Talk:Simvastatin

FDA

I was disconcerted to see the FDA equated to Federal Drug Administration. It is not ! The acronym FDA stands for Food and Drug Administration. It controls the purity of both foods and drugs.

Nwbeeson 17:43, 12 February 2007 (UTC)

Penicillium

Tabutterick 17:27, 7 October 2006 (UTC)—From website: By 1976, Akira Endo had isolated the first inhibitor (compactin) from yeast cultures in Sankyo, Japan. Correction needed:

Akira Endo had isolated the first inhibitor (compactin ML-236B) from the fungus, Penicillium citrinium in Sankyo, Japan. ref: Liao and Laufs, 2005. Pleiotropic Effects of Statins. Annu. Rev. Pharmacol.Toxicol:45:89-118

Pen. is not a yeast but a filamentous fungi. Since you listed the organism that sim. was isolated from you might want to include the name of this organism too.

Thank you for your time and I hope this is helpful. Tammy Butterick Third yr. Graduate Student UMN-Twin Cities Dept of Pharmacology [email address removed]

Question

My zocor was left in a rural mail box all day on a 90* day. checked temp. inside box. was over 150. Any damage? How tolerant is it to heat? Suggested max. was 89.

Sorry, you'd better check with a real pharmacist. JFW | T@lk 16:35, 2 January 2008 (UTC)

Linkspam

This article has been spammed several times now with the following link:

• Flash animation explaining in detail the mechanism of action of simvastatin. Requires flash 8 for visualisation

It is a fairly basic Flash animation that basically rehashes information already provided on statin with regards to the MOA of statins. I find it of no added informational value over the content already on the page. This Argentinian website has one other Flash animation (on benzodiazepines) and that is the entire content of the site. JFW | T@lk 16:35, 2 January 2008 (UTC)

urine

Does Simvastatin cause urine to be bright yellow? —Preceding unsigned comment added by 98.111.89.67 (talk) 01:21, 21 May 2009 (UTC)

No, I have taken of the Simvastatin for five years and it not yellow makes my urine to be. If ewe have of Urine of Yellow, it could be the drink they call Mountain Due, but likely Vitimin Bee. — Preceding unsigned comment added by 141.116.212.32 (talk) 20:57, 19 March 2012 (UTC)

Price

Article says "In the UK in 2008 the typical per patient cost to the NHS of simvastatin was approx £1.50." - but per how much? Per tab, per year? 82.31.207.100 (talk) 12:00, 22 July 2009 (UTC)

Deleted entry on Side effects

Dear Jfdwolff, you deleted my entry citing: this is excessive - please offer concise content based on the report, but ideally wait until the SEARCH trial has been formally reported.

I think my EDIT was a major event - worth posting - when the largest "watchdog body" (FDA) in the English speaking world, announces new guidelines AND labeling revisions on a drug.

You also "undo-ed" my removal of "citation needed" at: The maximum dose must not be more than 80 mg/day.[citation needed]

As noted in the history, I replaced the "citation needed" with a link to: [1]. There it is clearly stated: ... U.S. Food and Drug Administration (FDA) is informing the public about an increased risk of muscle injury in patients taking the highest approved dose of the cholesterol-lowering medication, Zocor (simvastatin) 80 mg ...

I reinsert the reference there.

When it comes to "side effects", I ask you kindly to cut away "the excessive" parts of my EDIT and reinsert the rest.

Albeit, I do think a mentioning of absolute and relative contraindications - as well as risk factors for side effects - is a natural part of an up-to-date and informing Wiki-article, dealing with a prescription drug.

I post this to your Wiki-page too.

