors reviewing this data? The wholesale cost of how many days to treat what? It doesn't even say. And, by the way, since I assume we are not supposed to mess with price data before the RFC, we are supposed to leave this error in the lead for how long?

• Lisinopril gives me "In the United States the wholesale cost per month was less than 0.70 USD as of 2018", based on NADAC. I can't figure out why that information is useful or belongs in the lead. Basically, lisinopril is a generic that nobody pays anything for anywhere. Yes, the wholesale cost is extremely low, and pharmacies give it away. So our information here isn't blatantly wrong, just not at all useful.

So, that's my sample. Number one and number two top prescribed meds in the US. This is wacky. With the extent of the problems you have raised on this page, how are we going to choose which drugs to use as meaningful and representative examples to put forward in the RFC? Seeing this amount of gibberish in leads of articles, I am becoming convinced again that we have to deal with the lead problem. SandyGeorgia (Talk) 02:43, 31 December 2019 (UTC)

And I'm afraid I may be going backwards on my suggestion that we only need to deal with the databases. One of the two errors above (levothyroxine) is not due to a database source: it is from a hard-print source. I may be coming back to we have a problem bigger than the databases. We have sources BEYOND these databases being used to insert formulaic undue information into leads. SandyGeorgia (Talk) 03:20, 31 December 2019 (UTC)

Sandy the prices from the Tarascon Pocket Pharmacopoeia are based on a $, $$, $$$, $$$, $$$$$ pricing symbol much like your holiday guidebook indicates if a restaurant is a cheap-eat or an expensive night out. I complained about it earlier at WT:MED. Here's what they the book says about its symbols: (the underline italics is theirs)

RELATIVE COST

• Code / Cost
• $ = < $25
• $$ = 25 to $49
• $$$ = $50 to $99
• $$$$ = $100 to $199
• $$$$$ = >= $200

Cost codes used are "per month" of maintenance therapy (e.g. antihypertensives) or "per course" of short-term therapy (e.g., antibiotics). Codes are calculated using average wholesale prices (at press time in US dollars) for the most common indication and route of each drug at a typical adult dosage. For maintenance therapy, costs are calculated based on a 30-day supply or the quantity that might typically be used in a given month. For short-term therapy (e.g., 10 days or less), costs are calculated on a single treatment course. When multiple forms are available (e.g., generics) these codes reflect the least expensive generally available product. When drugs don't neatly fit in to the classification scheme above, we have assigned codes based upon the relative cost of other similar drugs. These codes should be used as a rough guide only, as (1) they reflect cost, not charges, (2) pricing often varies substantially from location to location and time to time, and (3) MHOs, Medicaid, and buying groups often negotiate quite different pricing. Check with your local pharmacy if you have any questions.

So whenever you see "is inexpensive" or "under $25" that came from a "$". If you see "between $25 and $50" that came from "$$". And so on. If you see "more than $200" that came from $$$$$. So even if the drug costs an eye-popping $9000 a dose, we'll just say "more than $200". And as you point out, the majority of drugs are "under $25" even if actually they are just a few dollars. None of the values 25, 50, 100, 150 and 200 appear in the source-data for the wholesale price of those drugs. Those values are all artefacts of Tarascon's price grouping into $ symbols. Our readers couldn't give a damn about Tarascon's price grouping. Reverse-engineering a $ into "less than $25" is a heinous crime. Saying a thousand-dollar drug is "more than $200" is a heinous crime. -- Colin°^Talk 13:58, 31 December 2019 (UTC)

Lovely. (I unfollowed WT:MED because of the bullying; sorry I missed that.) So, we're using a source to insert UNDUE information into leads that is good for nothing. Walmart is a plague that has infiltrated every part of the US, and at Walmart, you get levothyroxine for $3.33 per month. If you're going to a different pharmacy than Walmart, most likely, your insurance is covering the drugs (I just picked up four prescriptions for my household, and paid a Big Fat $0 because we chose the right insurance).

In thinking about how this relates to or affects the general question we've posed, I decided to look at the other med we deal with most commonly in the clinic where I am an interpreter. I was not as familiar with metformin pricing, because we are often giving away free samples. (Actually, many patients have their family send metformin from Mexico.) So, I decided to check that one (diabetes). Wikipedia has:

• In the United States, it costs US$5 to US$25 per month. That is sourced to drugs.com.

I can't find those numbers in there; perhaps it is similar to the restaurant guide above. At any rate, fourth most commonly prescribed drug in the US, and it is also on the Walmart $10 for 90-day list. In fact, I believe Walmart may have $24 for 180 days of metformin. We have useless, UNDUE, inaccurate information in leads.

What remains astounding about this formulaic editing is that, in one demonstrable case where we SHOULD have information in the lead about price (epipen), there is NONE. We could give that as an example, but we can't edit prices right now. (If we decide we need that as a good counter-example, we can do a mock-up.)

In re-thinking how all of this impacts the formulation of the RFC questions, I am coming back to the lead problem, which must be dealt with.

J

These examples of pharmaceutical drug prices have been taken from the leads of some articles. Do they comply with Wikipedia policies on verifiability, due weight, no original research, and what Wikipedia is not, and do they reflect the guideline on leads?

We have to deal with the lead problem; that is where WPMED editing is focused these days, and that is where we are consistently finding problems. Alternately, I could be convinced that we could leave LEAD out of the RFC question, so as not to dilute the policy questions, but the fact that we are finding bogus drug price info in leads will be noted by those who bother to read and they can comment that it doesn't belong there. Open to ideas between I and J. SandyGeorgia (Talk) 14:31, 31 December 2019 (UTC)

Firstly the Drugs.com links mostly don't contain prices on the pages being linked-to. I assume Drugs.com moved their site content about a bit since the first link. Either that, or the editor was citing Drugs.com for other info and couldn't be bothered creating a separate link for the price info. If you look down the page, you'll see a "Pricing & Coupons" link. Alternatively, just Google "NameOfDrug Drugs.com prices" and that should find it. Metformin prices are here. The article also gives a developing world price of "between US$0.21 and $5.55 per month as of 2014" and links to the 500mg tablet. The MSH site says the Defined daily dose is 2g (DDD is what is being used for "typical daily therapeutic dose" even though WHO says it is not a typical therapeutic dose and should not be claimed to be such). Drugs.com agrees that a typical adult dose is 2g taken in divided doses. The $0.21 is clearly coming from the 0.0070 unit-price from cheapest supplier IMRES (which is an international supplier) multiplied by 30 -- so this is actually only one 500m tablet a day not four. I can't make $5.55 no matter how I try. The dearest price is 0.0372 unit-price from supplier MEDEOR/TZ (which you might guess, supplies just Tanzania) and would be $1.12 a month for 30 or $4.46 if we take four-a-day like the doctor ordered. I have absolutely no idea how to get "$5 to $25 per month" from Drugs.com, it seems to depend how much you order and even then there can be a huge price range. Metformin, according to Wikipedia, is the fourth-most prescribed medication in the United States, so you might hope WP:MED would care if the price is correct or even makes any kind of sense.

You can see from my Existing Prices page that most of the specific price information is only in the lead, and occasionally copied in the body. I think adding "should it be in the lead" to the RFC at this stage is premature, since "Is this all a steaming pile of ____?" is more immediately relevant. -- Colin°^Talk

I found Epipen info at Epinephrine (medication), which claims that "In the United States, the cost of the most commonly used autoinjector for anaphylaxis was about US$600 for two in 2016, while a generic version was about US$140 for two." We paid $280 for 2 last year, so I don't even know where to start. But the controversy about Epipen pricing is not even addressed in that lead, and here we have one instance of where it should be. We have formulaic insertion of dubious price data, with no regard to how a lead should be contructed. SandyGeorgia (Talk) 15:42, 31 December 2019 (UTC)

I need to dig up all the articles I previously have mentioned...

Pyrimethamine (edit | talk | history | protect | delete | links | watch | logs | views) is another example where there could be a great deal in the lede about pricing, but instead there is just the basic price information as found elsewhere. --Ronz (talk) 17:27, 31 December 2019 (UTC)

Draft:List of drug prices has an interesting lede, and appears to have entries not mentioned prior. --Ronz (talk) 17:34, 31 December 2019 (UTC)

I wish I could unsee that. When despair sets in, the healthiest thing I can do is go volunteer at the local food shelter. Every time I think we are getting a handle on this ... SandyGeorgia (Talk) 17:38, 31 December 2019 (UTC)

Draft:List of drug prices has entries that appear to have been written by other editors. --Ronz (talk) 17:58, 31 December 2019 (UTC)

I was just asked about that on my user talk (which is I suspect where Ronz saw it too). If an editor wants to invest time in something that might ultimately lead nowhere well that's their choice. It's even possible that the work helps move this conversation forward by providing "real life" examples that can be used in the RfC, or in this discussion leading to the RfC. This page needs to be where the conversation continues collaboratively but like with work Trypto and Colin have done doesn't mean work can't continue on the side also. Courtesy ping to QuackGuru. Best, Barkeep49 (talk) 18:00, 31 December 2019 (UTC)

Barkeep49, I could have this wrong, but please check the timestamps closely re "which is I suspect where Ronz saw it too". The timestamps give the appearance that your courtesy ping may have been redundant. SandyGeorgia (Talk) 18:03, 31 December 2019 (UTC)

Nope you're correct. My apologies. I've struck that comment. Best, Barkeep49 (talk) 18:06, 31 December 2019 (UTC)

As I thought. QuackGuro, since you seem to be following this discussion so closely that you posted to Barkeep's talk within moments of Ronz raising this issue, I would point out that your participation here could be useful. This discussion has revealed extensive instances of dubious price information in drug articles; your opinions on the topics might help us advance towards consensus. "Student editing" has not been shown to be a way to produce good outcomes, btw. SandyGeorgia (Talk) 18:18, 31 December 2019 (UTC)

I've been searching for other related articles, and came upon the draft earlier. It's an example of someone else's work on the topic.

For another example, here's an entry to the body of an article written by a SPA: [12] --Ronz (talk) 18:20, 31 December 2019 (UTC)

I'll probably create a workspace as I search articles, but I've found an example of (apparently) good price info in the lede, added by Nbauman (talk · contribs) [13] --Ronz (talk) 21:11, 31 December 2019 (UTC)

Remember that Abatacept the price statement is 4 years old. The lack of any community maintenance/upgrade/fact-check of these prices is a major issue. Also note that in the UK the price is confidential (in 2013) no matter what number appears officially in the BNF. In the UK, the powder for infusion is a tiny fraction of the price of the pre-filled syringes for injection. Getting the right price for this could be a challenge or impossible. -- Colin°^Talk 21:34, 31 December 2019 (UTC)

Yes, and it's a far better example, a far better source, and clear why the editor thought it met NOT. --Ronz (talk) 02:07, 1 January 2020 (UTC)

Status check

• We've more or less settled into a question that is approximately like H/I/J.
• We've got a few examples that we can explain in detail. (These could be posted upfront, or they could be part of individual editors' personal responses.)
• We've got pages (which we can link) that list hundreds of examples of current content.

What else needs to be done before the RFC is officially launched (other than waiting a couple more days)? WhatamIdoing (talk) 00:03, 1 January 2020 (UTC)

I guess it depends on how one interprets "approximately like", but I'm not sold on the idea that we have really settled onto anything. I'd say that the more recent suggestions are regarded as moving in the right direction, relative to the earlier ones, but I'm not satisfied that we are close enough to our destination. --Tryptofish (talk) 00:20, 1 January 2020 (UTC)

I'd like to see us write up the specific examples soon, so we can see exactly what we've got. And to be sure we have one example from each "database", the "restaurant guide" hard-print source, and one example not using this kind of sourcing. I'd also like to see a mock-up of the whole thing. Obviously, I'm gun-shy :) :) I certainly thought a broad, simple, one-question (is it in sync) was the right way to go because it wasn't leading, but it was only the right way to go to get "ilikeit" responses! I really want to see how this thing "looks" before we launch. That's why I keep saying we need to define the name of the page we will put it on, and start working there. SandyGeorgia (Talk) 00:36, 1 January 2020 (UTC)

Yes, I think the next step really should be to settle on that page name. --Tryptofish (talk) 00:49, 1 January 2020 (UTC)

Here are the ones I put up earlier ... we have evolved :)

1. RFC on NOPRICE and pharmaceutical drugs
2. RFC on pharmaceutical drug content
3. RFC on pharmaceutical drug pricing and sources
4. RFC on pharmaceutical drug prices and sources

SandyGeorgia (Talk) 00:53, 1 January 2020 (UTC)

As we have evolved, I like prefer #4. Have we decided if we still need a preamble discussing Ronz's price/pricing terminology distinction. I think we could do it in one or two sentences, and hope Ronz will do that. SandyGeorgia (Talk) 01:30, 1 January 2020 (UTC)

Maybe just RFC on pharmaceutical drug prices? WhatamIdoing (talk) 06:28, 1 January 2020 (UTC)

Fine with me. Happy 2020 to all! SandyGeorgia (Talk) 06:32, 1 January 2020 (UTC)

Likewise for me, thanks! --Tryptofish (talk) 21:35, 1 January 2020 (UTC)

Barkeep's Update

I had written a long update to the community spurred in equal measures by how close we are to the tipping point here (either towards success or towards a failure to formulate an RfC) and QuackGuru expressing a desire to appeal an aspect of the prohibition. Quack has now said they're not going to appeal so with half the justification for the update gone I undid it.

Barkeep's Summary at AN

A little over three weeks ago I closed a long and unsurprisingly acrimonious ANI thread relating to the behavior of several editors. The ANI discussion also had heavy elements of a content dispute around what should be or not be included in the Medicine Manual of Style page. The major finding was that an RfC was needed. In the time since I (as penance for closing that discussion) have been helping interested editors move towards an RfC. I am updating the community now both because I think we're going to be at a tipping point soon as to whether an RfC will ever get crafted (I'm hopeful but it's hardly a sure thing) and because an editor has expressed desire to appeal to the community for an exemption to one area of that close which I expect will be forthcoming soon. All are of course welcome to read the whole long discussion but here's my summary of major points since then: The prohibition on adding and removing pricing/costs information has largely held and worked without any editor being sanctioned. The initial efforts to formulate an RfC on the topic of price/costs, led by Guy quickly sprawled. Just over a week ago I closed other discussions and attempted to restart the discussion. Bad news: this new discussion is beginning to sprawl - and could reach a point where it becomes clear that no RfC formulation can be found with the current set of participants. Good news: there has also been general agreement around an RfC concept (labeled H/I/J on the page). Bad news about the good news: specific examples to include in the RfC still need to be found and agreed to. This could prove tricky in and of itself. A discussion about guidance for the lead of articles gained no participation and is now at its own RfC which is itself long and complex and I will not attempt to summarize here. There has been a collegial and collaborative atmosphere among those participating (with the only clear behavior line-crossing occurring at the LEAD RfC and quickly walked back by both editors when requested). Part of the reason for this is because few editors who are broadly in favor of pricing/cost information remain involved in the conversation. This is obviously their choice, but does present risks to whether the RfC will be successful even if it can be formulated. While all of the editors participating are incredibly skilled and knowledgeable about the topic – far more so than I – sometimes that understanding of complexity sprawls the discussion in interesting, relevant, and important to the topic ways but not necessarily ways that are helping lead to the RfC. I am hopeful that this update is helpful when considering the appeal that is about to come and in the interests of having some more uninvolved editors who can help move the RfC to launch. Best, Barkeep49 (talk) 01:08, 1 January 2020 (UTC)

If this is going to get to RfC the more focus we can have on the specific examples to be used the better. Naming is not unimportant but if we can't finish finding the examples for H/I/J the name won't matter. I suspect that this next week is going to be all the difference as to whether we will get the RfC launched and have it find a consensus (still my hope and well with-in our grasp) or not. Best, 01:32, 1 January 2020 (UTC)

Wrt examples, are we going to focus on one database/source or pick examples from several. If we pick one, then that should perhaps be part of the RFC page name, for we will certainly need other RFCs to tackle the other sources. If we pick one, then the MSH International Medical Products Price Guide seems an obvious first target. -- Colin°^Talk 11:22, 1 January 2020 (UTC)

Barkeep49 notes the lack of recent participation by those wanting prices. Indeed the last comment I can find was on the 16th December by Doc James, who suggested the RFC questions: "Sure we could start with "do you think the approximate price of a medication can be estimated for various regions of the world?" And "Should Wikipedia articles contain information about the cost of medications?". Furthermore I think it is relevant that when WP:NOTPRICES was quoted earlier, James claimed to agree with it, despite clearly disagreeing with others as to what it means. I note at Talk:Ivermectin#Price that Seraphimblade wrote "Pricing, per policy, is not permitted in articles, with rare exceptions when the price is a significant part of something's notability or is very extensively commented on (not just mentioned).". Ronz linked here saying "All discussion so far supports removal" and James yesterday replied "Ah lots of discussion supports keeping it.". James's two questions aren't a million miles away from my Question A: can we establish "the price" "for various regions of the world" and "should articles contain them" (though most of us want a "while obeying policy" included in that question). Rather than addressing that bigger question, we seem now to be focusing on chipping away at the prices, either by establishing each source shouldn't be used like it has been (and possibly discover if there is any way it can be used), or get community agreement that the current examples fail policy. Maybe that is the correct approach, but we need to be clear that the chipping-away RFCs are not asking the-big-question. Even if we conclude that our uses of sources A, B, C and D are all awful and should never have been permitted and must be swiftly removed, we still haven't resolved WP:NOTPRICES because some editors read it to mean one thing and others read it to mean another. -- Colin°^Talk 11:22, 1 January 2020 (UTC)

I think examples of content created by other editors are important to have, especially any that don't have the NOR, POV, and NOT problems. --Ronz (talk) 19:36, 1 January 2020 (UTC)

Dealing with a single source (MSH is used in more than half of the identified articles) means a simpler task for respondents. They tend to have the same set of issues, such as the question of how to using DDD to estimate a monthly cost and reporting a few data points as being representative of the entire developing world.

If you want a "good example", I could re-write one of the MSH and NADAC sources to (IMO) avoid NOR problems. We'd have to pick different drugs to deal with the DUE and NOT problems. WhatamIdoing (talk) 19:56, 1 January 2020 (UTC)

I think we have to decide next who is going to be the editor to start chunking text in where. My brain is linear. I am to a point where I am stalled until I see something on a page. And we know we don't want me doing the writing. SandyGeorgia (Talk) 20:21, 1 January 2020 (UTC)

If we focus solely on MSH, we'll have further RfCs, and need to make that clear.

I think WhatamIdoing's suggestion of having some rewrites would be very helpful. --Ronz (talk) 21:39, 1 January 2020 (UTC)

I don't know about that, Ronz; if we focus on MSH, and get a clear result, that should take care of the similar. Remember, in responses to the RFC, people can extend beyond the question asked. @WAID, I don't see how you can get a good example out of MSH, that doesn't muddy the picture wrt DUE WEIGHT. SandyGeorgia (Talk) 21:44, 1 January 2020 (UTC)

Barkeep used the formulation of good news/bad news, and I'm going to do my own version of it. First of all, I think it's entirely due to say out loud that we all owe Barkeep a debt of thanks for his very helpful guidance here. Thanks! I also think it's good that we seem to be having a growing consensus that it's a good thing to present editors in the RfC with specific examples to evaluate, as opposed to asking about generalities. And I do think that we are making genuine progress. For me, that's the good news.

Now for the... you know what. As much as we really are moving forward quite well, and despite the fact that we are approaching our self-imposed deadlines, I think that we have yet to resolve some really important issues for the RfC, and we cannot just wish them away. I'd rather get it right, than get it fast. We've been saying that G/H/I/J are getting close to what we want. But I want to be honest about that: I'm not really seeing a consensus that we are there yet.

I said something earlier, and I'm going to repeat it because some editors agreed with it then and I don't think anyone has really objected to it. I've said that the RfC needs to address two issues, both of them in a way that will lead to a clear consensus, one way or the other:

1. Whether drug prices should be widely presented on drug pages, and
2. What kind of sourcing is needed to support such content.

Those are not proposed questions. They are issues that the community needs to answer, in a way that no one will be able to argue against once consensus has been achieved. Even if we get a consensus that, no, we should not be citing drug prices to those sources, we still need a further consensus that, yes, we should present the information this other way. That's important: we need to get consensus for something and not only against something else. And I've also said that I don't think that we can really accomplish that in a single question. I also don't want to leave the RfC format so open that we fail to get focus in the responses.

So: it seems to me that we need to think outside the box, compared with G/H/I/J. I've been thinking about this hard, and it seems to me that we need to present the community with two or more specific choices. For each of those two or more, there should be specific examples of what it would look like on the page, how it would be sourced, and the policy-based rationales for it (or against something else).

If editors here are receptive to that, I can propose what it might look like, but I don't want to do that unless there actually is interest. --Tryptofish (talk) 22:16, 1 January 2020 (UTC)

Tryptofish, I think the consensus now seems to be a step-by-step approach rather than trying to formulate an RFC that solves all drug price issues in one big bang. So let's focus on that. I think an aspect of your first issue might lead many editors to optimistically / naively say "Yes sure, that sounds really useful to our readers" but when we go into the specifics of "is there really One Price" and "do we have any sources for that" then the response is more like "dang, this is hard and complicated and messy". For the second issue, I don't think it has ever been contentious that high quality commentary sources on drug prices can be appropriate for drug articles, provided we are conscious that "current affairs" sources may be temporal in nature and need reconsideration after a while. So there's a core of drug prices that we all have always agreed on, which leaves just the "routinely added to drug articles" contentious aspect. I think we are likely to make progress on the "As much as you'd like it, it really can't be done" approach to this. -- Colin°^Talk 22:49, 1 January 2020 (UTC)

Trypto, we must simply move forward now, even if we only take baby steps, even if we don't resolve everything. It has been a month, and issues are beginning to fester. Yes we owe Barkeep an enormous debt of gratitude, but I suspect he is beginning to weary, too. We need to get on with it. We have about a dozen editors here expending crazy amounts of time on something we will never get perfect. Let's set a goal to launch within a week (Jan 8); people will rise to the occasion. I don't want to be doing this the rest of my life, and if this is what Wikipedia is going to be about, I've got better stuff to do in real life. SandyGeorgia (Talk) 23:03, 1 January 2020 (UTC)

PS, Trypto, which doesn't mean I'm saying you shouldn't do a mockup of your suggestion, but let's not go back to square one here. SandyGeorgia (Talk) 23:04, 1 January 2020 (UTC)

Well, if the response is going to be negative, I too have better things to do. But I'm not going to support an RfC that I think is going to fail. If the consensus here is to go forward with a format to which I object, then so be it, but if I'm objecting to it, I think it's pretty likely that you'll get a negative reaction from the community, and I don't see what good that will do.

I do not think that there is a consensus that we should have a preliminary RfC now, and then have a follow-up RfC some time later. The virtue of having the community respond to specific examples is that we don't have to solve "all the issues" via some kind of complicated question; instead, we can have a consensus that a specific way of doing it is preferable to a different specific way – and that will cover everything that we need to cover for now. Of course we don't want naive answers, but that should not happen if, as I said, we have well-crafted explanations of how policy applies. But are we going to present those explanations in what would be, in effect, a POV way? Are we really going to present it as "As much as you'd like it, it really can't be done"? Talk about a rigged question! But if editors are presented with a choice: one is "it really can't be done, and here's why", while the other is "yes it can be done", then the community will see that as a neutral RfC and they can weigh which argument wins the day.

If I were to ask everyone here to go back to square one, well, I would not do that. I'm not doing that. That would not be fair. I'm saying that I can do the lift of showing how it could be done, and everyone else just has to take a look at it. That's not so hard. But I'm not going to do it if I'm going to be wasting my time. And I'm not going to do it if it's just a grudging "go ahead and make a mockup but we're just going to say no." But here's the alternative as I see it: you all go ahead and propose a revised version of G/H/I/J that actually works. Personally, I think that's near to impossible. But if you think that's going to be less work for you, go right ahead. --Tryptofish (talk) 23:38, 1 January 2020 (UTC)

PS: Let me put it this way. Please go ahead and do try to create a version of G/H/I/J that actually works. If it flies, I'll gladly support it. But if it turns out as I expect to be harder than it sounds, then I hope you'll have an open mind. OK? --Tryptofish (talk) 23:55, 1 January 2020 (UTC)

User:Tryptofish, I've just started a draft at Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices. I don't think it will answer all of our questions, but I do think it is capable of producing some useful information. I'm interested in whether you think it has a chance of producing some useful information.