Regards! 81.225.115.68 (talk) 16:34, 23 March 2010 (UTC)

This stuff has been known for ages. A single sentence, referenced with the FDA link, should be more than adequate. You are free to insert this yourself. JFW | T@lk 20:32, 23 March 2010 (UTC)

simvastatin... possible side effect

I have been taking simvastatin 10 mg. for approx 6mos. In that time I have developed severe itching on my left forearm, and now my right. It usually starts in the evening and is really severe at nightime. After trying about everything from ointments to removing any gold jewerly, several trips to my regular doctor, and also the dermatologists. The only thing that calms the itching, which causes a rase to appear, is ice packs. I am inquiring about medications at this point after so much lost sleep. I take the simvastatin10 mg. at nighttime, and a Losartan Potassium 25 mg, in the morning for Blood pressure. The only other med I take is Prilosec, which I have taken for many years.I need to research this med. as it lists rash and itching as a possible side effect. I am suffering terribly with this problem, and will welcome any imput about this situation. If you look up severe itching on the wed, many people suffer from this, just as I do. I am in my mid fifty's and female. Could this medication be the culprit......please advise.. — Preceding unsigned comment added by 184.19.128.71 (talk) 14:16, 9 December 2011 (UTC)

Please see WP:MEDICAL. Wikipedia authors do not give advice. Regards, Ariconte (talk) 20:01, 9 December 2011 (UTC)

Simvastatin 40mg contraindicated with amlodipine?

Should amlodipine be added as contraindicated when taking 40mg simvastatin daily?

I am a patient who (like others) has recently been taken off 40mg simvastatin and had it replaced with 20mg atorvastatin, due to also taking amlodipine 10mg. I had no noticeable side effects, but was informed all patients (in Scotland, UK) taking both amlodipine and simvastatin were deemed at higher risk of developing rhabdomyolysis, and therefore the simvastatin 40mg was being replaced with atorvastatin 20mg.

I believe the higher risk may be due to the amlodipine combination making the simvastatin 40mg more like an 80mg blood level, which is associated with increased risk of muscle damage or wasting. I do not know of the source for this contraindication, although I was advised by a doctor.

Daveco333 (talk) 15:20, 14 January 2013 (UTC)

Thanks for the heads up. Fortunately I have found sources which state this and have added it to the article. I also found some other things which are stated to be contraindicated and will be adding those sometime.OakRunner (talk) 06:55, 15 January 2013 (UTC)

Addition Helpful Information

Information regarding side effects, as well as route of administration would be helpful if included as well. This is general information that patients currently taking, or potential future consumers would most likely be interested in. Mbdy222 (talk) 03:27, 11 December 2013 (UTC)

Keeping the lead in easier to understand En

Have summarized "and to reduce the risk of coronary heart disease-related death, heart attack, stroke, or requiring cardiac revascularization procedures in people at high risk" as " It is also used to decrease the risk of heart problems in those at high risk."

Have left the body more specific and complicated. Doc James (talk · contribs · email) 06:43, 29 November 2015 (UTC)

Indication

@Doc James:

Your point is a good one, and I have to say that the description of the drug's indications in the package insert is awfully legalistic and cumbersome. I'm not thrilled with the language currently used in the body of the article, but dunno if something like "prevention of atherosclerosis-related complications such as stroke and heart attack" is taking too much liberty with the source.

If you have any thoughts on some language that captures the gist of this without sounding like it came out of a legal document, please go ahead and plug it in.

Thanks 73.162.132.47 (talk) 13:50, 29 November 2015 (UTC)

Sure have adjusted the body of the text to "The primary uses of simvastin are to treat high blood lipid levels and to prevent atherosclerosis-related complications such as stroke and heart attacks in those who are at high risk." Let me know what you think? Doc James (talk · contribs · email) 13:54, 29 November 2015 (UTC)

Thanks, this is great! 2601:643:8100:8AF4:F4BB:DF2E:D0E4:58CF (talk) 13:23, 30 November 2015 (UTC)

Statins in people with unknown lipids

We use them all the time in those post MI without checking lipid levels.

Others appear to view it the same "Statins also have benefits above and beyond cholesterol lowering. We have long known that statins lower the risk of premature death, heart attack, and stroke, even among individuals with relatively normal cholesterol levels—who are not exempt from having heart attacks or stroke."

This book agrees[2] Doc James (talk · contribs · email) 01:20, 23 July 2016 (UTC)

Lipophilic

Having read this (and other top google hits), I'm unclear if S is lipophilic (fat-binding) or hydrophiliac, another sort of statin. Re the recent Chinese study. Anyone? Johnbod (talk) 14:00, 3 June 2017 (UTC)

In depth discussion

Of its relatively low cost. https://www.sciencedirect.com/science/article/pii/S0735109717417827#undfig2

Doc James (talk · contribs · email) 03:31, 30 March 2020 (UTC)

Per the recommendation of the closer this "The wholesale cost in some LMIC is around US$0.01 to 0.15 per 20 mg dose as of 2014.