User:Ronz, on the subject of a re-write, I think the NOR problems could be avoided by re-writing the first to say "In 2014, a non-profit organization sold 250 mg tablets of ethosuximide for US$0.1845 each to recognized healthcare organizations in the Democratic Republic of the Congo. I'm not sure how to put that in the RFC "question", but I think it would be easy to post that as a response to the RFC (e.g., "It violates NOR, which can be got around by copyediting to say ____, but then the DUE problem becomes more obvious and insurmountable, especially if it's placed in the lead"). WhatamIdoing (talk) 01:37, 2 January 2020 (UTC)

The Congo example is NOTPRICE and UNDUE, though. We need policy-compliant examples. @Trypto, our choice is to end up at Arbcom, or put up an RFC to get us moving towards something, even if partial. Arbcom has already mandated that Where there is a global consensus to edit in a certain way, it should be respected and cannot be overruled by a local consensus, which gives us a good idea of how they might lean on multiple WPMED matters. I really think we should not be looking Barkeep49's gift horse in the mouth, and it's time to get an RFC going. We have to stop the paralysis by analysis, and accept a partial solution. SandyGeorgia (Talk) 03:05, 2 January 2020 (UTC)

Do we actually need policy-compliant examples in *this* RFC? WhatamIdoing (talk) 03:30, 2 January 2020 (UTC)

The example I've given above has only minor problems, at least from what's been pointed out so far. --Ronz (talk) 04:31, 2 January 2020 (UTC)

WhatamIdoing, Not necessarily, and WAID, your implication that the existing text is not "policy compliant" just confirms my frustration with having to ask this RFC. But, here we are. -- Colin°^Talk 09:20, 2 January 2020 (UTC)

Well I have been suggested the need for a prioritized solution from the get go. However, it is important not only that we get the RfC out (and that is important) but we do so in a way that will get the kinds of responses necessary for consensus for those priorities. Put another way, it is important that the right priorities are put forth and it is important that the broader community doesn't reject the RfC. I have been pushing a single question not because I think that's what is ultimately going to work (I don't - H/I/J would really be three questions after all) but as a way to try and focus on what's important and a way to focus the question so the community will provide feedback that leads to a consensus. I am not sure if the worse outcome of all this is no RfC or an RfC that comes up with no consensus. If there's no consensus because the community as a whole is split the way editors here are split well that's one thing. But if it's no consensus because of an ill-formed RfC well that's just an unforced error that will have spent a lot of editor time for naught. Best, Barkeep49 (talk) 03:32, 2 January 2020 (UTC)

User:Tryptofish, I never suggested "As much as you'd like it, it really can't be done" would be a question or that the RFC should take a non-neutral stance. Of course those crafting the RFC want to see an answer that is useful rather than one that does not resolve anything. I think there may well be a popular (though hopefully minority) vote to support prices per the agenda (Big Bad Pharma want to hide prices from consumers; Wikipedia is Not Censored), but an RFC must ensure that respondents carefully analyse whether this is possible. I object to merely asking the question as if the wish could be granted. I also don't know why necessarily we might conclude "a specific way of doing it is preferable to a different specific way", when generally not doing it is likely to be preferable, especially considering that "generally not doing it" has been WP:NOPRICES official policy for years.

User:WhatamIdoing, can you please avoid using the word "copyediting" like above. A copyeditor fixes minor issues with prose without changing the meaning or adding and removing facts or points made. Changing

• "The wholesale cost in the developing world is about US$27.77 per month as of 2014"

to

• "In 2014, a non-profit organization sold 250 mg tablets of ethosuximide for US$0.1845 each to recognized healthcare organizations in the Democratic Republic of the Congo"

Is very very much not copyediting. If a statement is untrue and not per-source, no amount of copyediting will fix that. -- Colin°^Talk 09:20, 2 January 2020 (UTC)

Dear friends, I am unwatching this page because, IMO, our considerable efforts here are being undermined by back-channel conversations, and the topic of drug pricing has not been confined to this remit as required at ANI. A few of us are doing all the work to solve problems that aren't being addressed as the ANI receommended. Sorry, bye. Ping me if there is any urgent need for my useless and verbose opinions. I will keep the RFC formulation page started by WAID watchlisted. Regards, SandyGeorgia (Talk) 14:18, 2 January 2020 (UTC)

Sandy I'm really sorry to read this and this is rather a blow to making further progress. We are already hampered with lack of recent participation from anyone on the strong-pro side of the debate. Btw, Barkeep49, I'm not sure if I broke the rules with comments at Wikipedia talk:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices. I thought that comments specifically on WAID's RFC text were appropriately made on the RFC talk page. But perhaps that's prohibited and we need to continue to discuss that here. If so, you are welcome to move the text over here in a sub-section, or ask me to do it. -- Colin°^Talk 14:25, 2 January 2020 (UTC)

Colin, going forward it would probably be helpful to reply here (though maybe collapse it?) to honor the discussion in one place element of the ANI close. Also I will join you in sadness of Sandy actively withdrawing from here. The lack of participation will be a problem in general, and the lack of participation of those most in favor of pricing does carry risks to a successful RfC. Best, Barkeep49 (talk) 22:54, 2 January 2020 (UTC)

I've moved it all here. I've also asked User:JzG and Iri's talk page stalkers to look over the draft and see whether it makes sense to people who are smart and highly experienced, but who haven't been actively involved in developing it. WhatamIdoing (talk) 23:16, 2 January 2020 (UTC)

If there are any "back door" discussions, I'd like to know where they are. (If it's just the talk page at WAID's draft, my opinion is that it's no big deal, other than just the practical issue of keeping the discussion in one place. But for that reason, I'm going to comment about it here, not there.)

Just so everyone knows, I'm watching this page closely, so you don't really have to ping me. (But I'm not troubled if you do.)

WAID: thank you very much for setting up that mock-up page. I've looked at it, and I'll comment here rather than there. I raised a concern about that format before, and I'll repeat it now. If we present the RfC in that way, we will potentially get a result that says that the mshpriceguide.org website (the only one cited in the three examples) should not be cited in that way. Then, a few months later, an editor will come along with a different source and make the same kind of widespread edits using that different source. And they will say: "but I didn't use that source that consensus said not to use, so I was honoring the RfC consensus." So my point is that, to get a useful RfC, we need to get consensus for something, in addition to getting consensus against something else. I see that as being a fatal flaw in the single-question approach to formatting the RfC. I also continue to believe that the way that draft presents the question comes across as a loaded question. It implies that there must be some sort of problem with policy noncompliance. And I can predict that the result of going that route is that editors (some of whom may have been quiet so far) will show up at the RfC quite loudly, and say that the RfC is bogus, and it will go off-track. And these concerns are the same ones I've been raising all along in these discussions, without them really being addressed.

On the other hand, I've gone ahead and created User:Tryptofish/Drug prices RfC draft 2, which shows a format for the RfC that I think will work. Please don't anyone get too hung up on any of the wording that I used there, because that will be easy to revise. --Tryptofish (talk) 23:36, 2 January 2020 (UTC)

Tryptofish see my user talk for more on back door discussions. Best, Barkeep49 (talk) 00:04, 3 January 2020 (UTC)

Thanks. I was just going to post that I've seen that, and also at Doc James' talk page. --Tryptofish (talk) 00:08, 3 January 2020 (UTC)

Tryptofish, I have two basic thoughts about your POV (which I mostly agree with), and if you promise to uphold my reputation for being verbose, I'll try to keep it short:

• Yes, we need to get consensus "for", not just "against". But does it have to happen in *this* RFC?
• Do we really think editors are so far gone into the voting mentality that we won't get responses that help us figure out what people are "for" as well? I keep hoping that we'll get responses that say rather more than just "N Bad dog. No biscuit!" or "Y Who's a good boy?!" WhatamIdoing (talk) 03:49, 3 January 2020 (UTC)

I'm sure in either the HIJ format or Trypto's format we'll get many responses, some of them at substantial length, beyond yes and no (support, oppose whatever). The two questions I'd throw out is which format poses the most important question (there will be voter fatigue, especially with one MEDMOS RFC already out there) to get a sense of consensus for/against and which format makes it more likely to get a consensus. Best, Barkeep49 (talk) 03:55, 3 January 2020 (UTC)

Potential accusations of bias

WAID, my answer to your first question would be "yes". My answer to your second question is that it will be a mess if we plan on figuring out after the RfC what the community is for. Who will make that decision? What happens if the closing admins see it one way, but some editors who are very active disagree? It's far better to ask, and get an unambiguous answer. Also, as I'm about to explain some more below, I've just revised my draft page in response to the feedback from Doc James and Colin. You, in turn, might want to revise your draft page in response to the feedback that I have given. --Tryptofish (talk) 21:30, 3 January 2020 (UTC)

@WhatamIdoing: I'm pinging you because I'm not sure whether you saw my comment immediately above. And I want to ask you this question: Let's say we are a few days into the RfC and editors who heretofore have not been active in these discussions suddenly find their voice and complain loudly that the RfC is hopelessly biased and should be discarded, because it basically presents only one "side", and then uninvolved members of the community start agreeing with them. What is you plan of action in that event? --Tryptofish (talk) 20:42, 4 January 2020 (UTC)

I appreciate you asked WAID, but IMO I really hope you don't try to sabotage the RFC by "complain[ing] loudly that the RfC is hopelessly biased and should be discarded" just because it isn't yours. That would not go down well for you at arbcom. Will others? I don't think the main question Do you think that this content complies with Wikipedia's standards for verifiability, due weight, no original research, what Wikipedia is not, and how to write a lead section is biased. It is the kind of question we ask of content every day. It is a very ordinary question for Wikipedians. It is really very neutral. Are the examples neutral? Well look at User:Colin/MSHData and see if you think they are representative. I think (with the substitution of diazepam for mebendazole) they are. If you think the background and info is biased then please argue specific problems. It is also asking for comments, not a vote, which is something I very very much support. All wiki wisdom suggests a plain vote on polarised options (which is your RFC) is a recipe for polarised and adversarial comments and disunity and in the end "consensus" by counting votes. I have no doubt that some in the pro-prices faction will totally ignore the factual, source and policy issues, and present their case based on Big Pharma suppressing prices and Wikipedia being Not Censored. We will see sweeping statements that of course WHO/MSH and Medicaid and BNF are totally reliable secondary sources. And drug pricing is such an obvious world concern you'd have to be a drug company shill to want to censor prices. And some people will be totally cool with wiki-docs doing original research. This will happen. Let it happen. If Wikipedia decides those things are more important then so be it. -- Colin°^Talk 22:16, 4 January 2020 (UTC)

As you know perfectly well, I did not say, loudly or softly, that "the RfC is hopelessly biased and should be discarded". I cautioned that other editors are likely to do so, if we do not get it right. I'm trying to get the RfC done right, and I'm quite comfortable with how that will go down if this ends up at ArbCom. --Tryptofish (talk) 22:22, 4 January 2020 (UTC)

Thanks for the ping, Tryptofish, because I did miss that.

I've been one of the regulars at WP:RFC for about a decade now. I consider accusations of a "biased" question to be par for the course on contentious subjects, and if you want to search the old archives, you will find that my opinion is consistently that claims that "The question is biased!" mean "My side is losing!" I'm not afraid of seeing those accusations, and my plan is to ignore them, because they say more about the fears (and usually inexperience) of the accuser than about the question. (Now, if you personally thought that the question was biased, I'd be very concerned, but that doesn't exactly seem to be your concern.) If you'd like, we could ask the other RFC regulars whether they think the question is biased.

The other theme in your comments is that the results might be hard to interpret. I agree with you: That's a risk. However, I see this phase as information-gathering, and then (as stated in the RFC "question"), I expect the next phase to involve a proposal that people can be for or against.

The way I expect to handle this is to care less during this RFC about summative "votes", and more about the rationales. Let's say, hypothetically, that editors read the three RFC examples and say, "Ugh, that's all wrong". What actually matters to me is the next sentence: Do they think it's bad because per-pill costs were converted to monthly costs? Or is that okay, and the problem is that the sentences are in the lead but not in the body? Or because MEDRS suggests a five-year timeline for sources (all the WT:MED regulars know what I think about that) and 2014 prices are now technically six years old? Or because they think NOTPRICE for a drug requires a source saying that the price of specifically ethosuximide itself is terribly important to the world, and no amount of sources saying that the price of WHO Essential Medicines for epilepsy can possibly suffice to prove that the price of ethosuximide is worth mentioning? Once we've seen which points of policy and common sense people care about, I think we can build on your draft to make an actual proposal for adding a section about prices to MEDMOS. Or, to put it another way, the purpose of this RFC is to make yours produce a clear consensus for fixing this guideline. This is just the necessary baby step to get us on that path. WhatamIdoing (talk) 01:52, 6 January 2020 (UTC)

OK, I'm glad we are discussing this now. I want to make it very, very clear what my motivation is: the community instructed at ANI that there be an RfC that would resolve the content issues underlying the dispute, and I want that RfC to end with everyone feeling like that goal has been achieved. I'm not referring to things like "fiascos" because I want that to happen. I'm referring to them because I want them to not happen. And you can be sure that this has nothing to do, for me, with whether my "side" wins or loses, because, perhaps more than anyone else who has been commenting here, I really do not have a "side". Now, if the community ends up being happy with two successive proposals, I think that would be a very gratifying outcome. But I'm not confident that this is going to happen, and I've had a lot of RfC experience, too. I think the community may well want a clear resolution in the first RfC of whether the kinds of price edits that Doc James made have, or do not have, consensus. I think there is a very strong risk that, when you have an RfC of the form: Here are three passages from three pages, with their cites. And here is what the sources actually say. What do you think?, a lot of editors are going to react by saying that it's flawed because why would anyone have an RfC like that if the sources actually were presented accurately. You are making it look like: Here is the way the sources were presented, but in fact, that's not what the sources say. Editors are likely to see that as biased. And that could make things take a very bad turn for the worse. And furthermore if the RfC is designed to not have a clear closing statement, that will make the community feel that the ANI instructions were not followed. I'm not saying that because I want to make trouble for anyone here. I'm saying it because I want to avoid the trouble happening. --Tryptofish (talk) 21:14, 6 January 2020 (UTC)

It looks like other people want a closing statement, so we'll have one.

You are making a prediction about how people will feel about copying some information from the source onto the page. I think it's a good thing to consider, and I think it's a reasonable prediction. My current guess is that some of them will feel that way, but most won't, and that the amount of that feeling won't have a serious effect on the discussion. I could be wrong.

The problem I'm trying to solve with that format is one of the "laws of the internet", namely that every click costs readers. If we don't put that information in front of everyone, then some of them will not click on the sources (and thus make comments that aren't based on the sources). Or they'll click but not scroll down (and thus unfairly think that the text is wrong, because the buyer prices are below the scroll, and none of the supplier prices add up to the numbers in the sentence).

If you can think of a way to put information about how that database is being used in front of participants' eyes without anyone thinking that it implies a failure of text–source integrity (beyond the fact, as you say, that nobody holds an RFC on this kind of subject without someone thinking that there's an opportunity for improvement), then I'd be happy to hear your ideas.

I do not know whether the principals will feel like, at the end of this, we have completely resolved the subject. My prediction is that we will have made progress, but that we will still have some work to do. WhatamIdoing (talk) 21:45, 6 January 2020 (UTC)

Those are good points and I appreciate this discussion, thanks. At the draft I'm working on, one of the things that I'm trying to address is that very issue of minimizing clicks, which is something where I agree with you entirely. I need a few more hours of work on that (will I ever finish responding on this page?), and maybe tomorrow you might want to take a look there and see if you like any of it. --Tryptofish (talk) 21:49, 6 January 2020 (UTC)

@WAID, I've just been looking at the two drafts side-by-side. In one fish's opinion, the draft you've worked on seems kind of chatty and maybe tl;dr. Perhaps it would be a good idea to take a look at that. --Tryptofish (talk) 00:06, 7 January 2020 (UTC)

I think that would be a safe prediction for almost everything that I write. ;-) I have more than once attempted to shorten something and ended up with a significant increase in the length. I can simplify, but shortening is not my strength.

The stylistic question is whether it's more appropriate to have short, dense text or longer, easier text. I can tell you that the latter is easier for me to write, but I cannot tell you which one is objectively better. WhatamIdoing (talk) 00:42, 7 January 2020 (UTC)

OK. While you were posting that, I was going back and reading the comments from Nil Einne that are collapsed in the #General, version 2 section below, and he comments about whether or not to have 2 RfCs. It's worth taking a look at. --Tryptofish (talk) 00:45, 7 January 2020 (UTC)

Convenience break

We are currently using secondary and government sources for prices such as Medicaid, MSH, and Tarascon. Unless people consider those primary sources? So not sure why "Secondary sources should not be required. Appropriate primary sources include: example, example." Doc James (talk · contribs · email) 05:42, 3 January 2020 (UTC)

Doc James, most databases are considered primary sources under Wikipedia's system. (The MSH and NADAC databases are second-hand or secondary data, which is not the same as a secondary source.) Primary sources can be perfectly reliable. That sentence could be completed with "Appropriate primary sources include the MSH and NADAC databases". WhatamIdoing (talk) 00:37, 4 January 2020 (UTC)

Responding to Barkeep post of 03:55 3 Jan, made while I was in Ceylon, asking which format will get more responses. Neither RFC is ideal, but IMO we were charged with formulating an RFC to address the wrong (indeed, a non-existent) problem, so it has been difficult to nail down. We typed for a month. We did our best, and we came to WAID's formulation. Should we switch gears now? I believe that Trypto's formulation will suffer the same fate as my ill-formed RFC on the medical disclaimer of several years ago. When you present options, people pile on other options. So, I go with WAID's, even if we are only addressing one issue at a time. SandyGeorgia (Talk) 14:53, 4 January 2020 (UTC)

Sandy, the solution to that would be to specify in the RfC introduction that no new versions should be added after the RfC begins, although editors are free to comment about alternatives within the discussion. And there is also that danger in the other format: editors could make all kinds of comments about how that example with [name of drug] could be rewritten in a particular way, without any consensus about which "particular way" is the best one. --Tryptofish (talk) 20:37, 4 January 2020 (UTC)

Tryptofish I appreciate that asking only about MSH-sourced text will not reliably put out the fires at NADAC or BNF or Tarascon or Drugs.com sourced texts. But if anything can be seen from the volumes I've written about the flaws in our texts, is that it is amazing that one can make so many mistakes and commit so many policy crimes in just a few words. I think if we try to explain why the "drug prices everywhere" approach is not just not-encyclopaedic but also totally impractical, for all examples, we will get totally bogged down. Fatigue will then likely to see over-simplistic replies like "Support: we using secondary and government sources for prices such as Medicaid, MSH, and Tarascon". We need to allow participants a chance to focus on a smaller level of practical issues than "all drug price sources".

I think Wiki largely discourages "prices everywhere" on fundamentally practical grounds, more than on "encyclopaedic" grounds. We aren't a standard paper encyclopaedia and already contain much trivia or dubious lists of facts. Practically, there are plenty sites (GoodRX, Drugs.com, BNF in the UK) where patients and readers can reliably find out about drug prices in their country, and get figures that are accurate TODAY for the indication or prescription they are concerned about, rather than citing a book from 2015 for a totally unknown indication and dose. All the evidence suggest Wikipedia is crap at this. Same goes for the prices of other things from mobile phones to insurance to properties in your area to train tickets.

I think it is a huge mistake to frame drug prices round concepts like primary and secondary sources, which Wikipedia has historically had mixed interpretations of meaning. James says above that the BNF is a secondary source, and it is true that it gets its information from the NHS, who in turn give a mix of regulated price and/or indicative price for the drugs, the latter of which comes from drug companies and pharmacy contracts. A better distinction is that all those sources (with the exception of Tarascon's $$$ symbolic prices, which have their own huge problems) are simply databases of prices of products with barcodes, and all those sources give their own unique kind of price (all different variants of wholesale or retail, some actual, some list, etc). Those sources are raw data, at a level of multiplicity and complexity that none of us are proposing is reproduced on Wikipedia.

Wrt notability of prices, saying "secondary sources have written about issues that are specifically about the pricing of those medications". Repeatedly it has been claimed that the fact that e.g. BNF include prices for all their drugs (similar for Drugs.com and Tarscon's book) means they have been written about. Clearly the authors of those sites/books, when writing about each drug, considered it relevant to give price data. And Google will find someone somewhere mentioning that X is a low cost drug compared to the new drug Y which is expensive. But doh!, all new on-patent drugs are expensive and most existing generic drugs are cheap, so that isn't exactly news to anyone that someone might make that remark in print or online. The advocacy argument for including prices is so strongly held by some, that we need a much higher barrier-to-entry than simply being written about in secondary sources.

I'm very nervous about get-out-of-jail clauses like "or used only with care". We aren't here to redefine fundamental policy. Anyone can argue they are careful. We see in the lead RFC that e.g citation excess is justified on the grounds that there is no policy against citations: any guideline-caution or recommendation to seek per-article consensus about citations is simply cast aside. An "or used only with care" clause simply says one can ignore the preceding text.

So I don't think, sorry, your RFC is appropriate today. Let's start with the RFC on MSH-sourced price statements today and see where that takes us. We can learn lessons from it. It may be that Wiki so clearly rejects raw-database-sourced drug prices that existing policy on WP:NOPRICES becomes the clear consensus, and we all do already know how to write about prices when newspapers, etc have made comments about them and give us a price-to-treat or a price-per-year without us having to get our calculators out. -- Colin°^Talk 08:54, 3 January 2020 (UTC)

Doc James and Colin, thank you both for the feedback. I've just made some revisions in response to that feedback (and I think it might be a good idea to, likewise, revise the H/I/J draft to address the feedback that I've given about that). Here's a quick summary of what I changed. I removed all mention of primary and secondary. Thanks for correcting me about that; I hadn't understood that properly before and I appreciate the opportunity to clear up my understanding. I changed the description of what had been primary sources to instead be sources that are databases of prices (based on Colin's mention of "raw-database-sourced drug prices"): please check me on that, as I can certainly change it again. I also removed that "get-out-of-jail" clause. As for the broader point that, presumably, everyone should already know that Wikipedia largely discourages "prices everywhere", I'm pretty sure that if everyone really agreed about that, we would not be having this discussion or this RfC. And as for the difficulty of tl;dr if we try to cover many database-style sources, I'm fine with having just a few, not every one. We can do as many or few as we wish. But we should do at least two, because then there will be an established general principle as opposed to something that could be gamed as being about just one source. --Tryptofish (talk) 21:44, 3 January 2020 (UTC)

More looking for "Medication prices can be included when appropriate sources are avaliable." Doc James (talk · contribs · email) 23:36, 3 January 2020 (UTC)

I appreciate the revision attempt. I think, though, the issues are too complex and require some effort on the part of voters to look at actual article text and actual usage to appreciate the problems. Simply asking people to support polar-opposite A or B approaches is wrong. Particularly as B is effectively asking people to support original research and undue weight and out-of-date sources. I don't think we should be asking people to support a fundamentally broken option. Nor do I remotely support the kind of question James poses above, which is leaving "when appropriate sources are available" to the judgement of whoever edit wars the best. -- Colin°^Talk 13:29, 4 January 2020 (UTC)

Tryptofish, I think your draft is too much of a skeleton at this point in the game. We've been discussing this since October and fatigue is already causing some to unwatch and drop out. I think we should put our energy into WAID's draft. It doesn't meet exactly what any one of us would have wanted, but nor does it ask to community for permission to do unacceptable things, which is what your question B asks and what in practice James's question would continue to permit to do. -- Colin°^Talk 15:02, 4 January 2020 (UTC)

Thank you both for your replies. James, my concern with "when appropriate sources are available" is that it presupposes that sources are "appropriate", which is something very much at the heart of the disagreements here. Colin, I would say the same thing about your objection to asking about part B: you are assuming that the consensus must be that the sources are inappropriate. But these are the things that we should be asking the community to determine, as opposed to, in effect, rigging the RfC to get a desired result. As for the skeleton, my intention is that interested editors here would be able to fill those things in themselves to complete the RfC, particularly when there are those of you who have already written and analyzed so much about it. I'm sure that you, for example, could easily provide examples and pro/con rationales. You probably could even copy-paste them. Of course, not doing that and then complaining that no one has done it ends up being a self-fulfilling prophecy. --Tryptofish (talk) 20:32, 4 January 2020 (UTC)

Notifications given

• [14] If there are any "back door" discussions, I'd like to know where they are. ... --Tryptofish (talk) 23:36, 2 January 2020 (UTC) Putting this here per your request, SandyGeorgia (Talk) 23:38, 3 January 2020 (UTC)

Sandy, I'm going to WP:AGF and assume that you did not see: [15]. --Tryptofish (talk) 20:06, 4 January 2020 (UTC)

Sorry, Trypto ... I was in Ceylon for a day :) Anyway, this section gives a place for others. My apologies, SandyGeorgia (Talk) 20:46, 4 January 2020 (UTC)

Newbies to the debate

User:Tryptofish thank you for the notification at WP:MED. I was not following the debate but would like to participate as a newbie. As I understand it, there area two parts of the debate. The first is regarding point #5 of the WP:NOTDIRECTORY which states,

"Sales catalogues. 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."

From what I can read, part of the RfC will debate whether or not medication prices falls into the exceptions listed above (e.g. is there a justified reason). The remaining question will debate which medications and which sources are acceptable? Can you confirm if I have this correct and if so, is the draft on your talk page now? Also which opinions you're seeking at this time. Thank you for shepherding this topic. Ian Furst (talk) 15:06, 4 January 2020 (UTC)

Ian, there has been much discussion about how the RFC should pose questions, give examples, be structured. There are currently two drafts. The first is Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices and is being discussed at the #Debugging the draft section below. The second is at User:Tryptofish/Drug prices RfC draft 2 and some comments about that have been posted above. James, above, has also proposed a one-line question, but nothing more than that. IMO the former, by User:WhatamIdoing is further advanced (the other being just a skeleton) and by focussing on one source and a few concrete examples, is best placed to uncover the issues surrounding the routine inclusion of drug prices. -- Colin°^Talk 15:50, 4 January 2020 (UTC)

The formulation of an RFC was remitted to this forum almost a month ago by ANI. WAID's draft is further developed, and while addressing only one part of the overall picture, I believe it has the best chance of giving us a clear answer on at least that one part. Depending on what kind of response it generates, the topic might broaden, but I fear that Trypto's format will not lend to a clear answer on any one part of the broader issue, as it will encourage others to suggest even more options. We have been working for a month; we should finalize and launch WAID's RFC in the coming week.

Also, welcome Ian! Since we have put so much work in to this, there is voluminous information to read on the page. I hope you will find the time to read through the entire large page, as it is late in the game to re-hash territory already covered. Regards, SandyGeorgia (Talk) 16:26, 4 January 2020 (UTC)

Ready, steady, go

User:Barkeep49, I think Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices is ready. As I understand it, ANI thought it would be best if an uninvolved admin endorsed its neutrality. Can you post a request at some suitable forum to find volunteer for that step?

Here are my thoughts about how to manage the RFC once it's underway, and I'd like to hear all of yours, too.

First, I'd like to encourage all the "principals" in the original dispute to stand down for the first day or two. Let's imagine that an admin certified it as neutral very soon. In that case, I could probably take the draft tag off and list it as an RFC as early as Tuesday. If that's the schedule we end up on, and if you think that other people might think you've got a dog in this fight, then please stand down until at least Wednesday. There's nothing like long or angry posts, especially from our recognizable community leaders, to scare off some contributors. I may not post my own views at all, and I certainly don't plan to do so during the early days. We can let this run for weeks, or even months if we're still getting good responses. There's no magic timer for RFCs. I promise that you will have a chance to have your say, even if your post is #10 instead of #1.

Second, I want us to be encouraging the uninvolved editors to engage in this RFC enough to tell us what they think. Some people will just want to dump a drive-by vote on the page, but if they're willing to explain their thought process, then I want to find out more. I am discouraging straw-poll or "survey" approaches, and I hope that you can all support that in practical ways, like breaking long discussions into sections with useful names like === Thoughts on X ===. Getting detailed explanations from our volunteer editors is a gift that we should treasure. I expect to be asking some editors questions to encourage discussion. If you think that you can ask a question that will draw out more details from an editor or that will encourage that editor to connect with another editor, then please consider doing that. Something like "Do you feel like your idea relates to what User:Example was saying last week?" or "Do you think that might work better with <this slight change>?" could be good. The goal is to get the other guy talking. A good, responsive question, phrased with respect, can be an excellent tool for producing further explanation. An amazing success looks like a couple of editors putting their views together to come up with something that's better than what any of them started with.

Third, if you see an opportunity to meatball:DefendEachOther, especially if it's someone from the other "side", please do so as quickly and as gently as you can. Nobody involved in constructing this RFC wants Wikipedia to get worse. We all have the same ultimate goal. If you'd like, I can ask the WT:RFC regulars to help out with this.

Fourth, I personally don't feel like I'll need an official "closing statement" to know what I've learned from this RFC. However, if you do, then please be bold and speak up now, especially if you'd like to have a "team of three" approach. Recruiting three people after an RFC has ended can be difficult and result in needless delays.

If others have advice they'd like to add, or would like to suggest a different approach, please post here. I'll make time to check this page between meetings (probably in ~12 hours or so). WhatamIdoing (talk) 06:41, 6 January 2020 (UTC)

User:WhatamIdoing I think it is important to mention that one seller like the IDA Foundation sells at the stated price in more than 130 LMIC. LMIC make up about 80% of the global population. And most people in these countries pay for their medications out of pocket.

Per "many are out of date" is fairly non neutral. Many of the prices are from 2015. That is not out of data but simple from 2015. Additionally many of them are not otherwise incorrect. They are simple approximates. Yes sometimes 30 days rather than 31 days is used for a month (using 30 days for a month does not make an approximate "incorrect".

That is a fairly one sided background. It is missing details such as that the lack of transparency around prices results in deaths per Doctors Without Borders.[16] Or that prices of electronics are often included in Wikipedia articles including featured articles. Doc James (talk · contribs · email) 07:11, 6 January 2020 (UTC)

I don't think it is important to mention one supplier (IDA) when there are 35 in the database and a third of all uses of the MSH database cite records with no suppliers at all. The majority of our citations rely on a buyer price, either because that is the only price or because it has been used for the upper-bound. The Guide says "Buyers: These prices should not be used as international reference prices". WHO/HAI says: How representative reference prices are generally depends on the number of suppliers quoting for each product.. We do not have a source saying "IDA is representative of wholesale prices in the developing world".

The "pay for medicine out of pocket" argument is also not directly relevant to quoting an international reference price. Again WHO says "in many low- and middle-income countries medicine prices are high, especially in the private sector (e.g. over 80 times an international reference price); availability can be low, particularly in the public sector (including no stocks of essential medicines); treatments are often unaffordable (e.g. requiring over 15 days’ wages to purchase 30 days’ treatment); government procurement can be inefficient (e.g. buying expensive originator brands as well as cheaper generics); mark-ups in the distribution chain can be excessive; and numerous taxes and duties are being applied to medicines" they give an example: "The price of originator brand atenolol 50 mg tablets is over 20 times the international reference price in all the countries except India (where it is still high at 5 times the reference price) and Kazakhstan. Even the lowest-priced generic is very expensive in all countries". So basically, the wholesale price of generic medicines to the state healthcare is irrelevant if the state healthcare has no stock of that medicine and the patient has to buy a premium-brand version on the private market. And that is the norm.

Wrt "Many of these are out of date or otherwise incorrect" I would agree we can state that more neutrally. The 92% of MSH prices in articles are from 2014 so lets say that "Nearly all cite records from 2014". As for being incorrect, we are not talking about number rounding or the exact number of days in a month, but basic maths errors with multiplying (or forgetting to multiply) or basic beginner-level statistical errors with how the data is offered. Perhaps a more neutral statement is that "the mathematical and statistical correctness of figures given has been questioned".

The background is merely the background on the source, and the question asked is simply about source->text policy. We are not at this stage asking that we should include prices in Wikipedia because otherwise PEOPLE WILL DIE. Let's leave advocacy out of Wikipedia please.

Similarly the WP:OTHERCRAPEXISTS argument also has no place in deciding if text meets policy.

In summary, James, you are welcome to make these points when you make your case in the RFC, but these points are not neutral facts, they are easily challenged, and most are not directly relevant to this RFC. -- Colin°^Talk 09:05, 6 January 2020 (UTC)

James, the notion that "prices are included in Featured articles" was covered above. If that faulty, WP:OTHERSTUFFEXISTS emerges during the RFC (as it is an oft-repeated meme), then I will have to unpack the analysis even further on the RFC. FAs are from perfect even when they get the star, and are even less so now that FAC and FAR have died (FAC stats-- I was 2007 thru 2011, scroll down), and there is basically NO ongoing review of older, out-of-compliant FAs. One of the FAs held up as an example was written by an editor whose socks supported the FAC, whose FAs I was forced to promote by "consensus" (of his socks), even though all of his FAs were awful. Someone will introduce that bogus argument to the RFC; I hope I don't have to unpack it there, and I hope that won't come from you. This particular RFC isn't looking at the broader pricing issue; it's looking at drug prices. And even at that, in some cases, the prices that are in Featured articles are in compliance with WP:NOTPRICE. I hope this RFC doesn't have to unpack all of this, which is beyond the scope of a first step. SandyGeorgia (Talk) 11:29, 6 January 2020 (UTC)

Quick replies:

• IDA offers some drugs to 130 countries: The description says "many countries", so I think that's already covered. This supplier could be important ...assuming that it's listed in the database entry being used. It's possible that editors will tell us that if an entry has a dozen supplier prices, or the suppliers sell to more than 50 countries (or whatever) that it should be considered "the wholesale price in the developing world", but when only suppliers from a few countries are listed, or when there are only buyer prices, then we shouldn't use it, because "IDA sells to 130 countries" is irrelevant if IDA doesn't report a price for the specific drug under discussion.
  • IMO the important point here is that other editors will tell us. We don't need to give our own views on this page. This is about "writing the question", not about "answering the question".
• My goal in saying that the prices are out of date or otherwise incorrect isn't to show any disrespect to the work that was done five or six years ago, but to indicate that in an ideal world, we would be updating this content anyway. If uninvolved editors read that sentence and think that we're hoping to improve that area of content anyway, so now would be a great time to give us their best advice, then I've succeeded.

WhatamIdoing (talk) 16:40, 6 January 2020 (UTC)

WAID, I fully endorse your launch-step commentary, and agree that most of us should initially stand down. I hope that admins intend to assure that the civility sanctions in place are, at this stage, aggressively defended (as by now, everyone is aware), and that in particular, as I mentioned explicitly in the ANI, CFCF is held to the civility restriction. Thanks for all your work!

Re: your mention of what we've learned: regardless of outcome, I learned a lot already. Only yesterday, when I saw your comments as you wrapped this up, did I understand that by staying focused on "what should MEDMOS say", the result is that we additionally cover the NOR/SYNTH problem. You were focused on "what should MEDMOS say", while I was focused on, "is there an example of these sources not using NOR/SYNTH". The search for the elusive example consumed too much bandwidth in this discussion, and that one's on me. SandyGeorgia (Talk) 11:40, 6 January 2020 (UTC)

SandyGeorgia — I do not believe I have on any occasion been uncivil, having with arguments pointed out what I percieve to be WP:GRIEFING. I understand that this position may be percieved as insulting as such, but it does not violate WP:CIVIL. If it did, we could never act in any way against the will of an individual editor (see: Wikipedia:Our social policies are not a suicide pact)
I have argued for my position and it is no matter how we look at it — a fully legitimate position to hold. If anything I find that the collegiality within WP:MED has been taken advantage of — and abusive and disruptive behavior has been let slide too long.
What is however noteworthy: chosing to single me out in the manner above, despite no comments from my part for a week, and me not having commented on the issue of PRICE for over 3 weeks. That does not seem in line with WP:CIVIL. Carl Fredrik ^talk 15:19, 6 January 2020 (UTC)

@CFCF: While I may disagree with some parts of your post, I agree with and acknowledge that singling you out here was not at all helpful or wise. I thought of this within minutes of posting, but unfortunately, pings are not undoable (another of the many reasons I hate the pingie-thingie-- you can't walk them back), so it didn't seem that striking it would be helpful. I do apologize for singling you out. At any rate, I hope you will agree with WAID regarding what she hopes to see in the conduct department from recognized leaders of WPMED. I will do my best, and hope you do as well. Once again, my sincere apologies. SandyGeorgia (Talk) 15:30, 6 January 2020 (UTC)

Apology accepted, and do feel free to accept my apology if I have been abrasive. I do fundamentally believe we are all striving for the same goal; that there is only a difference in lesser values. I believe we would do well to on occasion step back and ask ourselves if it truly is a tempest we see, or whether we can make out concave walls in the distance. Carl Fredrik ^talk 15:44, 6 January 2020 (UTC)

Just a note to all involved that I decided to take a break from this yesterday and am catching up on it today. I want to acknowledge that I've seen WAID's comment above but want to have caught up fully before I launch. As I am fairly busy at work this week, I may not be able to fully catch-up here until this evening. Just wanted to set appropriate expectations. Barkeep49 (talk) 17:19, 6 January 2020 (UTC

Thank you WhatamIdoing for moving this along. I think we're at a point where an update to the community will be helpful in order to get an uninvolved sysop (who isn't me) who is willing to to certify this as neutral (which I don't think we're quite at given James' concerns). I think you offer good general guidance about behavior during the RfC. Let me just add to the guidance you've said and say that even when entering the conversation not bludgeoning it will be important. Really try and pick and choose which conversations make sense to engage in and - even when you have value - consider leaving some of them alone.

The one piece that caught me off guard and I'd love to hear from others about is your comfort with no formal closing statement. It had been an intent of mine to try and find an uninvolved closer sooner rather than later (as RfCs do not necessarily need to run 30 days and are sometimes done before or after that cut-off) and possibly the "team of three" approach that you mention. Either there will be enough consensus to make changes to the MOS or there won't be and a subsequent RfC will be needed to formalize changes to the MOS. Even in this latter case, without a formal close (and to some extent even with a formal close) I fear the second RfC (really the third RfC, with the already launched LEAD RfC being the first) will end up rehashing a whole lot of the first RfC as editors debate exactly what was learned there. This is especially a concern as a subsequent RfC in a short time period will see diminished participation as compared to the first RfC. Best, Barkeep49 (talk) 20:06, 6 January 2020 (UTC)

@WhatamIdoing and Barkeep49: pardon my ignorance, but I don't know what you mean by "no formal closing statement". Also, how do you feel about pinging the earlier participants at this stage (Ronz, kashmiri, Seraphimblade, Signimu, did I miss anyone?) SandyGeorgia (Talk) 20:10, 6 January 2020 (UTC)

You know that some RFCs end up enclosed in colored boxes ("closed", to discourage further participation) and get a short note at the top ("statement", so nobody else needs to read the discussion)? For the last several years, someone's main contribution to Wikipedia has been listing most of the RFCs at a new-ish noticeboard to ask admins to add the box and write a closing statement. It's sometimes helpful and sometimes not, but with rare exceptions, it's not usually harmful (except in the sense of wasting time and discouraging editors from reading beyond the summary). I don't need this service, but I've no objection to it happening, if someone else wants it and someone can be found to do it. They should probably be warned that there's nothing vote-like about this, so it may require more work than the average RFC. WhatamIdoing (talk) 21:10, 6 January 2020 (UTC)

Ah, ok, I see. I thought we always had those, and I understand your reasoning. I don't care much one way or the other, but considering there were concerns that the past RFC on prices was not adhered to, I wonder if it would be helpful in this case. Defer to people who are not idiots about RFCs (moi :) SandyGeorgia (Talk) 21:39, 6 January 2020 (UTC)

Separately, I am concerned that having another RFC up (MEDLEAD) at the same time is a detriment, but I don't have any idea how to go about addressing/fixing that. If anyone has any advice for me, perhaps they will post to my talk. If you look at the talk page of that RFC, there was actually consensus building that caused many of us to move our initial positions, so I'm not sure what is accomplished by having that RFC stay open, but not sure how to withdraw it in recognition of the consensus that did develop among those who actively engaged at the RFC talk. Open to advice; Column B is actually a position that showed movement of the "keep it all" and the "delete it all" towards each other's positions. Is there a way to work that out off-RFC? SandyGeorgia (Talk) 20:17, 6 January 2020 (UTC)

Barkeep49, IMO the only contentious text is "Many of these are out of date or otherwise incorrect", though the example at the bottom of this page does rather add evidence to the latter problem, and I'm not sure we'd get many people seriously suggesting that the 92% of the sources from 2014 and 8% from 2015 are "up-to-date". I have made a suggestion above for alternative wording. However, I strongly disagree with James's other suggestions or complaints, which imo fall firmly into the category of contentious statements and arguments that participants can add during the discussion. We do need a wise neutral editor (don't see why it has to be an admin, but I don't make the rules) to decide, but satisfying all parties is not imo a requirement. For what its worth, WAID's RFC question is not the one I proposed and her approach to introducing the topic and recommending how participants respond is not how I'd have gone about it. And that's no bad thing. -- Colin°^Talk 20:41, 6 January 2020 (UTC)

FWIW if ANI hadn't specified a sysop I would be agreeing with you that any well qualified neutral editor would do. Best, Barkeep49 (talk) 21:00, 6 January 2020 (UTC)

And in rereading this I realize since I closed the ANI it feels like a bit of a cop-out. I will just note in case anyone needs the reminder that the language I used for closing and which had the community consensus behind it was not my own. As a closer I feel my job is is to reflect back the community consensus which is where the language came from. Best, Barkeep49 (talk) 23:12, 6 January 2020 (UTC)

• I'm just going to say this: I expect that by the end of the day today, I will have User:Tryptofish/Drug prices RfC draft 2 at approximately the same level of readiness as this one. --Tryptofish (talk) 20:20, 6 January 2020 (UTC)

• I would like to suggest that if we reach a point where an RFC has been chosen and agreed to be acceptable by a neutral bod, that we postpone launching it for a week, say. Everyone agree to go do something else entirely, and avoid prices and RFCs and stuff. If that helps clear the MEDLEAD RFC away, then all the better. -- Colin°^Talk 21:41, 6 January 2020 (UTC)
  • And I fully agree. That's a very good idea. --Tryptofish (talk) 21:44, 6 January 2020 (UTC)

I also think that's a good idea. But it will mean we truly take a week-off from discussion which I fear will be a tougher ask in reality than theory. Barkeep49 (talk) 23:08, 6 January 2020 (UTC)

I suggest that you decide on your report to the community first. But a bit of a cool-off might be good (doesn't have to be a week) before finalizing anything about the RfC might work very well. --Tryptofish (talk) 23:13, 6 January 2020 (UTC)

I don't think that we need any further delays. WhatamIdoing (talk) 02:52, 7 January 2020 (UTC)

• WAID, the organization and the conversational tone/style are excellent. It draws the reader in, and creates a "non-combative" environment, in a way that is decidedly not conducive to the "ILikeIt" votes we see in other RFCs. Again, very well done, and I look forward to seeing the kinds of responses such a well-designed RFC will produce. SandyGeorgia (Talk) 00:49, 7 January 2020 (UTC)

Why not link to previous discussions?

I wish to add a link to Wikipedia:Prices#Discussions_about_best_practices to the RFC on pharmaceutical drug prices. This link presents a list of all previous discussions of drug prices, which I feel match the subject of this RfC. The point of sharing links to this previous discussions would be to show the history of Wikipedia community discussion of drug prices.

SandyGeorgia objects, saying with a revert that "this is not an RFC on pricing, this is an RFC on source --> text integrity". What reason is there to avoid presenting this archival collection of previous discussions? Blue Rasberry (talk) 15:26, 7 January 2020 (UTC)

Blue, please read the entire discussion. The RFC proposed is not an RFC on pricing overall; it is specifically focused on source --> text integrity so that later an RFC on drug pricing can be conducted. Your addition complicates what was a narrower topic, and burdens the respondent with information that is not relevant to the narrower focus of the proposed RFC. SandyGeorgia (Talk) 15:31, 7 January 2020 (UTC)

Debugging the draft

Draft RFC at: Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices

Generics

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? SandyGeorgia (Talk) 03:08, 2 January 2020 (UTC)

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). -- Colin°^Talk 11:42, 2 January 2020 (UTC)

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. WhatamIdoing (talk) 22:01, 2 January 2020 (UTC)

Which examples to use

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. SandyGeorgia (Talk) 03:10, 2 January 2020 (UTC)

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. -- Colin°^Talk 11:42, 2 January 2020 (UTC)

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. WhatamIdoing (talk) 22:04, 2 January 2020 (UTC)

I'm not suggesting we pick complicated cases, but also not just pick easy ones: we need to be representative of the usage. Considering that a third of our drug price statements have no suppliers, I think we must include one as representative. An example we have previously discussed is diazepam which says "The wholesale cost in the developing world is about US$0.01 per dose as of 2014"[17]. This is also a drug people will be familiar with and a good example of the common situation that an old drug has many indications and possible doses.

I think we can abbreviate the per-drug commentary about "what the source says" by moving some of the background about "organisations" into a sub-section below. I think we need a short sub-section about MSH International Medical Products Price Guide. If you'd rather not include the "multiple formulations" fact in the per-drug section, then this would be the place to mention that Carbamazepine has 4 variants, Mebendazole has 5 variants and Diazpame has 3 variants in the database, each different strengths or formulations (tablets, syrup or ampoule). We could link each time to the by-name database search result. We can briefly explain buyers and suppliers. It is also a hard fact that it was updated every year from 1986 to 2015. This "is no longer being updated" not a minor fact when our readers consider policy for inclusion. I don't think we should keep information like that hidden from anyone. -- Colin°^Talk 10:15, 3 January 2020 (UTC)

Which example do you (you-Colin or you-anyone) think should be removed, to make space for diazepam? I'm happy to run any three MSH-based examples that people want. I prefer sticking with MSH (because one database is enough for people to wrap their heads around) and with only two or three examples, but I do not care what the examples are. WhatamIdoing (talk) 00:26, 4 January 2020 (UTC)

I think if we are going to replace, then dropping Mebendazole is my choice: it has similarities with Carbamazepine and I do want to be representative of real usage and issues. Wrt the database update, readers will not know it was typically updated annually. How about: "This database was updated annually since 1986, though has not been updated since 2015". -- Colin°^Talk 11:36, 4 January 2020 (UTC)

What the source says

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: Ethosuximide, Carbamazepine and Mebendazole. We can see from that:

• Ethosuximide is only listed in one 250mg tablet formulation. A wee problem is that if we update the search to 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.
• 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.
• 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.

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. -- Colin°^Talk 11:42, 2 January 2020 (UTC)

[snip]

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 BNF that you can't read in the USA, which likely focuses on the kinds of parasites we get in the UK

• Threadworm infections.
  • 100 mg for 1 dose, if reinfection occurs, second dose may be needed after 2 weeks.
• Whipworm infections, Hookworm infections
  • 100 mg twice daily for 3 days
• Roundworm infections
  • For Child 1 year: 100 mg twice daily for 3 days.
  • For Child 2–17 years: 100 mg twice daily for 3 days, alternatively 500 mg for 1 dose.
  • For Adult: 100 mg twice daily for 3 days, alternatively 500 mg for 1 dose.

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. -- Colin°^Talk 11:58, 2 January 2020 (UTC)

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?

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. WhatamIdoing (talk) 22:19, 2 January 2020 (UTC)

Hmm. I'm quite fundamentally opposed to us neglecting up-front to say that the price link used here is merely one from several options. I don't think it is acceptable to wait for some participant to notice, halfway through the RFC. The multiplicity reduced to One Price is a intrinsic problem with MSH, NADAC, Drugs.com and BNF sources. I appreciate we need to be compact, but we absolutely must IMO state that "the source" actually lists several variants each with their own price sets, and the editor has picked one.