"Simvastatin" (PDF). International Drug Price Indicator Guide. Retrieved 28 November 2015.{{cite web}}: CS1 maint: url-status (link)

Requires no interpretation. Doc James (talk · contribs · email) 19:42, 30 March 2020 (UTC)

Choosing to describe the prices published by two suppliers as "The wholesale cost in some LMIC" is a matter of interpretation. WhatamIdoing (talk) 21:07, 30 March 2020 (UTC)

Sorry no you are incorrect. You will notice the price by IDA Foundation aswell which applies to more than 130 countries. Doc James (talk · contribs · email) 21:19, 30 March 2020 (UTC)

Choosing to describe two-thirds of the countries in the world as merely "some", rather than "most", is a matter of interpretation.

Choosing to treat the IDA Foundation's wholesale list price as "the wholesale cost" for 80% of the world's population is also a matter of interpretation. 80% of the entire world's population live in LMICs. Does the IDA Foundation sell 80% of the world's simvastatin? Are there no other wholesalers that matter? (I hope they're not the only option, since their wholesale list price is four times what most countries report paying for a 20 mg pill.)

If you want to talk about the problems with the other half of the sentence, then choosing to include the buyer prices after the source itself says to mostly ignore those is a bad interpretation. Choosing to represent the 'wholesale cost' as 1¢ to 12¢ (one to twelve cents), when all the buyers except one (Sudan) report prices of just 1¢, 2¢ or 3¢, is misleading. Failing to notice that there is also a 15¢ (fifteen cent) price reported (by Sudan) in the same record as the 1¢ price is probably just an oversight/dyslexic moment. Failing to state the strength (when we know that most drug prices vary by how much active ingredient in them) is also a serious mistake, and all the more serious because the stated range is based on buyer prices from different size pills (the low price being what the Dominican Republic claims to have paid for 20 mg pills, and the high price being what Sudan claims to have paid for 10 mg pills).

I'm not convinced, in the general case, that finding sources that talk about the cost of this drug justifies using this particular database, but if we're going to use it, we should be using it correctly. That means writing something much closer to "In 2014, the International Medical Products Price Guide reported wholesale list prices of approximately US$0.02 and 0.08 per 20 mg pill" than "The wholesale cost in some LMIC is around US$0.01 to 0.12 per day as of 2014." What's in the article is neither good nor true. WhatamIdoing (talk) 23:38, 30 March 2020 (UTC)

Sure happy to go with "In 2014, the International Medical Products Price Guide listed wholesale prices of approximately US$0.02 and 0.08 per 20 mg pill for LMIC." The guide just does prices for LMIC so important to mention that. Doc James (talk · contribs · email) 00:04, 31 March 2020 (UTC)

Clarification of RfC

Should we state " Simvastatin is relatively low cost." at the end of the 4 paragraph of the simvastatin article? Doc James (talk · contribs · email) 21:31, 30 March 2020 (UTC)

Based on this 2012 article which states

Simvastatin... is a universally accepted and relatively inexpensive drug.

Elavarasu, S; Suthanthiran, TK; Naveen, D (August 2012). "Statins: A new era in local drug delivery". Journal of pharmacy & bioallied sciences. 4 (Suppl 2): S248-51. doi:10.4103/0975-7406.100225. PMID 23066263. Simvastatin... is a universally accepted and relatively inexpensive drug.{{cite journal}}: CS1 maint: unflagged free DOI (link)

And this 2018 review which states

The U.S. patent for simvastatin held by Merck expired on June 23, 2006, which catalyzed a large generic drug launch, with firms from India and Israel ramping up production (18). Costs fell from $1,200 to $40/patient/year, as priced by the Management Sciences for Health International Medical Products Price Guide (19). This reduction helped make statins cost-effective by WHO standards, and in 2007, statins were added to the EML as a therapeutic class. Given its lower cost and off-patent status, we proposed simvastatin as the representative example of the therapeutic class of statins. In 2007, statins were added to the EML with simvastatin as the representative.

Kishore, Sandeep P.; Blank, Evan; Heller, David J.; Patel, Amisha; Peters, Alexander; Price, Matthew; Vidula, Mahesh; Fuster, Valentin; Onuma, Oyere; Huffman, Mark D.; Vedanthan, Rajesh (February 2018). "Modernizing the World Health Organization List of Essential Medicines for Preventing and Controlling Cardiovascular Diseases". Journal of the American College of Cardiology. 71 (5): 564–574. doi:10.1016/j.jacc.2017.11.056.

Support

1. Support as proposer. The 2018 review makes it clear why the relatively low cost of this medication is notable. Doc James (talk · contribs · email) 21:31, 30 March 2020 (UTC)

   (Response moved to Discussion --Hipal/Ronz (talk) 17:12, 1 April 2020 (UTC))

2. support very clear per review--Ozzie10aaaa (talk) 21:51, 30 March 2020 (UTC)
3. support enough evidence from the abovementioned reference--Avicenno (talk) 10:45, 31 March 2020 (UTC)
4. support I am a physician in the US. The website goodrx.com shows many pharmacies will sell this for about $10 for 90 20mg tablets, a 3 month supply. That is clearly relatively low cost, relative to other drugs, to the cost of lunch 3 days in a row, and to the cost of 3 days of coffee at Starbucks. Kd4ttc (talk) 21:06, 31 March 2020 (UTC)
5. Support Given the two sources cited, there is no doubt about the factual accuracy of the suggested text. Editors are supposed to accurately and neutrally summarise the sources they use to write content, and it is obvious that the text complies with that without being original research or synthesis. The only remaining question is whether the information is WP:DUE. My answer is that when a drug's cost has fallen from $1,200 to $40/patient/year, it's clearly attracted sufficient attention to warrant mention in an encyclopedia. --RexxS (talk) 17:39, 1 April 2020 (UTC)
6. Support I too have taken a look at the two sources (PMID 23066263 and doi:10.1016/j.jacc.2017.11.056, above). Based on these sources, I support adding in a statement that "Simvastatin is relatively low cost" or, just, "simvastatin is low cost" to the end of paragraph 4.JenOttawa (talk) 00:52, 2 April 2020 (UTC)
7. Support. Agree with JenOttawa...Appears clear in the 2018 paper cited above. Including this in the lead appears "balanced", ie. simvastatin's notability weighs heavily on its low cost, as well as other factors. This low cost is referenced in numerous review articles and textbooks. Whispyhistory (talk) 11:49, 2 April 2020 (UTC)
8. Support I think we got to see both the big picture and the zoom on the RfC here. The big picture is that price information is a VERY IMPORTANT for the public in these time. Now, I don't mean it's important that they have the right price for medication. This is not the role of WP. What they want, what they see as important, is to gather information on the price, and have an ideal of the price. So, more precisely, I mean that they will look for this information, and they EXPECT to see something in the article. And the sooner the better. And considering how CODIV-19 affect our societies, I'd say their quest for information is very understandable. That's the big picture. Now, for the zoom, here, in this RfC, I think we can only confirm that stating concisely that the price is « relatively low » and giving as much attention and precision in the #Cost section as needed to be neutral, impartial and pertinent, is in accord with the letter and the intent of the RfC. --Antoine2711 (talk) 20:32, 2 April 2020 (UTC)
9. Support per others above. Flyer22 Frozen (talk) 01:51, 3 April 2020 (UTC)
10. Support per RexxS. COI: I have been taking Simvastatin since the mild stroke I had after which I voluntarily handed in my admin tools and a bunch of ill-spirited people claimed here it was under a cloud. Kudpung กุดผึ้ง (talk) 05:54, 3 April 2020 (UTC)
11. Support Drug pricing is not only important from a United States perspective. It has an impact on all types of health care systems regardless of whether from a monopsony perspective of a single buyer, or for prescribers or individuals. Swedish regions make different recommendations, often choosing atorvastatin over simvastatin, but centrally the discussion has been one of price difference between simvastatin and atorvastatin. Just to exemplify, this 74-page report from 2009 exclusively discusses pricing of various lipid-decreasing drugs, and is from the Swedish Dental and Pharmaceutical Benefits Agency (TLV). It mentions simvastatin 37 times, including on several pages which compare and discuss the price in detail. There will be more up to date sources from the agency as well, as well as up-to-date discussions from the regions — but the current discussion is rather about cost benefit analysis between atorvastatin and newer non-generic drugs.