The fact that the editor can link to just one pill size by URL is a artefact of the MSH website. With NADAC one can't even link to the drug at all, just that week's database of a bazillion prices. With BNF and Drugs.com one must link to a page that gives prices for dozens of formulations. So I don't think we should hide the fact that when the editor, seeking price information about this drug from MSH, typed the drug name into the search box, they got multiple results and picked just one. It is fundamental to what "the source says". -- Colin°^Talk 09:07, 3 January 2020 (UTC)

Colin, I've mentioned this, but perhaps you will think it would be better to add, for each example, something like (This is for the 100 mg pill; there are are also 50 mg pills, 250 mg pills, and a liquid in the database.) If you all think that would be better, maybe someone could make a list of the size/forms for each example? WhatamIdoing (talk) 07:14, 4 January 2020 (UTC)

WhatamIdoing, the improvements look good. Can we change "such as the size and dosage form " to "such as the strength and dosage form ". I would change "some drugs are available in different amounts" to "most drugs are available in different strengths", as "amounts" is ambiguous with bottle or package size, and it really is the norm for there to be multiple records. See User:Colin/MSHData where I started adding a count of variants but only got to "C" -- 65% of entries have 2 or more records. And the number of variants in the MSH database is much lower than the number of variants in Drugs.com or BNF. So multiple variants is very typical. This fact is a little buried in a (necessarily) dense intro section, so I do think it very much worth briefly repeating the explicit case for each drug exactly what you put in quotes above. When mentioning the guide, I suggest "International Medical Products Price Guide (website)". I plan to try to improve the article more: there's more room to expand in the article, but it is necessarily restrained by policy unlike a more casual intro we can do here. -- Colin°^Talk 11:30, 4 January 2020 (UTC)

Thanks for the strength/amount note. "Strength" is what the database uses, and it's what I should have used from the beginning. I think I've {{resolved}} every request in this section. WhatamIdoing (talk) 02:44, 6 January 2020 (UTC)

Buyers and sellers

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. -- Colin°^Talk 11:42, 2 January 2020 (UTC)

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. -- Colin°^Talk 11:42, 2 January 2020 (UTC)

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. -- Colin°^Talk 11:42, 2 January 2020 (UTC)

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).

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. WhatamIdoing (talk) 22:27, 2 January 2020 (UTC)

Wrt "I listed supplier prices because those were the ones used to create the text", no it was not just the suppliers that were used to create the text. In two of the three drugs, the upper range comes from the buyers. I believe the upper and lower prices were drawn from both supplier and buyer datasets in all cases there is a range, and it is mere chance whether upper or lower bounds come from one or another. Indeed, a third of the time, only buyer prices have been used because there are no suppliers at all. We need to bring in buyers, and two explain those two price datasets are not the same thing. We can't have someone claim "these are the prices offered by major suppliers to governments in the developing world", as has been done, when in fact one third of the prices have no supplier data at all, another sixth only list one supplier and another sixth only two. The reliance on and usage of inferior buyer prices is a fundamental problem with a large portion of drug prices. -- Colin°^Talk

 ToDo Thanks for explaining it again. I thought those only used buyer prices, but I was wrong, and that has definitely got to be fixed. I'm willing to do it (if nobody else gets there first), but I won't get it done within the next couple of hours.

I like the idea of explaining the MSH database in its own section. That could reduce the repetition. WhatamIdoing (talk) 00:22, 4 January 2020 (UTC)

 Partly done I've got two paragraphs up about the database. I have not yet looked up the high/low/median/ratio numbers for the buyer prices for the second or third example. I'd rather do that after we decide whether we're replacing one of them with diazepam. WhatamIdoing (talk) 07:19, 4 January 2020 (UTC)

I think it better to use "supplier" than "seller" since that's the terminology the source uses and what we've used throughout discussion and the terminology on the wiki articles. I suspect the reason for them using that word is that people might think the sellers are the drugs manufacturers themselves, or retailers. They aren't typical wholesalers either. -- Colin°^Talk 11:39, 4 January 2020 (UTC)

 Done and  Done. I no longer consider the RFC to be blocked on these issues. Speak now or forever hold your peace, and all that. WhatamIdoing (talk) 02:51, 6 January 2020 (UTC)

Missing links

The bits at Additional information can be found at... and 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. WhatamIdoing (talk) 22:27, 2 January 2020 (UTC)

I'm not clear where you are quoting from. A workspace on another page? --Ronz (talk) 00:55, 3 January 2020 (UTC)

Two paragraphs in the middle of the draft's ==Background==. I tried to fill them in with something, but I probably missed some appropriate links. WhatamIdoing (talk) 03:44, 3 January 2020 (UTC)

General

I don't want to be here, but here I am. Please feel free to ignore me, but. I still think there is no need to present three examples from the same database. We will get a result about one database. We could present three examples from the three different sources that have been incorrectly used, and get a broader result. It is the same principle; we have no good data on drug prices anywhere. SandyGeorgia (Talk) 12:30, 4 January 2020 (UTC)

I really don't want to get bogged down in explaining the differing problems with each database. It is hard enough with just one. The problem of just picking one medicine is that it doesn't show up the range of issues. If we only pick an example with supplier data, voters may think all records have supplier data. If we only pick an example with one pill size in the database and no syrups or ampoules, voters may ignore the problem with that multiplicity. If we only pick the worst possible example (there is in fact a usage where the "developing world" price is a totally invented work of fiction with no records at all) or most complex example, then folk may argue that this is unrepresentative and that that kind of problem is rare. I think three representative examples are not overloading folk too much. There are of course issues with MSH that are shared with other databases, and folk may also want to post a general comment that they think routine prices are wrong full stop, or a wishful-thinking comment that surely we could find better sources, or a non-policy comment that we should trust editors to do original research. -- Colin°^Talk 13:37, 4 January 2020 (UTC)

As I said, I have no problem if you decide to ignore me, since it is well demonstrated that I am the world's worst at formulating an RFC. But that's my opinion :) SandyGeorgia (Talk) 13:39, 4 January 2020 (UTC)

Well I don't want anyone to be ignored. None of us is getting exactly the RFC we'd have wanted, but I remain hopeful. -- Colin°^Talk 14:31, 4 January 2020 (UTC)

I won't feel ignored; I am perfectly fine with you all proceeding without my advice. But ... if I turn out to be right, I'll get 18 Girl Scout points and big, "I told you so" :) :) SandyGeorgia (Talk) 14:37, 4 January 2020 (UTC)

After a couple days away, I just looked at the RFC page, and it looks ready for launch to me. What work is remaining? Nice work, WAID. SandyGeorgia (Talk) 18:06, 4 January 2020 (UTC)

THanks, SandyGeorgia. I agree with the sentiment that it's hard enough with just one. After we get through this, we'll probably need to have (at least) one more RFC. The next one should be broader. I hope that we'll get enough information about the community's overall sentiment that we can proceed directly to writing a section for MEDMOS on what/when/how/why to handle drug prices. WhatamIdoing (talk) 02:55, 6 January 2020 (UTC)

General, version 2

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Actually, I'm feeling ignored, too. I think it will be a fiasco if that version of the RfC gets launched. And I've been saying so quite clearly for a long time now. If the consensus really is to do it that way, I won't stand in the way but I also won't refrain from expressing my concerns. I feel like a very small number of editors are, in effect, trying to run out the clock, and aren't really engaging with my expressed concerns, even though I've been revising my suggested version of the format in response to their concerns.

So here is what I would like. I hope that editors who have been watching here, or who have just started watching here, will provide additional opinions about the two draft versions: Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices and User:Tryptofish/Drug prices RfC draft 2.

I'm not asking for editors who have already expressed an opinion to repeat themselves here. I'm hoping that more editors will express their opinions, giving a wider range of input. Thanks. --Tryptofish (talk) 20:52, 4 January 2020 (UTC) A part of it struck. --Tryptofish (talk) 23:04, 4 January 2020 (UTC)

User:Tryptofish Would change "Drug (medication) prices should routinely be included in as many drug articles as possible" to "Drug (medication) prices may be included in medication articles when such prices are avaliable in suitable sources." Not sure how you are wanting people to weight in. Doc James (talk · contribs · email) 07:23, 6 January 2020 (UTC)

@Doc James: I'll try to work with that. I think, however, that a lot of the dispute that the RfC is hoping to resolve does center on the widespread inclusion of prices. --Tryptofish (talk) 21:42, 6 January 2020 (UTC)

I did this: [18]. --Tryptofish (talk) 21:55, 6 January 2020 (UTC)

Tryptofish, I don't really want to distract you from working on that, but I think that the main risk is that you'll end up with people opposing both. You might reduce that risk by reducing the number of sections for voting from four to one, and encouraging Prefer 1, responses rather than Oppose everything. WhatamIdoing (talk) 22:08, 6 January 2020 (UTC)

Actually, I was thinking much the same thing, so I appreciate that very much. (Although I think there will be more who support both than oppose both, but who knows.) I was thinking of just making an RfC comments section followed by an extended discussion section, and that would also help move it away from "voting". I'm very receptive to that. I started the draft by wanting to show how it could work, but that's open to change. I'm going to leave it as is for another day or so, but I welcome views about how to format that part, and I'll happily go with whatever has consensus. (Right now, I'm trying to write the pro/con rationales.) --Tryptofish (talk) 22:18, 6 January 2020 (UTC)

At this point, I've probably done as much with the draft as I can. After sleeping on it, I might make a few more tweaks, but that's probably it. It's certainly at the stage where editors can look at it and form opinions about it, and I continue to urge other editors to find ways to improve on it. --Tryptofish (talk) 22:56, 6 January 2020 (UTC)

Feedback from Sandy

OK, if you don't want other than new opinions, where do you want those of us who have been at this for a month to put suggestions and questions? SandyGeorgia (Talk) 03:38, 5 January 2020 (UTC)

I studied RFC draft 2, and went to the talk page there to enter some feedback. Tryptofish, you told us about this draft (above) on 2 Jan,[19] I took a day off, and today when I go to give you some feedback, I see you could have notified us a week sooner that you were working on it, when you notified Barkeep on 26 Dec. Then I got involved responding to Barkeep and didn't get to give you any feedback, but ... could you have told us sooner? I still don't know how to fill in a single part of Proposal 2, because I'm still waiting for an example from these databases that works. I am not aware of any way to usefully use these databases: could you fill in the examples for us? I don't know what to do next to help advance your draft. Corrected typo in date from Jan --> Dec in original post with timestamp 06:26. SandyGeorgia (Talk) 13:31, 5 January 2020 (UTC)

Sandy, I see that you have also reached out to me at my user talk page, over some of the same points, so I'm going to focus here only on the best ways for editors to work together on drafting the RfC. I'm very happy that you intend to give some feedback on that draft, and I look forward to making good use of it. And it's OK if you haven't gotten to it yet. About my notifying editors here, there was a consensus that we would take things a bit easy through January 1, during the holidays, and then get serious about it around January 2. And January 2 is when I posted here about it: [20]. It's certainly true that I started working on it before then, and I don't think there's any problem with my having done that. But I continued to work on it, on and off, in late December through January 1. So I didn't really think it was ready to show the rest of you until when I posted here on the second. I certainly was not trying to hold anything back from anyone, and I cannot imagine why anyone would think so. In addition, I actually wanted to see the other draft before I posted anything here, because I felt that if that other version were superior to my own, I would just discard my own. Again, no bad intent about that. On January 2, WAID posted her draft, and I gave my feedback on it as soon as I could, and then I notified editors here about the draft I had made (same diff above). That was all on January 2. The reason that I notified Barkeep earlier was because of this comment he had made to me on my user talk page: [21], and I felt that he should be aware that I had started working on it, as opposed to having it ready for discussion.

About filling in the draft that I started, I had hoped that editors would do that collaboratively, and I was only trying to show a format. I may be the worst person here to fill in the details, because the rest of you know a lot more about it than I do. If you and anyone else who is interested in the Prop 1 part of it want to put in whatever occurs to you, that would be great. I'd appreciate it if Doc James (or anyone else who wants to) could fill in some of Prop 2. I'll also take a stab at filling things in now. But I think that it's essential that editors recognize that one can put something into the draft and then someone else can revise it to make it better. This isn't like there's that part that says X but it really should say Y, so the entire format is unusable. Better just to change X to Y. And in one fish's opinion, WP:There is no deadline about having it ready to go live. We all are eager to be done with it and move on, but personally I'd much rather get it right than get it fast. --Tryptofish (talk) 19:05, 5 January 2020 (UTC)

User:Tryptofish how do you want me to contribute? Edit directly? Simple make suggestions? Are we allowed to use the talk page of the draft? My computer is having problems with the size of this page. Doc James (talk · contribs · email) 07:28, 6 January 2020 (UTC)

@Doc James: Any of the above, whatever might help. (But please keep in mind that there is a limited chance that other editors here will agree to using the version I'm working on, at least at first.) --Tryptofish (talk) 21:39, 6 January 2020 (UTC)

Yes to there is no deadline. But. On re-reading and recalling some parts of the activity on this page, I can see that Barkeep's Update on 1 Jan read to me (perhaps incorrectly) as if we needed to kick this into gear and get something up soon. It does seem like a month is a long time, and there is no doubt fatigue has set in (to wit, Ceylon). Looking at it from the perspective of a week later, that may not have been possible even when Barkeep posted his 1 Jan update to get this to launch, especially since the ANI close was predicated on the premise that the terms of RFC launch were: "an uninvolved admin after confirming that the question(s) are neutrally worded". In hindsight, I saw that three weeks had gone by, we still didn't have a single example to work with, so we needed to scale back what we were trying to accomplish and wrap this up.

This page has become sprawling; we seriously need to archive the older parts to a separate, RFC archive. At some point on this page, Barkeep indicated that you had presented a sample. I don't know where that is. If you have a sample, could you please add it to your RFC draft 2 page? Or should we wait to get the chlorthalidone sample clarified? As I've said elsewhere, I don't know how else to help on that draft without an example. And it's in your user space; the way we are having to work here is really constraining. Do we ALSO have to debug your draft on this page, or do we go to your user space talk?

I raised the dates because if the rest of us had known your were working on a draft, we might have focused on it; by the time we did focus, I at least felt we were under the gun to get this done. Again, water under the bridge, so onward and upward.

On filling in the draft, we are constrained that the ANI indicated Colin shouldn't do the drafting, and I believe my ability to formulate an RFC is already on display, so neither should I. What would be most helpful at this point is to get an example of how those databases can be used correctly. I am trying to work on the chlorthalidone example below, but it is in the middle of a sea text that does not belong on this page. On Part 1, I keep saying, what about something like Epipen, and ... talk about feeling ignored :) I hope you realize that there is too much volume on this page for us to all hear everything, and ignoring anyone is not intentional nor a matter of bad faith. And no, we can't put stuff in to your draft; you set it up in your userspace, and Colin can't edit it no matter where it is.

Considering it now appears we are not close to launching anything, we need to deal with the page sprawl here before we continue. SandyGeorgia (Talk) 19:29, 5 January 2020 (UTC)

Please bear with me, because I'm juggling these discussions on multiple pages now. I have no idea about Barkeep saying that I had a specific sample of that sort. What I did, outside of comments on this talk page, is User:Tryptofish/Drug prices RfC draft and User:Tryptofish/Drug prices RfC draft 2. (And I hope it's clear that I constructed v.2 based on comments to me about v.1.) About scheduling, I'm going to defer to Barkeep. Let me say for the record, and to everyone, that everyone who wants to is explicitly invited to make edits to draft 2, regardless of it being in user space. That has my explicit blessing! Doc James already made some edits there (and I reverted him and then changed it to something that I think accomplished the same thing better!). Suggestions on the talk page are welcome, too. As are suggestions here on this talk page; probably in a new section and not here. I can certainly look at and copy-paste what look like good examples amid the discussion here. And then I hope other editors will pitch in and correct the things that I will doubtless botch up. Ceylon? Sail on! --Tryptofish (talk) 19:44, 5 January 2020 (UTC)

I found Barkeep's words ... "Though I will note that at times both WAID and Trypto have presented modified versions that they feel is policy compliant. Those examples have not been satisfactory to you which is fine." It reads as if you presented a policy-compliant example that I rejected :( :( :( If that happened, I am not aware of it. SandyGeorgia (Talk) 19:53, 5 January 2020 (UTC)

I see. I'll let him clarify, but I would understand that as the two draft versions of the possible RfC, as opposed to an example, shown within an RfC, of a policy-compliant edit about a drug price. --Tryptofish (talk) 19:56, 5 January 2020 (UTC)

yea ... that's not how it came out to me. I think I am supposed to be seeing that somewhere on this page, valid examples of how to use those sources have been presented, but I have ignored/rejected them. :( SandyGeorgia (Talk) 20:00, 5 January 2020 (UTC)

User:Barkeep49, others, I think things have gone a bit off the track here. This top-level section heading was created to discuss WAID's draft and is now discussing the genesis of and participation at Tryptofish's draft. The former is imo nearly ready to roll and the latter little more than a sketch of an idea (sorry, but true). After almost a month since the ANI was closed and we were asked to form an RFC, it seems we are being dragged back to square one, still scrabbling around to find even one example to put into this second rival draft RFC. It seems we have two styles of RFC:

• WhatamIdoing: present some examples using one source, with some background on that source, and ask for comments about compliance with policy and to offer an open space to discuss guideline advice on drug prices. Emphasise that this RFC is not the final say but a step towards something.
• Tryptofish: present two polar-opposite positions on drug prices in articles and appropriate sources, along with some samples and (presumably brief?) arguments pro/con. And then ask everyone to support and/or oppose both options separately. Aim to settle the matter in one go.

The point of having the RFC is that we do not claim to know community consensus on this matter, and since polling is not a substitute for discussion, it seems wrong at this point to go for a simple poll, and to offer a false dichotomy that voters must pick positions on. Polling is known to polarise debate and separate voters into adversarial factions, so this would not seem to be a wise option when we have already seen incendiary claims of collusion with Big Pharma to censor Wikipedia and conceal prices from patients. We don't need closed-minds formulating some sound-bite that will destroy the opposition's argument. We need open minds to look honestly and carefully at this complex issue. So complex, that I think we do need to concentrate for now on one source and one region (developing world). I keep saying, please lets choose the least-conflict option, and an RFC that divides Wikipedians into two camps to try to outvote each other is not that, imvho. -- Colin°^Talk 21:43, 5 January 2020 (UTC)

My thinking is that Trypto's Draft will need an example, which it appears from a month of discussion may not exist. WAID's draft looks ready to go, and while it answers a much lesser question, at least it answers one question in the overall picture. I can see a scenario where we launch the version we have ready to go, and depending on the outcome, Trypto's becomes the followup to address other questions. I think we can do both here, but agree we need to maintain focus on finishing the one that is ready. SandyGeorgia (Talk) 21:50, 5 January 2020 (UTC)

Sandy, when you and I started discussing things earlier today, I became very optimistic about the direction things were now heading. Reading the newest comments here, that optimism has significantly diminished. I don't think that the community will respond favorably to having a preliminary RfC to be followed by another one later. And let me be very clear: have a fail on whatever is the first RfC, and it's going to be "ArbCom here we come". As for an example that may not exist, I think I addressed that just above. And as for Colin, if the ANI consensus was that he should not be the person to formulate the RfC, maybe he is also the person who should not be trying at every opportunity to shut down the discussion. Yes, I said that, and if anyone does not like it, I really do not care. Barkeep, if you think this is the wrong header level, or something like that (oh, the horror!), please feel free to refactor the page sections. But I don't think this talk page was created to discuss only one possible version of the RfC. The idea that the format I recommend is presupposing the view of the community or closed minded or polarizing, whereas the other one is nice and neutral, is laughable. --Tryptofish (talk) 22:21, 5 January 2020 (UTC)

Just to make it clear, there was not an "ANI consensus [] that [Colin] should not be the person to formulate the RfC". I thought someone had indicated that at some point (at ANI or here) but I may be mistaken because I can't find it. I am not going to add or edit any RFC text directly. Wrt "closed-minds" "open-minded" I should clarify I'm talking about how any RFC makes voters/commenters react, not about anyone here drafting an RFC. Hence, closed vs open question in the RFC. I am not going to respond to the other points here. -- Colin°^Talk 10:08, 6 January 2020 (UTC)

Re, Just to make it clear, there was not an "ANI consensus [] that [Colin] should not be the person to formulate the RfC". This is correct. There was one comment in the ANI: There may very well be problems, but I'm unconvinced that Colin is the best person to be the primary one drafting an RfC to deal with them. Nil Einne; I believe that Colin has acted correctly in respecting the spirit of that one comment, and leaving the actual drafting to other parties. I have full confidence in WAID because of her RFC experience and long-evidenced neutrality in all matters WPMED. She has done a fine job in laying out one part of the problem that needs to be examined before we can move to the broader issue of what to include in MEDMOS, while not giving respondents too much to deal with in one shot. Trypto, I hope you will back off on the term "laughable" and that we can move forward step by step, which is something we've discussed many times on this page. SandyGeorgia (Talk) 11:15, 6 January 2020 (UTC)

You know, I actually did not remember the ANI thing as having included that. But then, Colin said to me just below: Let me be clear: I am not going to write any RFC, and I don't think James should write one either.: [22] And then you told me just above that the ANI indicated Colin shouldn't do the drafting, which I see now that you have struck: [23]. Once you told me that, I figured that I just hadn't remembered it. That's what it came from. --Tryptofish (talk) 20:49, 6 January 2020 (UTC)

Explain to me please what you mean by "have a fail" on a first RFC; I'm not following. Could you give me a timestamp for what you are referencing with "I addressed that just above", so I know the reference? (We now have James participating to help generate an example, is my understanding of where we stand on that.) And since we have multiple times on this page talked about needing more than one RFC, I am confused (and saddened) that this has caused your optimism to diminish. I thought that possibility has been on the table for weeks?? It sounds like you are now saying that your RFC is the only acceptable one in your view ?? SandyGeorgia (Talk) 22:30, 5 January 2020 (UTC)

If the community finds that the first RfC is flawed and reacts negatively to it, that will be a fail. Timestamp: 19:05, 5 January 2020. I have never said that this is about me wanting it to be my proposal, but I am definitely saying that I expect to be able to have my comments discussed reasonably instead of being treated the way that is happening here, and I am trying my hardest to avoid having such a fail occur, which is above all what I really do want. --Tryptofish (talk) 22:42, 5 January 2020 (UTC)

OK, I understand your "fail" concern; it strikes me that WAID has put a lot of thought into it and that doesn't look likely to happen. But we know my record. At 19:05, amazingly a ctrl-f shows three of them on this page (we need an archive), but I located your post, and it follows what I am saying: we think/hope James will provide an example. OK, the page is a mess, and we are all possibly talking past each other, but you clearly feel you aren't being heard and you aren't getting breathing room in here. My plan: I will continue the discussion with James to try to get an example, work on trying to get the page archived, answer any direct queries or anything Barkeep asks, and otherwise back out of other discussions for a few days. I don't want you to feel ... ignored, disappointed, etc. I hope that will help. It's risky for me, because the last time I unwatched, and completely missed Draft 2, then you felt ignored. I'm at a loss :( SandyGeorgia (Talk) 23:12, 5 January 2020 (UTC)

Much better, thank you for that. I mean it. As you were writing this, I have been filling in the requested stuff at draft 2, insofar as I understand it. It will still require a lot of vetting and fixing by other editors here, but at least this is getting the ball moving. --Tryptofish (talk) 23:28, 5 January 2020 (UTC)

OK ... just to make sure you understand ... except for two initial and very simple questions on WAID's draft, I didn't help there at all. Equally, I will back out and not help on the wording of your draft. Not "ignoring" you, but just giving equal treatment to each. Deal? When (if ???) we get to a point of (I guess?) Barkeep asking for final opinions pre-launch, then I'll re-engage on wording, if I see anything significant. SandyGeorgia (Talk) 23:35, 5 January 2020 (UTC)

As far as I'm concerned, we are all volunteers. At this point, I have filled in possible examples for everywhere editors have asked for examples. Very likely, I made significant mistakes. But those mistakes can be corrected. I'm tired now, and will work on the "rationales" tomorrow maybe. In the mean time, everyone should feel free to make changes or suggestions if they want to. --Tryptofish (talk) 23:39, 5 January 2020 (UTC)

I don't think this talk page was created to discuss only one possible version of the RfC

By my count, at least four different RFC models have been discussed on this page (questions that would let us formulate text for MEDMOS, Tryptofish's two userspace drafts about voting on dueling texts for MEDMOS, and the narrower RFC on whether the existing content is our best work), so that's not likely that this page is only about one possible version of the RFC. ;-) The narrower RFC that I have drafted at Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices was not originally my idea, but I no longer remember who first mentioned it.