    Working also in global health, I can say that pricing is extremely important as to where and when drugs are recommended and offered, as can be seen in the article Evaluation of prices, availability and affordability of essential medicines in Lahore Division, Pakistan: A cross-sectional survey using WHO/HAI methodology doi:10.1371/journal.pone.0216122 , which states Affordability of majority of the medicines was comparable between India and Pakistan, nevertheless, the number of daily wages needed to get the standard treatment with originator brand of Simvastatin was found to be two times higher in Pakistan compared to India and Lebanon.

    The 2016 book "The Price of Global Health" ISBN:9781472438805 discusses Simvastatin in detail on page 67, stating how its price specifically contributes to high use internationally.

    In light of this, it seems using the 2012 and 2018 sources to support a high importance statement in this article is acceptable. Carl Fredrik ^talk 13:21, 3 April 2020 (UTC)

12. Support, because drug pricing is a tremendously important aspect.--Muddymuck (talk) 13:34, 3 April 2020 (UTC)

Oppose

• Oppose because the (good) originally cited source (as opposed to the one added later) doesn't say that. Actually, it's not even clear what that sentence is supposed to mean. User:Doc James, when you wrote that the drug is "relatively low cost", is that supposed to mean that:
  1. it's "a kind of mediumly-low cost" ('relatively low' as contrasted with 'actually low'), or
  2. "the cost went down, relative to the price charged at a different time period/under other circumstances", or
  3. "the cost is low, relative to the cost of other drugs"? WhatamIdoing (talk) 22:15, 30 March 2020 (UTC)

• Oppose. "is low cost" if POV laden US-centric. "Relatively" low cost begs for comparisons to be made in that paragraph. It was not always low cost, so the statement is time-specific. Better to cover the history of the cost in Simvastatin#Cost. For a scholarly treatment of a drug, cost is a very specific factor that will be easily found by someone looking for it under a heading such as "cost". Unless there is an aspect of notability of its cost specifically, cost doesn't need to be in the lede. --SmokeyJoe (talk) 01:09, 31 March 2020 (UTC)

• Oppose, not only because the wrong question is being asked, but also per Seraphimblade new data presented below. Further, adding this to the lead breaches the policy at WP:NOTPRICE; there is nothing noteworthy about mentioning the prices of this drug in the lead, and adding this content breaches the community-wide RFC that was just closed and that upheld WP:NOTPRICE and WP:LEAD. This is an attempt to skate around the RFC conclusion, while at the same time, obfuscating the issue with an unclear RFC question that was put forward with no prior discussion. If another RFC is desired to determine whether, by some definition of "relative" we want to include some mention of cost in leads, then that RFC should be correctly discussed and formed and put forward to the community. For now, there is nothing about this particular cost or drug that warrants any mention of price in the lead. And on top of all of that, putting forward an RFC where participants cannot carry on a normal talk-page discussion (and moving their comments when they do) is not conducive to consensus building. SandyGeorgia (Talk) 01:38, 2 April 2020 (UTC)

Neither

• Wrong RFC. (The FULL RFC, linked below in Discussion section, has already rejected a good portion of this text; the additions just complicate it further.) Previous RFC already answered this; the text does not belong in the lead, and much of the text in the body is also disputed. SandyGeorgia (Talk) 22:31, 30 March 2020 (UTC)
• Appears to ignore Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices. --Hipal/Ronz (talk) 21:58, 30 March 2020 (UTC)
• And this edit is nearly identical. --Hipal/Ronz (talk) 22:04, 30 March 2020 (UTC)
• Let's wait for ArbCom results. --Hipal/Ronz (talk) 03:45, 31 March 2020 (UTC)
• This is, to all intents and purposes, ignoring the consensus reached in the RfC. Graham Beards (talk) 11:25, 31 March 2020 (UTC)
• The RfC is malformed (it is a "request for votes", not a request for comment, given the discouragement of discussion below), and we already had it anyway. If secondary sources explicitly say it's "relatively inexpensive", I've no problem including that in the body. If they don't, we don't either. Seraphimblade ^{Talk to me} 18:48, 1 April 2020 (UTC)