I think my reply at Wikipedia talk:Manual of Style/Medicine-related articles#Potential accusations of bias applies here, too. WhatamIdoing (talk) 03:15, 6 January 2020 (UTC)

Collapsing as suggested by Barkeep49 Nil Einne (talk) 13:15, 6 January 2020 (UTC)

I got pinged here. I'm not going to read the whole discussion but I've read some brief snippets. I will first say I don't see anything wrong with Colin being involved in a community drafting process. I do think it will be a mistake for them to be the one to draft an RfC on the matter by themselves. Frankly, I think it will be a mistake for anyone to draft the RfC by themselves but from what I saw at ANI, I stick by my view that it will especially be a mistake for them to be sole drafter since the way they approach things IMO doesn't help earn support. OTOH, if most others, including those like Doc James and others who have been in opposition to Colin's views, feel it will be best for Colin to draft the RfC by themselves, then I defer to their view since they surely know far better than me. Also, while I understand the need to avoid excessive complexity, I would think carefully before using 2 RfCs. From what I've seen in the past, by the time a second RfC rolls around, there tends to be a great deal of 'not this crap again' i.e. community frustration and disengagement from the process. If editors do feel it's best to hold 2 RfCs, then at the very least this requires very careful planning and engagement IMO. Finally, I guess there's something major I'm missing since I don't understand how there can be any attempt to 'run out the clock'. This is not an issue which is likely to go away anytime soon or one which is most urgent at a certain time. (E.g. I can understand how something on US presidential elections will be less important in a year's time.) Editor's should give ample time to any discussion to come up with the best RfC taking on board everyone's views as far as possible, preferably reaching a clear consensus. (I know it may be weird to talk about a consensus on wording an RfC and I'm not suggesting people do an RfC on the RfC wording. But this page seems to have enough participants with diverse viewpoints that I would hope something good is achievable.) In some cases maybe even an informal straw poll will be useful although I'd also urge caution since I'm sure we all know it shouldn't be a substitute for discussion. Edit: Read a bit more. If editors are starting to get frustrated with this process and disengage I agree that this is a problem. I think this is a case where there's a delicate balance act between not letting perfect be the enemy of good; and not producing something which will leave those involved feeling their concerns were ignored or produce an outcome with is disputed or unclear. Edit 2: I should perhaps clarify that as my concern is with Colin specifically being the sole drafter, they may alienate everyone from supporting their view by their approach. So frankly if those who, for lack of better word, "support" Colin want them to be the sole drafter, that is good enough to allay that concern as long as they understand if things go pear-shaped they shouldn't blame the community. But this won't deal with the fact that an RfC drafted only by Colin with no feedback by anyone else may be biased or otherwise problematic, the same as with an RfC drafted only by Doc James etc. Nil Einne (talk) 11:38, 6 January 2020 (UTC) Thanks for commenting, Nil Einne. I think we've had enough words said on a hypothetical situation that is going to remain hypothetical. Please lets return to discussing the RFC rather than specific editors or admins. -- Colin°Talk 12:42, 6 January 2020 (UTC) @Nil Einne: Apologies but I was pinged here and I don't know why. I don't think I've visited this page, let alone commented in a long time. I think the ping was because of something I said at ANI about you drafting the RfC but frankly the discussion is so long that I don't think I can be bothered figuring it out. If it is only hypothetical then I'm unsure why I was pinged, since I'm fairly sure I never said you could not be involved in drafting the RfC along with the community. If I did, I apologise without reservation. In any case, I wanted to make my views clear if they're being discussed and misunderstood. Or if they were correctly understood, I felt it best to re-iterate the point I intended to make. I stand by my views expressed here and I think at ANI. But do agree it's not that important since ultimately it will pan out how it pans out. If mistakes are made in the drafting which destroy any result, well all I can say is me and others tried to help in suggesting the best path forward, it's unfortunate if it wasn't followed. I will collapse this discussion as suggested by Barkeep49 somewhere above. Nil Einne (talk) 13:15, 6 January 2020 (UTC) @Nil Einne:, I pinged you because I did want to make sure we had stayed true to your concern, so your feedback was useful. Sorry if my ping created discomfort. I really despise this new-fangled pingie-thingie, as it creates so many side issues (recalling that you have tried to help me learn how to use it, but now I want to unlearn it :). In the "olden days", I would have gone to your talk page, and notified you that I had mentioned you, and explained why. I may go back to the old ways. Thanks for weighing in, SandyGeorgia (Talk) 13:26, 6 January 2020 (UTC)

Discussion about how this was worded

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

I'm having a hard time with the phrase "run out the clock" after we typed ourselves blue in the face for a month ... ??????? Many many many times I asked, please name the RFC, put up a mock up; you didn't, WAID did. I feel that a month is a pretty long clock. SandyGeorgia (Talk) 22:32, 4 January 2020 (UTC)

Well, I put up two such markups, but let's not let the facts get in the way. As I said, I'm not asking for editors who already expressed an opinion to repeat themselves. --Tryptofish (talk) 22:36, 4 January 2020 (UTC)

Barkeep49 I know you said that certain concerns should be done on a user talk page rather than a guideline talk page, but I'm prevented from doing that. I have to say I'm finding these allegations by Tryptofish to be rather against our assume good faith policy, and not conducive to collaborative working. Trypto, here you are frustrated that I haven't helped fill in your skeleton RFC and suggest I'm deliberately leaving it bare in order to comment that it is unfinished. The allegation that folk are "rigging the RFC to get a desired result", and query to WAID about her response to a potential complaint raised "that the RfC is hopelessly biased and should be discarded" do not make me feel comfortable. Your "let's not let the facts get in the way" is fightin' talk, Trypto, please tone it down. Some of us have been at this since October! Let me be clear: I am not going to write any RFC, and I don't think James should write one either. I can express my opinions about the content/focus of the draft RFCs and you guys can accept or reject it same as with any other editor here. I think we are all rather tired, and frustrated at the lack of participation by experienced editors in helping drafting any RFC, but lets please collaborate and compromise, not fight among ourselves. -- Colin°^Talk 22:45, 4 January 2020 (UTC)

Well, that's one way to frame it. In any case, I think this demonstrates that it would be useful for more editors to participate in the discussion if they want to. And if consensus is against me, I won't stand in the way. --Tryptofish (talk) 22:52, 4 January 2020 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Post-ANI Discussion and Clarification

There has been a fair amount of requests for clarification and interpretation occuring at my talk page (see [24]). Out of respect for the consensus that "The question of drug pricing is remitted to a single venue" I note the above diff and then copy over the current discussion that had been occurring there to here to be continued. Best, Barkeep49 (talk) 15:51, 3 January 2020 (UTC)

Content from Barkeep49's Talk Page
The following is a closed discussion. Please do not modify it.
Just a note to those around here, I was just asked on DocJames talk page specifically about updating. I had discussed this previously with two other uninvolved syosps on IRC and all three< of us feel that updating information already present in an article does not qualify as "adding or removing pricing" and can be done even while the RfC creation process plays out. courtesy pings to @Ronz, Colin, SandyGeorgia, and QuackGuru:. Best, Barkeep49 (talk) 06:25, 2 January 2020 (UTC) I think that tagging/amending/updating prices on articles should be included in the moratorium. While I have no intention of editing the prices at present, the contentious issue is not just whether prices are included or not but that existing prices make false claims, do not represent what the source says, cherry-pick one database record rather than another, use prices drawn from buyers and suppliers, etc, etc. All these issues have been a source of conflict over the years. I wouldn't support the idea that James alone is permitted to modify their own price statements, and all evidence suggests that anyone else amending them will result in conflict. It would also be highly disruptive if editors modified the article text of drugs being used as RFC examples such that they deviated from the examples presented at RFC. We don't want the RFC discussion on what should be said to be played out by edit warring on the articles. It would simply be better that any statement about prices be left alone for now. -- Colin°Talk 10:40, 2 January 2020 (UTC) Thanks for the ping, Barkeep; I am following the discussion at Doc James talk. 1. These personal exceptions for Doc James are part of why we are where we are. It is awkward that we can't consolidate conversations because of a) prohibitions on pinging/posting and b) lack of engagement in one place. One point of the ANI close was to prevent disputes from spreading. At ANI, "The question of drug pricing is remitted to a single venue". Full Stop. Your words. I agreed with JzG on these conditions instead of supporting a topic ban on Doc James as requested by another sysop (Nil Einne). Doc James has not come to the single venue to discuss, and one party is prohibited from posting to Doc James talk, and yet that party can be discussed there. This is a formula for dispute-spreading. There should be, in fact, no discussion of the price dispute at James talk, other than your notifications and further clarifications with James and Peter. 2. I have always been and still am opposed to back-channel decisions on IRC. (That is not "a single venue".) Conversations regarding a sysop who is continually given exceptions for behavior (eg edit warring) should be in full view of everyone else affected. Who are the two sysops who agreed that we can grant this change to the clearly established conditions? By conducting business off-Wiki, your excellent conduct in this matter so far puts you at risk for being drawn in to the precise pattern that needs to be addressed. Please provide the names of those sysops. 3. My recommendation is that you walk back this private discussion and decision, and leave the ANI close as was clearly agreed. I agreed with JzG's approach only because it was so carefully worded, and having been down this road before, knew what might happen. It has. Doc James breached the close. Please respect your own ANI close, and do not complicate a years-long dispute with non-public discussions where three sysops decide to exempt one sysop from a community agreement. OWNERSHIP is at the core of the pricing dispute and all previous disputes: exempting one editor, who has not engaged with the rest of us who are attempting to solve the problem, from a community-wide decision which accounted for this very possibility furthers the very problem we are attempting to solve. SandyGeorgia (Talk) 13:55, 2 January 2020 (UTC) @SandyGeorgia: I was one of the editors who was consulted on IRC. The off-wiki consultation was clearly disappointing for you, and I'm sorry about that and will aim to be more transparent in this matter. It probably won't make you feel better, but I was presented the question in a very abstract sense and was not aware of the identity of the participants, and certainly did not intend my comments to be about giving a particular sysop an advantage or special exception over others. My reasoning was that the spirit of verifiability doesn't allow us to keep old bad information if newer, equally- or better- sourced information is available -- it must be updated or removed, and the closure explicitly prohibits removing it, so updating it is the only option. Additionally, updating pricing doesn't seem to involve the same dispute as to whether prices should be included or not. Thanks for your comments -- I hope I have addressed some of your concerns, and if not, please don't hesitate to reach out further. Best, Kevin (aka L235 · t · c) 18:22, 2 January 2020 (UTC) it must be updated or removed Howso? What's the hurry? Is there some BLP-like requirement? --Ronz (talk) 20:27, 2 January 2020 (UTC) @SandyGeorgia: thanks for all your thoughts here. I want to acknowledge that I've seen them. I think some of your criticisms of me are more than fair but want to take a few hours to think on them before replying (especially because other pieces of the analysis I respectfully disagree with at first blush). Best, Barkeep49 (talk) 15:40, 2 January 2020 (UTC) For today at least, pinging me will only increase my need for a calming cup of tea. That "tipping point" has been passed by sysops allowing the very behaviors we seek to address, to fester and grow by a participant who has not engaged. This Is The Pattern. Regular editors, who want to add medical content, have no place on this project. We have competent, qualified medical editors who have written numerous guidelines, featured articles and featured lists, but who do not have a sysop flag attached to their account, who are doing everything they can to assure medical content on Wikipedia is accurate, and being undermined by those who have a flag attached to their name. This is why good editors quit. This is why medical content is suffering. This is why good editors no longer engage to remove vandalism and quackery. This is why good editors stop trying to bring medical content to featured status. This is why I stopped editing for years and unwatched hundreds of medical articles. This is Wikipedia. SandyGeorgia (Talk) 16:02, 2 January 2020 (UTC) Sandy, (who I'm intentionally not pinging based on what she wrote above as there's only so much calming tea in the world but who I will ping tomorrow) thanks for all your thoughts. As I've expressed to you in the past, when you were working on the edit request, I knew that being the sole sysop involved in these issues was going to be trouble sooner or later. And now we're here, in part, because I took a half measure in this regard. There had been an increasing number of decisions that I had been asked to make about this situation. While the all the decisions had been respected I had become uncomfortable being the sole uninvolved sysop attempting to properly carry out the community's will in this regard. What I should have done was to solicit wider feedback formulate a different version of the update I'd posted and then reverted at AN. What I did instead was to reach out to others on IRC. I understand why this opaque measure rubbed you the wrong way. While I appreciate L235 chiming in, what I should have done after making the first mistake of consulting on IRC rather than AN was to just own the decision as my own - as I felt that updating prices was ok before the discussion and after. I included the IRC mention as a way of being clear what I had done but rather than being transparent it diffused responsibility for the decision in a way that it shouldn't have. Why was updating ok with me when I'd said even adding a tag was not? In my thinking it's different because it's not adding something new and because the embargo is designed to ameliorate the conflict not preserve bad information. In the time that I've been working on this conflict I've worked hard to treat all editors with respect. Especially because the core group of editors, whether they carry the sysop user right or not, deserve immense respect for the longstanding ways they've made Wikipedia a better place. I can, and will if you or some other editor would like, explain how I've tried to treat all editors the same regardless of sysop status. But essentially my approach has been to make a polite request for specific action where I've observed a line being crossed. So far every time I've made a specific request to take/rescind an action the editor has agreed. I have also, attempted to follow the ANI close statement that there will be "no rehashing of grievances" by acting on not what's happened in in the past with editors but what's happening now. All of this has applied to all editors including DocJames. But I also remember acutely what it's like when you don't have the sysop flag. I wrote, in a line I had to remove from my ACE statement due to space constraints, "I remember what it’s like to feel put down not or otherwise dismissed because" I wasn't a sysop. We lose so many good editors for so many reasons and I'm sorry that the conditions here are such that we're going to (potentially) lose you. The places you've chosen to contribute in this dispute have been made better because of your contributions. I can only hope you decide Wikipedia remains worth it. As to the specific asks you've made, I have struck my statement here and on Doc's talk that refers to the discussion IRC. I am willing to discuss the decision to say that updating is OK further and have now laid out my thinking rather than just giving a "because me and two people you can't comment about said so" reasoning. Just to reiterate, updating feels different than adding or removing because the ANI close was about ameliorating the dispute and where the information is already present updating serves our readers without changing the scope of articles involved in the dispute. If you don't want to discuss it further we can all head back to AN/ANI or go to ArbCom as has been discussed below. If we head to AN/ANI (and obviously if it ends up at ArbCom) it will likely mean I step back from attempting to moderate the dispute for at least a bit to give the community space to weigh-in and indeed offer feedback on my own actions. As for the final bit of keeping discussion at WT:MOSMED you're absolutely right. It has, at minimum, spread to this page, Doc James' user talk, WT:Prices, Talk:Ivermectin. I'm happy to take a more assertive stance on pushing stuff over there (for instance I should have replied to several of the questions posted here there). As you note some conversation will still be needed at on user talks but this would be much more one on one discussion. To that end if you (or others) want to continue conversations about updating with me, we should create a section to do so there. If you wish to discuss my actions that would of course remain more appropriate for this page (or AN/ANI/ARBCOM). Best, Barkeep49 (talk) 22:29, 2 January 2020 (UTC) I am back from Ceylon; I found life in a country where pings are outlawed very relaxing. Do you want me to respond here, or do we want to keep discussion at WT:MEDMOS? My suggestion would be that we continue this particular aspect here, in the spirit on not splitting a conversation. SandyGeorgia (Talk) 12:41, 3 January 2020 (UTC) Barkeep49, I think your decision to permit editing of price information is a rational one, assuming the conflict is only about addition or subtraction (or moving to body), and assuming that updating the text might change it from "bad" to "good". That really isn't the case; it is just differently bad. Attempts to resolve some of the OR or false claims have been rejected by reversion and on several occasions caused protracted dispute. I only see that being more likely during an RFC. You say you are not keen for an embargo to "preserve bad information" but no amount of tinkering or updating data from 2014 to 2015 is going to make the information good. Nearly all of the prices are many years out-of-date, wrong and misleading. We've lived with that for years and really it is best if they are left be for a little while longer. -- Colin°Talk 13:12, 3 January 2020 (UTC) We may be in disagreement about the "rationality" of the decision, Colin; I have very big problems behind the logic in this decision, and am surprised no one has seen the logical flaw. I am waiting to hear if this is the right place to have that discussion, and to make a recommendation. SandyGeorgia (Talk) 13:18, 3 January 2020 (UTC) FYI, User:Colin/PriceEdits contains a computer-generated list of all price/cost insertion/deletion edits to 530 drug articles by any editor since 2015. It also contains my analysis of where editors have come into conflict. Plenty examples of why I note my concerns above. To take an example of the kind of "copyedit" being suggested by User:WhatamIdoing at the MEDMOS discussion, an editor changing "the wholesale price in the developing world is" to "The median buyer price according to the International Drug Price Indicator Guide was" sparked an edit war at Lactulose. -- Colin°Talk 10:40, 2 January 2020 (UTC)

I look forward to learning about the flaw that Sandy sees with allowing the updating of information. Best, Barkeep49 (talk) 15:51, 3 January 2020 (UTC)

Acknowledged, but I am off now for several hours. I will post once I am home (unless I get in an accident on snowy roads :( SandyGeorgia (Talk) 16:05, 3 January 2020 (UTC)

Barkeep49, I'm not sure this move is a good one, though I see why you did it. I am uncomfortable with complaints about an admin decision as to whether recent edits break AN/I closure (or similar edits will so in future) being made on a guideline talk page, rather than the talk page of that admin. Isn't that what you keep reminding us? I would prefer if your user talk page was a safe space to raise concerns about current edits and your moderation of the topic discussion, and we leave this page to discuss drug prices on articles and what an RFC might say. -- Colin°^Talk 16:10, 3 January 2020 (UTC)

I actually was hoping, too, that it would stay at Barkeep's page, but for a different reason (I had no plans to rewatch this page with all parties not even coming to the table ... I have done my share, and it was a waste of my holiday season, as things resulted). I'd be much happier if this separate discussion stayed where it was. Gotta go, now I will be late and driving on icy roads, whatever you all decide. SandyGeorgia (Talk) 16:15, 3 January 2020 (UTC)

Sorry to drag you back here and be safe. Best, Barkeep49 (talk) 16:35, 3 January 2020 (UTC)

Colin, way to fairly throw my own words back at me :) I think this is best for a couple reasons. I think discussion around these issues are tied into the larger discussion and so the ANI consensus needs to be respected - plus I have a pretty thick skin. Some number of editors who might be interested in this topic might not know to go to my talk page for hidden pertinent discussion. Additionally, I would love if other uninvolved sysops engaged in helping to moderate this dispute and putting this here makes it easier for them to weigh-in as necessary. Finally, I think it helps send the signal that were I to close a discussion on some other page saying it should be had here, that I'm applying the ANI to all editors - even myself. I am, of course, willing to admit when I make a mistake. If it proves that having these discussions here make things worse than my user talk well I'll reverse course again. Best, Barkeep49 (talk) 16:35, 3 January 2020 (UTC)

Responses to post-ANI feedback

I'm back; thanks for the well wishes. While I was driving, I tried to organize my thoughts to avoid my usual verbosity. It is unfortunate to clog this page with this feedback, but I understand Barkeep's reasoning for wanting to keep this here.

I would like to unpack my concerns in steps, so as not to drop a wall of text filled with my usual typos on this page, and for us to be able to calmly digest the different components.

1. Misunderstanding about my charges above
2. Questions/concerns about 3 x IRC
3. Logic of the decision applied
4. Has everyone been treated equally?
5. Where do we stand, and how does that affect where we go next?

Starting with No. 1, I felt completely betrayed yesterday. Usually I apologize for an outburst, but I hope no one feels I have something I need to apologize for, because I pushed back from the computer and hit the break button before I completely exploded. I always apologize for misunderstandings when my wording is not careful, so in that vein, I am sorry if Barkeep felt I was questioning his integrity or saying he had disrespected me or us or done something intentionally deceptive or malicious; that is not the situation.

But yesterday did not feel like this month was well spent. The ANI started on December 5, and today is January 3; we expended the entire holiday season on this, and we all typed 'til we were "blue in the face" with unfailing good faith and very little need for, as Barkeep said, people to walk things back. (I will discuss in part 4 whether some people should have been asked to walk things back, but my concern there is not aimed at Barkeep.) Those who participated here (which I will later distinguish from the MEDLEAD RFC) showed that they can address this dispute calmly and without behavioral issues, which is part of why I do not feel we are yet to the arb stage. As we have all expressed (and I believe sincerely meant), Barkeep has gone above and beyond the call of duty and has been exemplary in his treatment of all of us. Yet, through no malintent or negligence, we came yesterday to a most unsatisfactory juncture, for reasons I will unpack bit by bit here.

Basically, I feel our good faith was taken advantage of. I believe the problem yesterday happened because Barkeep has been shielded from full information of what he was walking in to, by necessity, because we are not allowed to "rehash old grievances". So, Barkeep could not have foreseen yesterday's reaction to something that, to many of us, was entirely foreseeable, because it precisely fits the pattern we have been dealing with. I'll unpack that in part 3.

When Barkeep posted to AN, I cheered him, because it has become obvious that he was working too hard. When he retracted his AN post, I worried. I find it a bit disgusting that there are probably twice as many people who participated at the ANI than have participated at the MEDLEAD RFC, and it is unconscionable that what I asked in the ANI (when I laid out my terms) that more eyes watch these events, and Barkeep closed by asking for more volunteers, he got none. I would like to revisit the ANI when I get to Part 5.

Kevin, thank you very much for stepping forward with reassuring information, but I never thought that Barkeep's conduct back-channel needed to be questioned; he has given no reason for doubts about his integrity or how he would approach other admins. My concerns had to do with him not knowing the full picture, and perhaps unwittingly falling into something he might be unaware of.

And that relates to Part 2. Barkeep, I have emailed you a description of things that have happened to me in the past on Wikipedia-- many years past-- as a female editor. To be able to move forward, I would like to ask if either you or Kevin know why the third admin on IRC has not self-identified as Kevin did. I hope you can view my question in the context of the private information I sent you, and understand that it would be reassuring to me if that admin would self-identify. If they won't, that will force me to ask the question in a less-than-desirable way. Meanwhile, I hope we'll all give a good re-read to the ANI thread, because I want to next raise some specifics about where we stand. That's all for now; Barkeep and Kevin, please let me know if it is likely that the third IRC admin will speak up. I'll continue afterwards with Part 3. Regards, SandyGeorgia (Talk) 22:34, 3 January 2020 (UTC)

Moving on to Part 3: logic of the decision applied (although we haven't heard from and don't know the logic of the third admin, or whether they have been previously in conflict with anyone here).

The ANI close put an "embargo on adding or removing pricing during this process". James broke the embargo, but was not sanctioned (we will deal with that in Part 4).

Barkeep said: Why was updating ok with me when I'd said even adding a tag was not? In my thinking it's different because it's not adding something new and because the embargo is designed to ameliorate the conflict not preserve bad information.

And Kevin (aka L235 said: My reasoning was that the spirit of verifiability doesn't allow us to keep old bad information if newer, equally- or better- sourced information is available -- it must be updated or removed, and the closure explicitly prohibits removing it, so updating it is the only option. Additionally, updating pricing doesn't seem to involve the same dispute as to whether prices should be included or not.

So it is easy to see that both Barkeep and Kevin are operating from a position of wanting to preserve the integrity and verifiability of information to our readers, while minimizing conflict. So far so good. Well intended, makes sense.

But here's the problem. We have reams of evidence above that all of the drug price information we have presented to our readers in these 500+ examples is bogus. We have computer-generated analysis that shows essentially all of the prices were inserted by one editor. I have been asking for a month, and we have not yet seen one single example of these database sources being used correctly. So, questions are:

1. How do we protect the integrity and verifiability of content for our readers by disallowing the tagging of bogus information for the benefit of our readers, while
2. Allowing the very person who inserted all of the data to begin with to go about correcting it, when we have no indication that editor has engaged to understand why the data is a problem?

How does that make sense? It doesn't help our readers, integrity of the content, or verifiability at all, and gives no one who wants to alert our readers that there is a verifiability problem with the data that ability, at the same time that the very person who made all the errors was granted an exception to breaching the ANI close. Perhaps a bot could go through and tag every instance in Colin's data with a dubious tag, while at the same time including a link to the talk page of the article, where the ANI embargo would be explained. James should not be touching this data, as we have no indication that he understands the errors he has made. But it needs to be tagged for the benefit of our readers: that is amply evidenced in lengthy discussions on this page.

Have the admins who made this decision understood that the issue is not just whether we allow pricing data in drug articles; it is about data that has been shown to be 100% bogus, and as of now, is a disservice to our readers, full of multiple kinds of errors, entered by one person only? SandyGeorgia (Talk) 19:27, 4 January 2020 (UTC)

So I better understand why you were hoping to keep this on my user talk because it's a little more relaxed to talk about an editor without naming that editor. I appreciate that you're trying to walk a fine line here. I'm waiting to respond more fully until you've completed all five parts. Best, Barkeep49 (talk) 21:29, 4 January 2020 (UTC)

Sample of price calculations

@Doc James: Would you like to reply to any of that? --Tryptofish (talk) 21:38, 4 January 2020 (UTC) struck --Tryptofish (talk) 21:52, 4 January 2020 (UTC)

User:Tryptofish what claims are you wanting me to address? If people want to discuss how to summarize this source I am happy to.[25] If they are saying that this source is unsummerizable or simple false well that is a different discussion. Doc James (talk · contribs · email) 02:44, 5 January 2020 (UTC)

@Doc James: Anything at all that you can provide useful information about, particularly if it helps in creating the best possible RfC we can produce, would be most welcome, in my opinion. As Sandy notes correctly below, however, it would be best to have such a discussion in other sections of this talk page, and not here.

My reason for pinging you had been, however, the comment about whether you do or do not appear to understand. I have concerns about that comment. Barkeep replied to me (the comment that is now below) that this would not be helpful to discuss here, so I struck the ping to you. When I logged in today, I was planning to raise the issue again at Barkeep's user talk page, but I see that Sandy has very kindly reached out to me, so I'm just going to pursue it with her at my own talk page. --Tryptofish (talk) 18:33, 5 January 2020 (UTC)

User:Tryptofish still not clear what you are asking about? Doc James (talk · contribs · email) 07:25, 6 January 2020 (UTC)

James, Trypto originally pinged you to my post above (19:27 on 4 Jan); that post ended up on this page from a moved discussion, and continuing discussion of some aspects of it does not belong on this page (behavior conduct issues rather than content/development of RFC), which is why Barkeep asked Trypto to strike the ping to you. To sum it up, we are working now to see if you understand the levels of problems in the price examples. I have had some concern that, since you have forbidden interaction with Colin (and you appear to read only posts that ping you), there exists a very real possibility that you aren't even aware of the concerns we are discussing. SandyGeorgia (Talk) 11:54, 6 January 2020 (UTC)

Yes I understand clearly that these prices are rough estimates. They are for one common dose at one point in time from one or more buyers or sellers in LMIC at the wholesale level. It is not the price for every dose and at all point in time or at the point of sale with all taxes etc included.

I also equally understand that medicine is not an absolute science but deals in shades of grey with most of what we know being approximates at best. That when medications are studied, the population included in these studies do not generally match the patient in front of me. Those in studies are generally younger, have way fewer comorbidities, are less often women, and many not be of the ethnic background of my patient. That simple because a p value is reached, does not mean a clinical benefit will occur, or that a lack of a p value being reach means the medication is useless etc, etc, etc. And yet we still include these details in Wikipedia without generally stipulating that these are not universal truths for all people at all points in time.

In fact it appears that what is being requested for prices of medications is something we do not demand of other areas of medicine. Yes it would be wonderful if medicine and economics were as precise as physics or math, but it is not. Providing rough estimates of benefit of a medication is similar to providing rough pricing / cost information of a medicine. Both are useful IMO and why I spend my free time adding them. Sure we disagree about the benefit of these rough estimates.

Now if people are interested in how we should make these rough estimates better I am happy to discuss this. If you feel providing any rough estimates for any where in the world is impossible well than I guess we have found our fundamental disagreement. Doc James (talk · contribs · email) 12:25, 6 January 2020 (UTC)

James All of that is helpful, and we know that you understand all of that, but we are trying to present something useful and accurate to our readers, who are not necessarily statisticians, physicians, pharmacists or economists. IMO we have not done that so far with drug prices.

I picked the simplest example from those I've seen so far, using a common medication (chlorthalidone), but the other examples we've discussed have bigger issues than the chlorthalidone example. I picked chlorthalidone because I've dealt with it so much as a Spanish-language interpreter in a free clinic, and because that example of how we represent cost is not plagued with as many SYNTH problems as we see in other drug articles. (Interpreting is tedious repetitive work, because working with dozens of different doctors, you end up having to tell different patients the same thing over and over, because you have to exactly repeat what the doctor says ... it would be much faster for me, the doctor, and the patient, if I just said, OK, do you want me to explain to them in my own words that they must cut their chlorthalidone tablet in half, but the standards and ethics of interpreting don't allow for that.) Chlorthalidone, in agreement with the Cochrane review, is commonly prescribed at 12.5 mg for hypertension, in my experience, without variation. We have presented one cost, based on 25 mg x 30, without considering different doses, what is the most common use, and for what indication we are giving that cost. Perhaps it would be more helpful if we continued all example discussion below in the new section you have started on DDD. SandyGeorgia (Talk) 13:17, 6 January 2020 (UTC)

Yes it is a rough cost. Sure some people take 12.5 and some take 50 mg. Do you want me to provide a price range for 12.5 to 50 mg? I can do that. I am happy to do that. It will still be accurate and useful if I do that. Doc James (talk · contribs · email) 13:27, 6 January 2020 (UTC)

James I cannot tell you what range to pick; that is original research/synthesis, and presenting information not supported by the source. What we should be looking to achieve (and the reason I picked this very simple example) is to present something useful and accurate to a common (layperson) reader of Wikipedia. We should not be using SYNTHESIS from multiple sources to do that, especially when our synthesis (in some examples), goes way beyond simple math, and includes a multitude of assumptions that are not transparent to our readers. Please have a look at the WP:CALC section of NOR, and let's continue this below in the new section you started. The other examples have many more problems than whether we are reporting 12.5 or 25 mg prices, and whether that is for hypertension or diabetes. SandyGeorgia (Talk) 13:38, 6 January 2020 (UTC)

You do not need to tell me what range to use. That is easy to find in the references. Multiplication is simple math. Doc James (talk · contribs · email) 13:54, 6 January 2020 (UTC)

The discussion is continued below; continuing this in two sections is unhelpful. Please understand that when you are synthesizing information from multiple sources to decide how to do that math, it is not simple math. SandyGeorgia (Talk) 14:02, 6 January 2020 (UTC)

Doc James, I will give you a simple example. How did you derive the specific information entered for chlorthalidone?

In the United States the wholesale cost is about US$13.50 a month.[26]

SandyGeorgia (Talk) 03:06, 5 January 2020 (UTC)

User:SandyGeorgia Sure. Cost per 25 mg tab of chlorthalidone is 0.45 USD per the ref. 25 mg is a commonly used dose[27] and the defined daily dose.[28] There are about 30 days in a month. 30 * 0.45 = 13.50

If people want the exact calculations for ever one happy to put them in as comments with refs to the DDD. Doc James (talk · contribs · email) 10:13, 5 January 2020 (UTC)

The above "calculation" makes it sound simple and source-based, but it isn't. Let's please avoid claims on this page that aren't source-based. It needs to be made clear that the source in the article neither defines a typical dose nor a typical indication, both of which are necessary to state a monthly cost of treatment if all one has is the average price of a 25mg pill. The Drugs.com link (which isn't used as a source for that price claim) also does not claim a "commonly used dose". Indeed as both Drugs.com and our article state, there are two uses of this drug: one for high blood pressure and one for what our lead calls "swelling" but is actually fluid retention (oedema). The first may be treated initially with a 25mg dose, which may be then risen to 50mg if insufficient response and up to a maximum of 100mg. The maintenance dose is 25 to 100 mg, with the link not providing any guidance as to where in that range is common. The edema indication is treated with 50 to 100 mg orally once a day, or 100 mg orally every other day; some patients may require 150 to 200 mg orally at these intervals. The BNF gives somewhat different guidance, perhaps reflecting differences in prescribing practice in the two healthcare systems. The article gives a monthly cost to treat, but neglects to mention the indication being treated. Wrt DDD, a measure designed solely for drug utilisation studies, it is most interesting that the paper linked above notes we used the World Health Organization DDD classification to analyse dose–response relationships. This classification implies that a dose of 25 mg of chlorthalidone is equivalent to a dose of 25 mg hydrochlorothiazide. This assumption is probably not valid. A recent cross-over trial suggest that chlortalidone is about 1.5–2 times as potent as hydrochlorothiazide with regard to antihypertensive efficacy. -- they admit using the DDD for a purpose that WHO explicitly warn against: "DDDs do not necessarily reflect therapeutically equivalent doses of different drugs and therefore cannot be assumed to represent daily doses that produce similar treatment outcomes for all products within an ATC category". We are similarly abusing DDD for our cost-to-treat claims, made all the worse since there is no published information about what exact indication a DDD was calculated for.

The question asked was "How did you derive the specific information entered for chlorthalidone"': this information was not derived from the source used, and indeed was not derived from any source offered. -- Colin°^Talk 19:05, 5 January 2020 (UTC)

James. OK, so far we are to gather that you chose to present an interpretation of a 25 mg dose for diabetes (apparently based on information from other sources). Why did you choose that dose and that condition, as opposed to another condition which may have a different dosage? And how is this not SYNTH? Why did you not choose the very common 12.5 mg dosage (even correctly cited at chlorthalidone on Wikipedia to a Cochrane review) for high blood pressure-- which requires the patient to split the tablet, since there is no such thing as a chlorthalidone tablet made in the recommended dosage for high blood pressure? SandyGeorgia (Talk) 19:37, 5 January 2020 (UTC)

Drugs.com says for hypertension "Manufacturer recommends initial dosage of 25 mg once daily; may be increased to 50 mg once daily. Some experts recommend dosage of 12.5–25 mg once daily based on efficacy and tolerance demonstrated in clinical studies."

Sure I picked a middle value. User talk:SandyGeorgia how do you propose summarizing? Doc James (talk · contribs · email) 02:40, 6 January 2020 (UTC)

James the original text you said was for diabetes, but now we are talking about high blood pressure, right? Does the source indicate which is the most common use? Also, you are citing drugs.com for recommended dosage for high blood pressure, but even our article better cites a higher quality Cochrane review in support of 12.5 mg (common dosage in my experience as well).

A meta-analysis of trials of chlortalidone for high blood pressure found that lower doses of chlortalidone (e.g., 12.5 mg daily in ALLHAT study) had maximal blood pressure lowering effect and that higher doses did not lower it more. (Musini VM, Nazer M, Bassett K, Wright JM (May 2014). "Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension". Cochrane Database Syst Rev (5): CD003824. doi:10.1002/14651858.CD003824.pub2. PMID 24869750.)

I don't believe 25 mg is a "middle value" for any condition for which the drug is used; is it? The drug is used for multiple conditions, and at multiple dosages. Does the source used give you the information used to decide which dosage to report for which indication?

I cannot recommend a way to summarize the information from the database because doing so appears to involve original research ala synthesizing of information from multiple sources, all of which brings us to the various problems mentioned throughout this page.

How do you propose summarizing, considering these problems? In order to move forward with the RFC, we have been searching high and low for an example of policy-compliant use of the source (NOR, V, SYNTH). This is separate from the whole question of whether we even should be putting database prices in the leads of articles, so we are hoping you will provide us an example, so that the RFC can present the best possible information for consideration of the broader problem. SandyGeorgia (Talk) 03:22, 6 January 2020 (UTC)

We can say "In the United States the wholesale cost is about US$13.50 a month as of 2019 for a dose of 25 mg per day." Which requires no synthesis. I do not see an issue with using the DDD for an approximate.

If you look at page 19 of the Cochrane review the 25 mg dose lower BP by 13.6 well the 12.5 to 15 mg dose lowered BP by 10.1. So not exactly equivalent. We see a trend to greater benefit with 25mg. Doc James (talk · contribs · email) 07:33, 6 January 2020 (UTC)

James, wrt "which requires no synthesis", are you accepting that all the price claims where articles state a cost per unspecified dose, or per day or month for some unspecified indication, and the source lacks a single and explicitly therapeutic dose value, fail WP:SYNTH? As for DDD, WHO reject this usage, saying it is a misuse of a technical metric designed solely for medicine population utilisation research. If it was a valid use, the MSH Price Guide would have a column for "Cost per day". They don't and so we can't claim that either: that would be WP:OR. As for 12.5 vs 25mg, the fact that sources disagree suggest there is No One Dose. -- Colin°^Talk 10:57, 6 January 2020 (UTC)

There are common doses. And there are common dosage ranges. Yes we all agree there is no one dose. WHO does not reject cost per DDD. They mention it as one possible price metric. What do you think of "In the United States the wholesale cost is about US$13.50 a month as of 2019 for a dose of 25 mg per day."

So if the MSH Price Guide had a column for "Cost per day" you would be satisfied? What about cost per DDD? Doc James (talk · contribs · email) 11:03, 6 January 2020 (UTC)

James, if the sources said what we claim in the article text, we'd all be much happier, though there would still be questions of WP:DUE, etc. None of our sources give "Cost per DDD". You are performing WP:OR. -- Colin°^Talk 11:36, 6 January 2020 (UTC)

We have sources that give "cost per DDD"[29] Doc James (talk · contribs · email) 11:49, 6 January 2020 (UTC)

James, when you say We see a trend to greater benefit with 25mg, who is "we" and what do you mean? SandyGeorgia (Talk) 11:59, 6 January 2020 (UTC)

Sandy in the table of the Cochrane review. Doc James (talk · contribs · email) 12:05, 6 January 2020 (UTC)

James The Cochrane review is a meta-analysis looking at many trials. Do you disagree with the summary of the review that is at chlorthalidone now? A meta-analysis of trials of chlortalidone for high blood pressure found that lower doses of chlortalidone (e.g., 12.5 mg daily in ALLHAT study) had maximal blood pressure lowering effect and that higher doses did not lower it more. SandyGeorgia (Talk) 12:16, 6 January 2020 (UTC)

Did you read the table on page 9? I provided the exact values from it. The long term dose for DI is recommended at 50 mg per day. Sure we have 12.5, 25 and 50 mg as common doses. But seriously we are splitting hairs.Doc James (talk · contribs · email) 15:43, 6 January 2020 (UTC)

I encourage you all to save this for the RFC. This is "answering the RFC question". It is not "writing the RFC question". Whether any part of this calculation should count as SYNTH is something that other editors can tell us during the RFC. We don't need to have this discussion today, and we should not have it here. WhatamIdoing (talk) 16:57, 6 January 2020 (UTC)

I'm trying to demonstrate why we need the first RFC before we can move on to the second. SandyGeorgia (Talk) 17:03, 6 January 2020 (UTC)

Actually Sandy I'm beginning to regret commenting on this. As an aside I found this and this saying "Mentioned in the NICE hypertension guidelines (CG127) at a dose of 12.5mg-25mg, but only available as a 50mg tablet.... Hygroton® tablets discontinued by manufacturer October 2013. New generic product available as 50mg tabx30=£88.04." and "chlortalidone has become very expensive (£88 per month) and therefore rarely used in the UK". The BNF confirms only 50mg tablet available in UK at £88 for 30. The price of "£88 per month" either assumes a 50mg dose or assumes that the unused portion of each tablet is discarded each day. I found a source suggesting the tablet is dispersible in water, which would permit a crude method of achieving a quarter-dose by taking only a quarter of the dispersed liquid, and discarding the remainder. That isn't optimal or economic. Anyway, it does indicate there is actually a notable cost factor influencing UK prescribing [which doesn't necessarily mean we have to quote a cost in GBP, merely note it is expensive in the UK so not commonly used], and that there may be reliable secondary sources discussing the cost issue in the UK, but also that the dose-cost calculation in the UK may not be straightforward due to only the 50mg tablet being available. It doesn't excuse doing original research or synthesis on the topic. -- Colin°^Talk 21:02, 5 January 2020 (UTC)

Yes that would be interesting to include.Doc James (talk · contribs · email) 02:40, 6 January 2020 (UTC)

Barkeep49, could you please move this discussion out of a section that we all agreed should not be here, to its own section where we can further discuss the example? SandyGeorgia (Talk) 14:38, 5 January 2020 (UTC)

I think it ran its course and trying to move it feels more disruptive than just leaving it here. Barkeep49 (talk) 23:45, 6 January 2020 (UTC)

Back to responses

I don't think that would be helpful. Barkeep49 (talk) 21:46, 4 January 2020 (UTC)

With that noted, and I do realize that there has already been discussion about whether to address these things here or in user space, I feel the need to say that I'm uncomfortable with having this kind of discussion here. To lay out a case against a particular editor, well, I'm just not comfortable about this. --Tryptofish (talk) 21:58, 4 January 2020 (UTC)

I also admit to some discomfort - hence my reply to Sandy above - but am hoping that parts 4 & 5 are forthcoming soon so that it can be judged in total. Barkeep49 (talk) 22:21, 4 January 2020 (UTC)

Wellllll ... I am over here cursing at now having totally lost Parts 4 and 5 to multiple edit conflicts :( :( I will start over, but yes, this is awkward. Do you still want it here? SandyGeorgia (Talk) 22:28, 4 January 2020 (UTC)

SandyGeorgia, oh no! It doesn't recover if you go back? Please go ahead and finish here at this point. If I need to walk back my decision to move it here I will. Barkeep49 (talk) 22:38, 4 January 2020 (UTC)

Perhaps you've noticed it takes me quite something these days to make even a simple post :) Essential tremor, eyesight, and no, I have never figured out why I so often lose the whole thing in edit conflict. Almost done re-composing in sandbox. Might not be as carefully worded. SandyGeorgia (Talk) 22:43, 4 January 2020 (UTC)

Part 4: Barkeep49 said:

In the time that I've been working on this conflict I've worked hard to treat all editors with respect. ... But I also remember acutely what it's like when you don't have the sysop flag. I wrote, in a line I had to remove from my ACE statement due to space constraints, "I remember what it’s like to feel put down not or otherwise dismissed because" I wasn't a sysop. We lose so many good editors for so many reasons and I'm sorry that the conditions here are such that we're going to (potentially) lose you. The places you've chosen to contribute in this dispute have been made better because of your contributions. I can only hope you decide Wikipedia remains worth it.

First, thank you Barkeep for the kindness in your response. As to whether Wikipedia remains worth it, I am first and foremost a medical editor, and next, was highly involved in the featured article process. Obviously, I would prefer to contribute medical FAs to Wikipedia, and I can better spend my time IRL if I can't do what I do best here. That's why I'm here, trying to resolve this conflict.

I do believe you have treated everyone equally, and with respect. I'm glad you raised the memory of what it feels like to be treated lesser when you don't have a sysop flag. In my case, I never wanted it, not only because it would be a distraction from contributing content, but because of one of my earliest experiences on Wikipedia. I was attacked by someone claiming to represent "we admins";[30] the position expressed there was completely fictitious, against every behavioral policy, and I had no recourse but to sit on it. A few months later, Raul appointed me FAC delegate, and a year later, that admin was desysopped. I understood then that a fact of Wikipedia's dispute resolution processes was that it takes a long arbcase and a lot of different instances of misuse of the tools to deal with admin abuse, so we regular editors had best simply accept and live with that reality.

In this instance, although you have treated everyone equally, and "adminning" the MEDLEAD RFC was not your remit (and no other admin came to your assistance), let's look at how non-sysops vs sysops have fared.

1. On this page, notice that the "remit to a single venue" is casually overlooked until I pointed it out. I am not sure a regular editor would assume so casually that they can break the ANI condition.
2. Look at the statements aimed at WAID and myself here; no response from anyone. In contrast, at the end of this section, notice how you are respected; the same poster is asked to dial back.
3. In this section, even while we are under sanctions, look at the alphabet soup thrown at me, after I tried to resolve an (admittedly) malformed RFC. AGF?

Yes, you have treated everyone equally and respectfully. But nonetheless, not everyone ends up being treated equally. I have a tough skin because of years of corralling cats at FAC, and having to stay above it and stay neutral in disputes no matter what was thrown at me. But the effect piles up, and then it is best to take a break for tea, and I'm sorry that occurred on your watch, which has been fair.

The reason it occurred when it did is because I so abhor the effects of backchanneling (something that was well understood during my tenure at FAC, and everyone knew if they cooked up support off-Wiki, I'd shut down their FAC ... and don't even think of emailing me about your FAC unless it is something like a serious COI, which did happen once, and I wrote the arbs). My issue is that if you had had the same conversation with those admins in public view, others would have had the opportunity to point out the items in Point 3, without us coming to this level of awkwardness after the fact. All of this thread could have been avoided; transparency works. I still feel awkward about putting this on this page, but understand why you wanted it here.

I believe Part 5 is now completely summarized back on your talk, but having lost a bunch of this post, I may need to go back and re-read everything to see what I have not addressed.

I think we have a way forward, in addition to the RFC, that doesn't require arb intervention at this point. I believe it has now been revealed that the premise that the ANI close was founded upon was faulty, and we can revisit. That does not mean we should not launch the RFC that we have worked so hard on. Best regards, SandyGeorgia (Talk) 22:57, 4 January 2020 (UTC)

Thanks for your thoughts and concerns Sandy. I'm going to respond to your statements in two pieces. The first will be at my user page and focus on my conduct and that of others. The second part is here and will focus on the core content issue (should updating pricing information be covered by the ANI embargo). I normally wouldn't split discussion like this, but in this case there are related conduct issues (relating to my conduct and the conduct of others) and content issues (related to an interpretation I made of an a community decision. As one part of that close makes clear that the question of pricing is related to a single forum, it's important that the content based discussion be held here, while this talk page remains an inappropriate venue for conduct decisions. This is an imperfect solution but all available solutions are imperfect and so we're stuck with trying to make the best of a difficult situation. Now onto my response.

You write "We have reams of evidence above that all of the drug price information we have presented to our readers in these 500+ examples is bogus...[removal of conduct related discussion addressed on my talk page]... I have been asking for a month, and we have not yet seen one single example of these database sources being used correctly." This is where I think we've been ill served that the people who feel that pricing information has been used correctly are not participating as actively as those who oppose it. Though I will note that at times both WAID and Trypto have presented modified versions that they feel is policy compliant. Those examples have not been satisfactory to you which is fine. Different Wikipedians can have different interpretations of our policies and guidelines. So I would suggest in fairness that your second sentence is really "we have not yet seen one single example of these database sources being used correctly in my expert opinion" (with the words in bold being my addition). This kind of situation is what the essay WP:POLSILENCE is talking about because everyone reading this should know that the silence here doesn't mean that everyone agrees. And at the end of all of this, that's why we're having an RfC to find out if people agree with you (and the interpretation of policy and guidelines that you and others who share your beliefs cite).

That RfC, hopefully, gets us a consensus that lets us start to adjust articles around drug pricing again. In the interim when asking to interpret the embargo I have been attempting to balance "What will keep this conflict from escalating?" with "What will serve our readers?". So adding disputed tags serves our readers but did not, in my evaluation, do enough to serve our readers to outweigh the potential that had to escalate the conflict. Similarly adding to a draft (which obviously won't be seen by most readers) does not offer enough benefit to our readers to outweigh the potential to escalate the conflict. In this case I made the judgement that it could potentially help the conflict (by possibly showing a formulation that some editors would find appealing) while also helping our readers. Of course it could also exacerbate the conflict. That's why I decided this was the time I needed others thinking. Through a mistake filled route we got here (which I've previously addressed and accepted responsibility for) we do have a second uninvolved sysop (L235) offering their related reasoning that reached the same conclusion. I have, for reasons I explained in more depth in the conduct response on my user talk page, not felt that any history was appropriate to consider in light of the ANI's consensus that there would be "no rehashing of grievances.". What I read you writing here is that you weigh the competing priorities of service to readers and conflict escalation differently. Which I understand and have and will continue to consider but also does not at this point change my interpretation of that balance. Best, Barkeep49 (talk) 04:07, 5 January 2020 (UTC)

I believe WAID's example were of a hypothetical "if-then" format; perhaps she will correct me. If Trypto has an example, then it would be most helpful if he would fill it in at User:Tryptofish/Drug prices RfC draft 2 so we can all understand it. And perhaps Doc James will answer the questions about how the data in at least one article was derived. SandyGeorgia (Talk) 06:31, 5 January 2020 (UTC)

Barkeep49, I may be wrong but I think WhatamIdoing offered an example of revising the text to eliminate the WP:NOR problem but accepted that then it introduced a WP:DUE problem. Indeed, I think their point at the time was that DUE was the underlying problem. I have not actually seen anyone (other than James) offer article text + source that they themselves believe is fully policy compliant for the purpose of a lead in a drug article, but if I'm wrong I would like to see it. On another note, I feel all this analysis over the ANI restrictions and whether they were broken and fairness of treatment, is really getting us into off-topic timesink territory. Further, when we launch an RFC, I really think WT:MEDMOS could do with all this ANI section being archived away. None of it is relevant to what our article text should say and what our guidelines should say. -- Colin°^Talk 10:18, 5 January 2020 (UTC)

Following up, I am fairly certain that the words in my expert opinion have never come from my mouth, and I really hope never been typed by my fingers. In real life, I would not be likely to promote myself as an expert even in areas where I am. On Wikipedia, we should deal in facts, not opinions, and I was explicitly addressing the facts that have surfaced after a month of reviewing these articles looking for one good sample. I believe my words covered the facts to date: I have been asking for a month, and we have not yet seen one single example of these database sources being used correctly. That doesn't mean there may not be one; yes, we are hamstrung because of silence of those supporting this data source. Re WP:POLSILENCE, I am not convinced that essay applies here, and I wouldn't even use it at the MEDLEAD RFC, where it might apply-- it's an essay. More significantly and to matters at hand, if we can get the chlorthalidone example moved to its own section, we can continue to explore now one example. SandyGeorgia (Talk) 17:55, 5 January 2020 (UTC)

Barkeep49 Trypto has clarified above, and his understanding is the same as mine. We do not have a policy-compliant example of these database sources being used (yet, we are working to get James to explain his derivation), and Trypto does not have one either, and there is not one on this page. We need to get older portions of this page archived (perhaps to a separately numbered archive of this page as I mentioned before); no mere mortal can work this way. We are not tracking in here what people have actually said, and what I said above about having not a single sample yet appears to be correct. SandyGeorgia (Talk) 20:34, 5 January 2020 (UTC)

I strongly suggest we archive the older sections at the top of this talk page to Wikipedia talk:Manual of Style/Medicine-related articles/Archive 10RFC, link that archive to the top of the remaining sections, separate out the chlorthalidone discussion with James above from the discussion that does not belong on this page, archive the rest of that discussion, and create a clearer work space here. SandyGeorgia (Talk) 20:38, 5 January 2020 (UTC)

We definitely do need to clear-up our workspace (I am having trouble following it and I can't imagine trying to jump into this fresh). I might not get around to do this for a day or so though. Barkeep49 (talk) 00:33, 6 January 2020 (UTC)

I think that Wikipedia talk:Manual of Style/Medicine-related articles/Archive Price RFC might be a more typical name. However, I don't care what it is, so long as some stuff gets moved into it soon! WhatamIdoing (talk) 03:54, 6 January 2020 (UTC)

I have always assumed that when SandyGeorgia talked about not having an "example of these database sources being used", that "these database sources" was a key qualifier. Database entries can't justify the importance of their own contents to the world, so the importance of including that data point needs to come from a different source. WhatamIdoing (talk) 03:39, 6 January 2020 (UTC)

WhatamIdoing Seeing the clarity in your final draft RFC has me hanging my head as I am now realizing how much we have not been always understanding each other on this page; no wonder it’s 800KB! I was stuck on-- if we can do it for Epipen, and we know we can, we need James to show us a policy-compliant example of what he is doing. I was concerned with how to deal with SYNTH, NOR etc, while you stayed focused on, how can we generate MEDMOS text. I suppose my repeated requests for a sample made no sense at all :) Very well done. (And I saw a post somewhere up there about everyone knowing your views on recent (five-year) sources ... I missed that ... could you fill me in on my talk? SandyGeorgia (Talk) 03:49, 6 January 2020 (UTC)

No need to take it elsewhere: Read (or remember any version of) WP:MEDDATE, and then just imagine what anyone involved in writing MEDRS would think about proposals to remove good content about a rare disease solely because the cited source was six years old. Wikipedia:Nobody reads the directions, but we love to guess their contents based on the shortcut and what someone told me several years ago about a completely different situation. WhatamIdoing (talk) 03:54, 6 January 2020 (UTC)

Ah, ha ... like me always having to update my sources at TS, when I know the older papers-- written in the heyday of TS research, when there was money it it and top minds wanted to be in the field-- are so much better quality than many of the newer ones. SandyGeorgia (Talk) 04:18, 6 January 2020 (UTC)

Collapsing not that important comment as suggested by Barkeep49. Nil Einne (talk) 14:17, 6 January 2020 (UTC)

Comment I don't really know where to leave this since it mostly concerns the whole page including the latest thread (at this time) but I don't want to make a new section so I'll just leave it here. I've been spending way too much time on Wikipedia so don't want to get drawn into this page although I've already read too much than I intended to but I wanted to make a quick comment as an outside non admin observer from what I read. While this is the talk page of an MOS page and so I understand unrelated stuff may come up, may I suggest given how things are going at the moment, that editor's try and keep the focus on how to improve the MOS page. This will include discussion on the RfC but such discussion should focus on the RfC wording. By this stage, I'm not sure it's particularly useful for editors to try to explain their PoV to each other too much since IMO it's clear it isn't helping much. In other words, comments should be something like "from my PoV, I think we need to add X to the RfC" or "from my PoV, the this part of the RfC should be reworded to". I appreciate that after you've done that, you may need to offer some explanation of why you feel so, and this may involve discussing your PoV, but I do feel there's perhaps a bit too much discussion which doesn't seem to relate to the RfC wording or other proposes changes to the MOS page. I appreciate the ANI directed all pricing related discussion here, but I don't particularly see much point for most discussion like the merits of DDD until the underlying issues are (hopefully) resolved via the RfC and I strongly suspect that was the intention of the ANI participants. Yes I appreciate there may be some irony here given my recent posts, and I'm personally often involved in diversions of a thread or discussion, but it does seem to me that in this particular case, there is need for focus, especially by those who care a great deal about the outcome. At the very least, it may be worth voluntarily collapsing such discussions. Also, I would urge anyone interested, to participate in forming the RfC. I appreciate this is a long and confusing process, but I don't see any attempt to exclude or ignore participants. So I don't think the community will take too kindly to anyone who clearly had the opportunity to help draft the RfC but either didn't take part or didn't participate enough to make a meaningful change, who later complains about the RfC wording. I'm going to AGF that no one will be foolish enough to think they can get away with saying after the RfC, okay great, but I can do X because the RfC never actually asked about it, so there was no consensus. As a final comment although my view counts for little, IMO the embargo should apply to everyone equally. This means Doc James can update or "fix" information, but so can everyone else. If an editor makes a change and others object because they feel it is making the article worse, then it should voluntarily be reverted. If editors just feel it isn't improving anything, then it can stay since whoever made the change clearly feel it's improving things. I appreciate this creates an unfair situation since those who feel the info needs to be removed because it's inaccurate etc, can't do anything. But those who feel it is useful, like Doc James probably often can. And I understand how frustrating it must be for those who feel the info we have is damaging, But it seems the best temporary solution. By letting Doc James etc fix identified problems, we lessen the risk editor's may feel 'well clearly there are problems, but I maybe they can be resolvable". Doc James etc have had some opportunity to demonstrate that it is achievable and how, and the community can evaluate the result. This gets back to what I said earlier namely there should be a focus on the RfC. While I understand the view that another day is too long, it has already been very long that another 2 months (I'm assuming we'll have an RfC result by then unless there's the dreaded 'no consensus'), is IMO not going to greatly change any damage caused by having the information. Nil Einne (talk) 14:17, 6 January 2020 (UTC) Nil Einne, regarding the focus of this page, we all agree, and have taken your comments on board several days ago. The section you are posting in now was (most unfortunately) moved here from a talk page, after I needed calming tea from one incident, and I think we all wish it could have been moved back, but we are where we are, and moving forward. Conduct issues are separate from RFC issues. I'm sorry you had to read through all of that, which is wholly off-topic on this page, but it ended up here as a result of good faith on the part of the admin who put it here. SandyGeorgia (Talk) 14:46, 6 January 2020 (UTC)

DS

I have a procedural/administrative question. I see that there is a DS notice at the RfC draft page, based on this being related to WP:MOS. It had never occurred to me that we are working under a DS situation here. Are we? --Tryptofish (talk) 20:20, 4 January 2020 (UTC)

I put it there so respondents wouldn't fall afoul-- yes, we are. The same DS notice was added at the talk page of the MEDLEAD RFC by Barkeep (didn't stop people from misbehaving, though :) SandyGeorgia (Talk) 20:48, 4 January 2020 (UTC)

@Barkeep49:, sorry to saddle you with anything more, but you or another admin need to do the Wikipedia:Arbitration Committee/Discretionary sanctions#Awareness for this talk page. I think that includes an edit notice here. --Tryptofish (talk) 20:59, 4 January 2020 (UTC)

Was I not supposed to place that template at the new RFC? I am not aware of the intricacies; I placed it to follow suit on what was done at the other RFC, so we wouldn't forget to let people know when they come to the RFC ... SandyGeorgia (Talk) 21:08, 4 January 2020 (UTC)

No problem there. Anyone may place that template (although I think it goes at the top, not the bottom). --Tryptofish (talk) 21:10, 4 January 2020 (UTC)

Ah ... I first put it at the top, but then thought we would scare people off, and they wouldn't participate ... so I removed it to where discussion would begin. Well, not to worry, I'm sure Barkeep will fix it before launch at any rate. I was just afraid we'd forget. SandyGeorgia (Talk) 21:15, 4 January 2020 (UTC)

(edit conflict)I'm happy to fill out DS related paperwork but when I went to put the edit notice here it was already present. I've been handing out individual DS alerts as people join in the conversation here (I some how had missed Trypto until just now and have a couple others who've joined in the last week who I don't think have notices). As of now there are no page restrictions for this page (e.g. 1RR) so I didn't think an edit notice was necessary. Best, Barkeep49 (talk) 21:21, 4 January 2020 (UTC)

Yeah, I kind of got a laugh out of getting the alert to me right after I posted here. And I just now saw the notice at the top of this page, so I'm dope-slapping myself for not noticing it earlier. However, I know that there is a recent ArbCom rule that an edit notice, which is something that appears in the edit window whenever one makes an edit, and not simply a top-of-page template, which is what we have here, is required. Only template editors and admins can do that. And DS do apply to things like personal attacks, regardless of individual page restrictions. --Tryptofish (talk) 21:26, 4 January 2020 (UTC)

Tryptofish, yeah if I, or another uninvolved sysop, enabled some sort of page restrictions like 1RR an edit notice is required. However there are no such restrictions yet levied on this page. So there is a general notice that it falls in the scope of DS and there is specific editor awareness through DS alert but no edit notice is needed. Best, Barkeep49 (talk) 21:44, 4 January 2020 (UTC)

OK. That's why they pay you the big bucks, and not me! (Not to mention that mop!) --Tryptofish (talk) 21:46, 4 January 2020 (UTC)

IMO it feels superfluous at best, and I'm concerned about it discouraging participation. But I wouldn't remove it without asking at one of the ArbCom noticeboards. Although the page is in the MOS "namespace", the contents have very little to do with the MOS. WhatamIdoing (talk) 03:48, 6 January 2020 (UTC)

@WhatamIdoing:, I'm pretty sure you can move it to the talk page, as was done at MEDLEAD RFC. SandyGeorgia (Talk) 12:38, 6 January 2020 (UTC)

Defined daily dose (DDD)

There has been a fair bit of discussion on whether or not DDD is appropriate for rough estimates of medication prices. We have a number of sources which support this use. Specifically the government of Canada says the DDD can be used to provide "a rough idea of the daily cost of utilizing a drug in a specific formulation" and "provides a rough idea of the cost differential between the two formulations of the same drug". We are using it for the first purpose. Doc James (talk · contribs · email) 11:19, 6 January 2020 (UTC)

James, I think our priority right now should be to launch an RFC. There's a whole section at WHO on DDD and specifically on its use and abuse. It very much argues against the use we are doing, and why their sole focus on DDD is for utilisation. And yes at a crude population level, it could give a rough idea of the cost of utilising that drug in a specific formulation. That's up to researchers to judge if it meets their needs, not Wikipedians. What it doesn't represent, is the dose that an individual patient might take and thus cost them per day or month. Repeatedly MSH and WHO have to remind us it is not a therapeutic dose nor does it represent average prescribed doses (which themselves vary from country to country and year to year) . Wrt your second example, yes WHO give that as an example of how it could be used to compare the cost of e.g. 5mg tablet vs 10mg/5ml syrup. But, if you think about it for a moment, all you are doing with that is agreeing on an arbitrary dose to compare two formulations: the actual dose need not be representative of any therapeutic value. It's just a number.

Furthermore, there are no sources saying what indication the DDD was calculated for or what choice they made if their own source lacked a clear "maintenance dose" value (they sometimes pick initial and sometimes max). When we have a drug for multiple conditions (epilepsy, neuropathic pain, mental health disorders), the DDD is totally useless because the cost to treat really depends on what indication you are treating, and you don't know that. DDD is a red herring. Our only source that offers it (MSH) warns about its careful use and does not themselves use it to give a cost-per-day, which should be a clear warning sign that this is inappropriate original research. The other sources (Drugs.com, BNF, NADAC) do not give a DDD or indeed any one dose, so any attempt to use them to give a cost per day/month/treatment is both original research and synthesis of sources. -- Colin°^Talk 11:50, 6 January 2020 (UTC)

Yes the DDD only provides a "rough idea"[31] of the daily cost. Yes it does not provide "detailed" description of the cost. That is why we use the term "about". Doc James (talk · contribs · email) 12:14, 6 January 2020 (UTC)

This source converts the MSH data into price per year with "Carvedilol is listed on the Management Sciences for Health International Drug Price Indicator Guide with average price per tablet of $0.20 or $144 per year for twice daily treatment"[32] Doc James (talk · contribs · email) 12:21, 6 January 2020 (UTC)

James, it is so "rough" because it is for population studies. The kind where someone says we might spend £1.5 million on a drug, but it probably doesn't change the point if the actual cost is £1 million or £2 million. Wikipedia is giving a price in dollars and cents for one patient, and then waving the word "approximately" about as if that absolves all sins. As for the paper from 2011, it is wonderful what Google can turn up. I tried to find the record they quote. Carvedilol in 2011 gives three doses. The 6.25mg tablet has a median (only) supplier price of 0.0414. At the DDD of 37.5, is six a day x 365 = $90. The 12.5mg tablet has no suppliers and a median buyer price of 0.1669. That's three a day x 365 = $182. The 25mg tablet has no suppliers and a median buyer price of 0.2041 which is pretty close to the "average price per tablet of $0.20" they mention. But wait, 25mg doesn't go into 37.5mg, and they mention "twice daily treatment" so I guess they mean 50mg per day. That price is twice a day x 365 which is $149. Not quite the $144 they give but close.

What does this tell us? The paper mentions "per tablet... twice daily" and yet there is no tablet dose that is 18.75mg. This is because DDD is not actually a therapeutic dose that any patient might take. Their maths mostly work at 50mg. Looking at Drugs.com we see the 6.25, 12.5 and 25mg tablets "twice a day" being the initial and then tritrated "if tolerated" up to the maximum, but lots of other dose options too. That really isn't the paper to convince anyone that DDD is a useful measure, when they don't use the DDD of 37.5mg but instead 50mg. Further, we see that if we did try to use the DDD, we get yearly prices of $90, $149 and $182 depending on which tablet size we chose. All three tablet sizes make sense for individual patients and indications and stages of treatment. This is why we don't allow original research: the numbers are effectively random. -- Colin°^Talk 13:25, 6 January 2020 (UTC)

The argument here is similar to saying, "doses of medications are random". Please note they are not. There are well accepted dosage ranges. Do we need a RfC to ask "are dosages of medications random" as that is the argument you are making? Doc James (talk · contribs · email) 13:32, 6 January 2020 (UTC)

No, I'm saying that original research produces random numbers. The source gives three pill sizes and none of them are 37.5mg or 18.75mg. You say we should use DDD and then you cite a paper that looked at the DDD of 37.5mg and went ??? that's not gonna work and picked 50mg instead. Decisions decisions decisions and each time a different result. If the researchers had searched in 2010 rather than 2011, they'd only have the 6.25mg tablet, and nobody is taking six a day unless they have no other choice. -- Colin°^Talk 13:59, 6 January 2020 (UTC)

On the big picture, we have (mis)spent a lot of bandwidth on this talk page trying to sort out the various problems (SYNTH, NOR, WEIGHT) in price text in our drug articles. We went down that path when we (I?) were (was?) seeking one good example of drug pricing information from these databases that did not have SYNTH problems, and did not find one. We can save a good deal of time by having you actively engaged in those discussion, James, and I'm not sure forbidding pings will help us move forward. Do you read all posts here, or do we have to ping you to each post? I ask because I really hate this pingie-thingie myself; when I come to a page I participate in and follow, I pull up a diff of everything since I last read, and the extra pings are just an irritation. Do we need to ping you, and if we are trying to sort out the price data in our drug articles, how can we assure you see the discussions if Colin is forbidden from pinging you? SandyGeorgia (Talk) 12:25, 6 January 2020 (UTC)

I guess the question is do we have a fundamental disagreement? Do you believe it is possible to provide a rough estimate of the cost of a medication in LMIC or other region of the world? This can be broken down into two parts:

1) Do you believe it is possible to provide a typical dosage range for a medication in adults used for a specific purpose?

2) Do you believe it is possible to provide a rough price for an amount of medication in LMIC?

The popular press manages to determine the cost for a course of treatment "Sovaldi treatment cost $1,000 a pill, or $84,000 over 12 weeks." The Guardian managed to determine the typical dose, the typical duration of treatment, and the rough cost per dose than do the math. [33]. What you call SYNTH and NOR is simple WP:CALC. WEIGHT is clear per sources such as Doctors Without Borders.[34]

The next question than becomes one of knowledge parity. The popular press generally just writes for wealthy people in the developed world. Do those in LMIC deserve to have pricing information for medications they may care about? My position is yes, and we have excellent sources such as MSH that provides these details. Doc James (talk · contribs · email) 12:55, 6 January 2020 (UTC)

I am thinking these could be two useful questions for the RfC. User:WhatamIdoing User:Tryptofish wondering your thoughts? If either of these are false than we would all agree that it is impossible to list a price for a medication for an area.

Other questions could be is multiplying a dosage range for a purpose by the rough cost estimate by a time period WP:CALC or WP:SYNTH and are prices of medications WP:DUE.Doc James (talk · contribs · email) 13:17, 6 January 2020 (UTC)

James, these aren't yes/no questions that apply in all cases. We can find drugs with one standard dose and we can find drugs with many suppliers in the MSH. But in the general case, no you can't. There are multiple indications, multiple dose ranges, multiple patient ages, weights and liver function and existing medications.

What matters isn't so much right now these abstract questions, which are complicated to answer, but actual sources and actual texts in actual articles, which despite months of discussion have not changed. If you believe these things are possible, and possible generally for most drugs (over 500 have these prices), then argue the case when the RFC is posted. There is a reason why WHO/HAI have only 14 core global medicines and survey at most 50 (at specific strengths and formulations for specific indications and patient age and specific treatment duration or daily dose). The MSH database is way too sparse to be a reliable source for 500+ medicines. It is officially not a reliable source for international reference price if there are not many suppliers. That's WHO/HAI official policy. Which trumps any Wikipedian opinion. -- Colin°^Talk 13:34, 6 January 2020 (UTC)

James, it is helpful to have you fully engaged in understanding that these are complex questions even for those of us who understand the sources and understand SYNTH. The problems we have now in more than 500 articles go way beyond what an average reader, or even RFC respondent, can understand. Diverting energy now towards addressing those problems is a distraction from the RFC. But, we must continue to make sure you are fully engaged with us in sorting out these problems. We have this split now between the sample price discussion above of chlorthalidone, and this section; let's continue here. Do you now see that what we have presented to our readers for chlorthalidone, in the lead of an article, is neither useful nor accurate nor in accordance with NOR ? Sorting out that we have a big problem in 500+ articles is a very different matter than deciding via RFC whether drug prices from databases should even be in our articles at all. SandyGeorgia (Talk) 13:55, 6 January 2020 (UTC)

After our discussion what I see is that what we have in our article on chlorthalidone is a perfectly reasonable estimate of the price per month of the medication in question. Looking at the references yes 12.5 mg can be used, 25 mg can be used, and 50 mg can be used. Could the price range from 6.75 to 27 USD? Sure. I prescribe medications that range in price from pennies to 10,000s per dose (a million fold difference). A 2 or 4 fold difference fits well within the range of "about".

Additionally I believe our readers are smart enough to realize this. Doc James (talk · contribs · email) 14:14, 6 January 2020 (UTC)

I chose chlorthalidone as a starting example because it is the one of the simplest I have seen in these discussions; the text we have presented on other drugs has far bigger problems. It is your opinion that our readers can sort it out. It is my opinion (and others) that what we have here is a problem not only of LEAD, NOTPRICE and WEIGHT, but a problem of SYNTH. Do you see why we need a separate RFC on that matter before we move on to the wider RFC? How can we ask Wikipedia editors whether price information should be included, when we do not even have price information that we all agree conforms with other policy ? SandyGeorgia (Talk) 14:31, 6 January 2020 (UTC)

James, mathematically, you cannot say "the wholesale cost is about US$13.50 a month" if you feel the price is only accurate to within 2x or 4x approximation and you don't care if 12.5mg, 25mg or 50mg tablets are used. Our readers trust what we write and really no amount of "about" or "approximately" covers us if we give a price to four significant figures. It is one thing if our sources use that language, but it isn't a sticking plaster for dodgy maths. They may look at treatment X and treatment Y and conclude that treatment Y is 2x or 4x more expensive than X whereas in fact the difference in price is down to the random chance of original research. Btw, at Carvedilol we give a "wholesale cost per dose". What does "per dose" mean? The dictionary tells me it is how much you take at one moment of time. So a DDD of 50mg but taken twice a day would produce a 25mg dose, but in a once a day sustained-release tablet would produce a 50mg dose. I don't think there's any consensus that we should provide prices in dollars and pence and then excuse our original research random results by saying the prices are only meant to be accurate to two orders of magnitude and our readers are bright enough to know that. But you can try that claim at the RFC. -- Colin°^Talk 14:35, 6 January 2020 (UTC)

On all of this about the "rough estimate": Editors who are responding the RFC are welcome to express opinions about whether the example sentences would be clearer if they included words like "rough estimate". Editors might advise us, for example, that the current examples aren't great, but that if we added words like 'Using the defined daily dose to create a rough estimate of costs' to the start of the sentence, they'd be satisfied. Or they might tell us to use fewer significant figures, so that "about $13.50" becomes "on the order of $10". Or they might say not to combine the DDD with the MSH's price per pill with the Canadian source about using the DDD this way, and tell us to just use the price per pill. They might even tell us to omit the dollars-and-cents and instead search for a source that would let us write "generally considered inexpensive". They might tell us all sorts of things. But again, all this is "answering the question", and the goal on this page today is only to write the question. Answer the question next week, please, and on the other page. WhatamIdoing (talk) 20:31, 6 January 2020 (UTC)

Generally there is one main indication and regardless typically most if not all indications generally use similar doses. Most medication have a fairly narrow dosage range. Some of the sellers offer the medication in more than LMIC 100 countries. Qualifiers applies to all evidence within medicine and most of the time we have no idea how the qualifies affect claims of benefit as they have just not been studied. But these still not prevent use from providing an overview. Yah sure MSH is not as good when there are fewer supplies. Same as a meta analysis is not as accurate when their are fewer RCTs. Doc James (talk · contribs · email) 13:51, 6 January 2020 (UTC)

When our math is doubly wrong (12.5 vs 25 mg for chlorthalidone), we cannot say we are within a "fairly narrow dose range", and that is only one very simple example. SandyGeorgia (Talk) 13:57, 6 January 2020 (UTC)

Are you saying 12.5 to 25 mg is a wide dosage range?

Now back to the question at hand. Do you believe that there is an accepted dose range for a specific indication in a typical adult? We can go with this if you do not want to use DDD. Doc James (talk · contribs · email) 14:09, 6 January 2020 (UTC)

I am saying we don't have sources to back up the information we are giving our readers without using SYNTH, and our personal opinions, what we have experienced or seen as physicians or people interpreting for physicians, should not be coming in to play at all. We do not have sources that back up the information we have presented unless we do synthesis. And we do not have sources that, according to DUE WEIGHT, tell us what to present in the example of chlorthalidone. The problems in other articles are worse. This is probably why we should be respecting WP:NOTPRICE and not presenting these prices at all based on database sources, but that is my opinion.

What would be helpful to see is whether you have any example, for any drug, that discusses drug cost in a way that does not breach, IMO, WP:SYNTH. Then we could more accurately discuss WP:WEIGHT and WP:LEAD issues. SandyGeorgia (Talk) 14:22, 6 January 2020 (UTC)

What I am saying is we do have sources that provided accepted ranges for medications plus we have sources for DDD. It is thus a simple WP:CALC to convert price per dose to price per day for a typical dose or dose range which is more useful than just the price per amount by itself. Doc James (talk · contribs · email) 14:27, 6 January 2020 (UTC)

So do you see that we have a policy disagreement as to whether this is simple math without synthesis that needs to be put forward in an RFC, because we got ZERO feedback on the matter when we posted a question to the NOR noticeboard? And that we need to sort that out before we can solve the bigger question? We have not, throughout these discussions, seen one straightforward example of drug price information from the sources used in over 500 articles that we can all agree does not involve SYNTH. SandyGeorgia (Talk) 14:35, 6 January 2020 (UTC)

We have "As of 2016 a 12-week course of treatment costs about US$84,000 in the United States, US$53,000 in the United Kingdom, US$45,000 in Canada, and about US$500 in India.Hill A, Simmons B, Gotham D, Fortunak J (January 2016). "Rapid reductions in prices for generic sofosbuvir and daclatasvir to treat hepatitis C". Journal of Virus Eradication. 2 (1): 28–31. PMC 4946692. PMID 27482432." Not sure if you consider this SYNTH aswell.

But yes lets put the SYNTH versus CALC discussion to a RfC. Doc James (talk · contribs · email) 14:53, 6 January 2020 (UTC)

it isn't a simple calculation to convert. Firstly the sources don't give a price per "dose" either. They give a price for one tablet size or another. Even if we thought DDD was acceptable (which WHO, who invented it, don't) it doesn't necessarily divide into specific tablet sizes (see above for 37.5 DDD) so no there is not a straightforward calculation. The drug may be once a day or twice a day or some other option, and this may depend on what kind of tablet you take. These are all things a doctor will decide at prescription time. The most you can do, James, is convert a price per day to a price per month, assuming it is obvious the indication requires long-term treatment, of course. -- Colin°^Talk 14:39, 6 January 2020 (UTC)

Yes we known that you think that WHO does not think that it is acceptable. But it does not appear that WHO thinks that it is unacceptable. Doc James (talk · contribs · email) 14:53, 6 January 2020 (UTC)

I think Nil Einne (above, collapsed) has a point. Most of this involves one party making a claim and then another party disagreeing. We can do that in the RFC. I think this should wait till the RFC, when other voices can chip in with support or rejection and hopefully a consensus form. There's zero evidence this discussion is heading towards any consensus, that's why we are having the RFC, to get other voices. -- Colin°^Talk 14:55, 6 January 2020 (UTC)

RfC are we allowed to multiple the "typical dosage range per day of a medication in adults as used for a specific purpose" by the "price per dose" to get the cost per day for a specific purpose? Doc James (talk · contribs · email) 14:58, 6 January 2020 (UTC)

Example article text + source please, which gives either of those things, singular. -- Colin°^Talk 15:15, 6 January 2020 (UTC)

We probably don't have an example of an existing article that talks about "typical dosage range per day of a medication in adults as used for a specific purpose" because MEDMOS has said "Do not include dose or titration information except when they are extensively discussed by secondary sources, necessary for the discussion in the article, or when listing equivalent doses between different pharmaceuticals" for years and years and years, and the appetite in the community for putting easily vandalized dosage numbers into articles has basically been zero. Let's please not try to change that rule today. (I'm willing to talk about that later, and I even have some ideas about how to manage vandalism, but whether that information is encyclopedic is a discussion for another time.) WhatamIdoing (talk) 20:20, 6 January 2020 (UTC)

User:Doc James, my thoughts on your second suggested question ("Do you believe it is possible to provide a rough price for an amount of medication in LMIC?") is that the question is too general for other editors to grapple with. I can tell you my own answer (i.e., I believe it's possible to do this at the wholesale but not retail level, for some but not all drugs, and that most articles could be improved), and I believe that at this point, my answer has more factual and policy basis than the beliefs of >99% of Wikipedians, no matter what their beliefs are. But I don't think that asking about uninvolved, non-expert editors' beliefs helps those editors help us. The current RFC draft is essentially three worked examples of how the most common source has been used. We're inviting editors to look at that and tell us how much better we can make it. That's more likely to produce informed comments than merely asking editors what they believe ought to be possible hypothetically. WhatamIdoing (talk) 20:46, 6 January 2020 (UTC)

Reboot

Allright, we are spinning our wheels. (Not complaining, since this is much better than the alternative, which was silence.) Let's start over.

James, on this page we have been discussing a SYNTH problem. You believe this is simple math, others do not. You believe using other sources supports the math you are using to add text cited only to a database. Let Colin pick a typical example, and you write text that incorporates all of those other sources you are using to support your math, and shows how you have used them. Then we can talk SYNTH vs. CALC. And from there may emerge an example to be used for an RFC. SandyGeorgia (Talk) 15:07, 6 January 2020 (UTC)

I dont' want to be accused of cherry picking. James cites Carvedilol above. Try that. -- Colin°^Talk 15:15, 6 January 2020 (UTC)

Sure lets. "In the United States, the wholesale cost per dose is less than 0.05 USD as of 2018."NADAC as of 2018-12-19". Centers for Medicare and Medicaid Services. Retrieved 22 December 2018."

Per the reference all doses at that point in time were less than 0.05 USD per tablet. Doc James (talk · contribs · email) 15:47, 6 January 2020 (UTC)

Your source does not say what string you searched with. If I search with "Carvedilol" I get prices less than $0.05 per tablet, though the source does not say if one "tablet" equals one "dose", nor that I need to take that twice a day (so costing me twice as much). If I search with "Carvedilol ER" I get prices of $6.44, $6.61, $7.08 and $6.57 for each 10, 20, 40 and 80mg extended release tablet. Again the source does not say that I only take that once a day. See also Drugs.com Carvedilol Dosage and Carvedilol Prices. So 5 cents or 7 dollars? -- Colin°^Talk 16:03, 6 January 2020 (UTC)

OK, the first example missed by a factor of 100. (Imagine our readers trying to sort that ?!?!?!) James got to choose that example, now Colin gets to choose one. Next. SandyGeorgia (Talk) 16:36, 6 January 2020 (UTC)

Can I ask all involved (Sandy, Colin, James) how this is helping us move forward with the RfC? If you all agree it is helpful I don't want to stand in its way and I'm glad for James' involvement as well but this seems to be continuing the conversation that has been ongoing for as long as this dispute. If it's not helpful maybe it's best put aside for now. Barkeep49 (talk) 18:02, 6 January 2020 (UTC)

Barkeep49 My reasoning: there is resistance on this page to launching WAID's RFC, and I am working to build understanding that there is a logical reason why we need that RFC before a broader one. Realizing the possibility that James was not following all of the discussion here earlier (possibly because of disallowed pings), I tried to start over and go through an example with him. We can probably close this off now; I hope we can see that the first (WAID) RFC is not without merit, and there really is a need to consult the community on how to use these sources, since we got no response from the NOR noticeboard. SandyGeorgia (Talk) 18:06, 6 January 2020 (UTC)

I agree per comment I made above, though this has at least provided an excellent example of when I say many of the prices are incorrect, we aren't just talking rounding errors from choosing a 30-day month! "Some of our article prices are incorrect by a factor of 100". Original research -> random numbers. Anyway, back to the RFC. -- Colin°^Talk 18:20, 6 January 2020 (UTC)

I think it's been helpful in clarifying the NOR concerns, and thank Doc James for participating. --Ronz (talk) 19:33, 6 January 2020 (UTC)

Barkeep49, to be honest, what's the most frustrating here is that a fait accompli was apparently rewarded. Generally speaking, when it becomes apparent that a large-scale change was not clearly supported by consensus, especially when it was also against policy, it should be reversed, not maintained, during the discussion on it. WP:NOPRICES is currently policy. If we want to have an RfC on whether it should or shouldn't be, we should have that, at WT:NOT (not here). Policy can change. But until and unless it does, the status quo ante should have been restored, and that was that prices are almost never included. Seraphimblade ^{Talk to me} 01:56, 7 January 2020 (UTC)

Seraphimblade, I hear you. When I first started trying to mediate this, I thought similarly and looked for the status quo version to roll this back to you. However, I have become convinced through education by those with institutional memory and lots of reading that this dispute goes back years and, at various times, there has been more support for including pricing information. Knowing that an RfC has been promised it's possible that some number of those who are in favor have not participated, especially as this page grew and grew and grew in length. I don't think anyone, on any side of this disagrees that WP:NOT plays an important role in this discussion. Best, Barkeep49 (talk) 02:11, 7 January 2020 (UTC)

This part of this question has been under discussion in various ways, off and on, since at least 2014. The practical options are:

• leaving it alone, because the difference between having this content in articles for 59 months or for 61 months is basically a rounding error, or
• blanking a few lines from more than 500 articles (and re-blanking it again in some cases, because not everyone will notice edit summaries, etc., and assume it was an accident or otherwise not warranted), and then maybe needing to restore all of those a month or two later.

I prefer not to blow up people's watchlists over this. Let's do it right, once, when we have a solid agreement on what "doing it right" looks like. WhatamIdoing (talk) 02:25, 7 January 2020 (UTC)

@Seraphimblade: and my concern was, in what order do we approach these issues (NOT, DUE, LEAD, WEIGHT) when it became apparent we didn't even have a policy-compliant (NOR) example to put forward (in the opinion of those who believe the samples are not CALC, rather OR). If we put forward a RFC just to determine if the community supports pricing in articles, and find out that the community does support drug prices in articles, does that endorse these databases being used? We have to get this question addressed first.

Also, when I was digging around to sort all of this out, it was quite disconcerting to find that we had redirects away from NOT (WP:PRICE, WP:PRICES, that earlier pointed to NOTPRICE)) to an essay, and the first line of that essay stated that Wikipedia had no policy on prices. That misleading info stood for four years (I corrected it last week). So how do we know how much of the community was misinformed by a changed redirect that pointed at faulty info? SandyGeorgia (Talk) 02:45, 7 January 2020 (UTC)

(edit conflict) SandyGeorgia, well, the junk essay was certainly a problem, saying "There's no policy on prices" when, well, there was one. I'm generally in favor of giving wide latitude on essays, but that stops at blatant factual inaccuracies, and "There is no policy on prices" is factually false when, well, there most certainly is one. But I think that's a bit backwards. If the determination is that we shouldn't include prices at all, the question of sources for them becomes entirely moot. It's only if we determine they should be that we even have to care about how to source them. Seraphimblade ^{Talk to me} 02:48, 7 January 2020 (UTC)

Even the strictest reading of WP:NOT indicates that Wikipedia should include at least some prices. Therefore the question is always "when and how?" rather than "always or never?" WhatamIdoing (talk) 02:54, 7 January 2020 (UTC)

(edit conflict)Well, sure. In exceptional cases, we should include prices. I don't think anyone would argue that, for example, I Am Rich should not include pricing information; that's why it's notable. There was another example I can't recall right to hand of a single treatment that costs over $2 million, and that price has similarly been extensively covered in reliable sources. We should include that there. In the Shkreli incident, price was the main issue, extensively discussed by reliable sources, and so the article must include information about it. But for general articles about products, drugs or otherwise, where the price is mentioned but not especially significant? That's exactly what NOPRICES is meant to exclude. In exceptional cases, we include prices. But most of the immediate cases aren't exceptional, and we don't include them routinely. Seraphimblade ^{Talk to me} 03:02, 7 January 2020 (UTC)

And if other editors agree with you that, e.g., the price of WHO Essential Medicines (whose "essentialness" is partly a factor of their low cost) aren't "exceptional", then eventually we would remove those prices. In between now and then, it's IMO better to leave well enough alone than to guess that your view is the one that the RFC(s) will eventually produce. Wikipedia:There is no deadline for this, and even if there were, the deadline would not be "1497 days after the date was added to diazepam". WhatamIdoing (talk) 19:31, 7 January 2020 (UTC)

@Seraphimblade: Here is what editors possibly saw for years. Yes, in which order to approach this is a dilemma. There was a point that I thought we just needed to go back to ANI, present the data developed by Colin showing how many editors have tried to remove this data over the years, and look for a new directive. That decision is above my paygrade. So, in which order do we proceed now? It is my opinion that WAID has a well-crafted RFC, while the alternative needs considerable work towards refinement, and the experience of WAID to turn it into something less confusing. But yes, there is a risk we are approaching this in the wrong order. I dunno; I am hoping Barkeep has an approach to AN that will help sort all of the different factors, but including that we don't know how many editors were misled for four years. Add to that the OTHERCRAPEXISTS meme that even FAs have prices (some of which are compliant with NOTPRICE, and some of which shouldn't even be FAs, I say with former FAC delegate hat on), and we have lots to sort. SandyGeorgia (Talk) 02:58, 7 January 2020 (UTC)

Discussion at the Administrative Noticeboard

I have notified several individual editors but also noting here that I have posted at the Administrative Noticeboard. Barkeep49 (talk) 03:45, 7 January 2020 (UTC)

RfC about the ordering of sections within Diseases or disorders or syndromes

To my thinking, Diagnosis is intimately linked with Signs/symptoms/Characteristics/Presentation and should follow it (hence proposal is to move it up two slots to follow that section. I have come to this way of thinking when writing leads that the information flows more naturally that way. This also allows for (possibly) less duplication as similar material is adjacent in the article. I can't see that there was much discussion about the original order. Cas Liber (talk · contribs) 13:25, 7 January 2020 (UTC)

For those unaware, this stems from editwarring at Schizophrenia, where Cas had re-ordered the narrative of the article, and Doc James re-instated his preferred, set order. This re-ordering of content in the body and lead of articles according to a personal preference has been occurring for years, although I am mostly aware of the damage that results to Featured articles, when the narrative is forced to fit a certain order not prescribed by any guideline, and certainly not by policy.

I am unclear why we are !voting in a community-wide RFC on an issue that surfaced only hours ago, and has not even been discussed by the principals. In fact, it's apparent that the first respondents are not even sure what they are !voting for. Casliber I suggest you withdraw the RFC tag, so that you can re-submit a properly positioned RFC after Doc James has explained his rationale for edit warring, and discussed the specifics of the flow of the narrative at Schizophrenia. SandyGeorgia (Talk) 16:36, 7 January 2020 (UTC)

Should the Diagnosis section be moved up two slots in the suggested list?

• Support Cas Liber (talk · contribs) 13:27, 7 January 2020 (UTC)
• Oppose --Ozzie10aaaa (talk) 14:02, 7 January 2020 (UTC)
• Oppose --QuackGuru (talk) 14:12, 7 January 2020 (UTC)
• Polling is not a substitute for discussion, and that needs to stop right here, right now. SandyGeorgia (Talk) 15:12, 7 January 2020 (UTC)
• Support Little pob (talk) 15:09, 7 January 2020 (UTC)
• Polling is not a substitute for discussion, and that needs to stop right here, right now. See discussion. SandyGeorgia (Talk) 15:12, 7 January 2020 (UTC)
• Support We have discussed this extensively and have a consensus recommendation backed by many discussions and people over the years. It is a great default which we should not have to debate on each of 10,000+ medical articles. We have a norm and an orthodoxy, and anyone who wants an extraordinary exception should explain what is different about any outlier cases. Blue Rasberry (talk) 15:17, 7 January 2020 (UTC)
  • We have a consensus guideline that does not mandate any set order; it recommends headings. Please engage the facts with discussion, not !voting. SandyGeorgia (Talk) 15:22, 7 January 2020 (UTC)

Discussion about the best order

Discuss other alternatives or elaborate on this option here - more specifically if anyone can come up with an exampled of a medical syndrome where Diagnosis is not intimately linked with Signs/symptoms/Characteristics/Presentation. I'm all ears. Cas Liber (talk · contribs) 13:33, 7 January 2020 (UTC)

well this isn't a syndrome, but a more general example of medical sections for a condition per NIH US Department of Health and Human Services NIH/GARD Neurofibromatosis-1

...….... 1.lede(summary)

2.Symptoms

3.Cause

4.Inheritance

5.Diagnosis

6.Treatment

7.Prognosis

--Ozzie10aaaa (talk) 14:20, 7 January 2020 (UTC)

@Casliber: I'm no expert on general medicine, but in the field of hyperbaric medicine, nitrogen narcosis is diagnosed by response to treatment (i.e. ascending), and a diagnosis of decompression sickness is only confirmed when the symptoms respond to treatment (i.e. recompression), so it's probably a bit more complicated than a standard "symptoms – diagnosis" link. Nevertheless, you make a good point and I wouldn't object to altering the order in our guidance to bring diagnosis just after symptoms if it seems that it would be beneficial in the majority of cases. Anyway, I believe we should treat this as "soft guidance", the sort of advice that is helpful in many cases, but is accepted as non-prescriptive whenever a good reason presents to deviate from it. --RexxS (talk) 18:26, 7 January 2020 (UTC)

Cas Liber, you can't use signs, symptoms, characteristics, and presentation to diagnose famously asymptomatic diseases, like garden-variety Hypertension. It usually works in your specialty; it doesn't work for everything.

(I've no objection to re-ordering the suggested list.) WhatamIdoing (talk) 19:43, 7 January 2020 (UTC)

Two problems

1. Problem #1 is Cas's RFC question. Problem #1 says that the suggested order currently runs (in part) "Symptoms, Cause, Mechanism, Diagnosis" and he thinks that it should run "Symptoms, Diagnosis, Cause, Mechanism" (or some other system that put the symptoms and diagnosis together).
2. Problem #2 is SandyGeorgia's concern. Problem #2 says that the long-standing text in MEDMOS is being ignored. That text says, "The following lists of suggested sections are intended to help structure a new article or when an existing article requires a substantial rewrite. Changing an established article simply to fit these guidelines might not be welcomed by other editors. The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition. Do not discourage potential readers by placing a highly technical section near the start of your article." (emphasis added).

Notice that it's possible to "support" changing the suggested order and "oppose" enforcing the suggested order on all articles, and to "oppose" changing the suggested order and "support" enforcing the old order everywhere, and all the other possible combinations. If you are going to "vote" (which you probably shouldn't be doing...), then please be clear what you're voting on. The RFC question is about what order the suggestions should be in. The RFC question is not about whether that suggested order should be enforced strictly. WhatamIdoing (talk) 19:48, 7 January 2020 (UTC)

The original format (with separate numbered sections to make vote-counting easier) is something that's discouraged by Wikipedia:Requests for comment/Example formatting. I've re-arranged it to the usual chronological order, and since folks are having such trouble figuring out what the actual question is, I've put that question right in the section heading. In particular, User:Blueraspberry may have voted "Support" on something he either opposes or has no opinion on, because his (nicely explained) comment has next to nothing to do with the question at hand. On the other hand, Ozzie10aaaa and QuackGuru dumped unexplained votes on the page, so nobody has any idea whether they were voting against Cas's proposal to improve the order, or if they are instead disagreeing with SandyGeorgia's view that they shouldn't force every single article into exactly the same order and don't actually care whether the recommended order has the diagnosis before or after the mechanism section.

I encourage everyone (including Cas Liber and Little pob) to read that question, decide if you have an opinion on that question, and make sure that your "vote" is accurately represented. And maybe you should even take a moment to explain why you think that a suggested order of "Symptoms, Cause, Mechanism, Diagnosis" is better or worse than an equally suggested order of "Symptoms, Diagnosis, Cause, Mechanism". That's what we really need from you. WhatamIdoing (talk) 20:01, 7 January 2020 (UTC)

Malformed RFC, polling is not a substitute for discussion

WP:MEDSECTION says:

The following lists of suggested sections are intended to help structure a new article or when an existing article requires a substantial rewrite. Changing an established article simply to fit these guidelines might not be welcomed by other editors. The given order of sections is also encouraged but may be varied, particularly if that helps your article progressively develop concepts and avoid repetition. Do not discourage potential readers by placing a highly technical section near the start of your article.

Casliber you have started an RFC predicated on the notion that a set of order of section is mandated by MEDMOS, when no such beast exists. Further, there has been no discussion, even with the usual "Me, too" !voters lining up (without discussion), of whether one order even works at all. Please stop voting and start discussing, with specifics for articles. This is not a popularity contest; polling is not a substitute for discussion. MEDSECTION is quite clear that we have recommended headings; extension of guidelines to apply them as if they were policy, without discussion of specifics as they relate to the narrative of specific articles, is not going to be helpful. SandyGeorgia (Talk) 15:18, 7 January 2020 (UTC)

Bluerasberry claims: ... we should not have to debate on each of 10,000+ medical articles. We have a norm and an orthodoxy, and anyone who wants an extraordinary exception should explain what is different about any outlier cases. We do not have an "established norm and orthodoxy", we have recommended headings that have been enforced by fiat. What would be disruptive would be for every article to explain why its particular narrative differs from a set order. At Tourette syndrome, constraining "Classification" to come before "Characteristics", for example, makes it very difficult to talk about tics before they are even defined. There is not a set order that works for every topic. There is a suggested order that may work for many topics. Our "readers" do not go article to article to see what we put where: a typical reader most likely goes to a medical topic of interest to them, and expects to find a narrative in that article that works for that condition to make their reading work in a logical order. What works for one article may not work for another; that is why guidelines are guidelines. SandyGeorgia (Talk) 15:27, 7 January 2020 (UTC)

Came back to change !vote after realising that §Diseases or disorders or syndromes actually deals with separate a type of article to §Drugs, treatments, and devices or §Signs or symptoms etc – rather than separate sections within the same article (self-facepalm). And also noting that the suggested order for §Diseases or disorders or syndromes is largely reflected by the likes of Patient UK and Ozzie's given example. Have struck instead. Little pob (talk) 16:16, 7 January 2020 (UTC)

Little pob, that's how/why discussion works ;) :) SandyGeorgia (Talk) 16:19, 7 January 2020 (UTC)

Okay, now I am awake with coffee. Right then, the question is Is this list proscriptive? As Doc James thinks it is by this comment. As does Ozzie10aaaa. Cas Liber (talk · contribs) 20:00, 7 January 2020 (UTC)