  In addition, sources don't even agree on what the price is. Another one (actually brought to my attention by Doc James) from Consumer Reports ([3]) states that the average cost for a month of generic simvastatin is $71, which certainly does not match the "$10 to $20" figure previously given in the article, and Consumer Reports is a very reliable source for pricing data. Is that still "relatively inexpensive"? Relative to what, according to whom? If sources don't even agree on what the cost is, I don't see how we can accurately discuss it in the article. Seraphimblade ^{Talk to me} 18:51, 1 April 2020 (UTC)

Discussion

Everyone is to put their discussion in their own section.^{[Disputed – discuss]}

Comments about RFC

I saw this discussion at WT:MED, under this discussion about the recently closed RFC on pharmaceutical drug prices.

This (new and immediately second) RFC is premature and malformed for two reasons.

First, there was essentially no prior discussion about what should be in this particular RFC about this particular drug, after the price text was (twice) removed per the RFC, [4] [5] and then later reinserted (twice) by James.

Second, the text proposed for discussion does not encompass the full disputed text. [6] Any conclusion reached about that one sentence is not helpful for any purpose, and an RFC to discuss that one sentence is not be likely to yield any useful conclusions.

The full disputed text is more extensive, using again and still the kinds of sources discussed at the recently closed RFC:

• Simvastatin is relatively in expensive. The wholesale cost in some LMIC is around US$0.01 to 0.15 per 20 mg dose as of 2014. The defined daily dose is 30 mg per the World Health Organization. The price decreased from roughly US$1,200 to $40 per year of medication following the patent expiring in 2006. In the United States, it costs about US$10 to 20 per month since patent protection ended. In the UK in 2008, the typical per-patient cost to the NHS of simvastatin was about £1.50 per month. (40 mg/day costs UK NHS £1.37/month in 2012) The price in Canada is about $CAD 130 to 160 per year as of 2016.

Sources
References

James, could you please begin to use edit summaries? Editors removing the text per the RFC most kindly used full and descriptive edit summaries about why the text was being removed. Since there are 530 articles to be reviewed, these edit summaries are helpful. When reinstating text already removed once, per the RFC-- knowing the reinstated text is controversial-- an edit summary should be more descriptive than "adjusted". SandyGeorgia (Talk) 22:01, 30 March 2020 (UTC)

• Kd4ttc while I agree with your particular response about goodrx (and the good fortune we have to be able to use that app in the United States), the issue here (not explained because of how this RFC was launched, without discussion about how to frame the question) revolves around the Wikipedia policies WP:NOTPRICE, and WP:WEIGHT, and the guideline, WP:LEAD. An RFC closed only this week found no reason to alter the given policies for drug pricing in the lead. The proposed text is skating around that conclusion, and not addressing WP:WEIGHT, WP:LEAD or WP:NOTPRICE. So the overall question is actually a different one, as to whether this information belongs in the LEAD (per the RFC and Wikipedia policy) or the body. SandyGeorgia (Talk) 21:54, 31 March 2020 (UTC)

@Doc James So, perhaps you can explain the meaning of "relatively inexpensive" in a country like, for example, Venezuela with inflation off the charts? How does that work? SandyGeorgia (Talk) 23:53, 30 March 2020 (UTC)

Comments by User Doc James

Some like all encompassing RfC. I prefer very narrow ones. We can have more RfCs on other issues later.

@WAID I think people understand relatively low cost. It is why this source had no problem says it is relatively inexpensive. Doc James (talk · contribs · email) 22:09, 30 March 2020 (UTC)

@User:Seraphimblade Sure so what is sufficient discussion is a judgement call. Doc James (talk · contribs · email) 23:29, 30 March 2020 (UTC)

Consumer reports list the "nationwide retail average for January 2014" which is not the NADAC nor the cost to the consumer after discounts. And it still shows simvastatin as relatively inexpensive... Doc James (talk · contribs · email) 01:02, 2 April 2020 (UTC)

Comments by WhatamIdoing

"People" might, but "I" don't. I've thought of three different sets of facts that "people" might (mis)understand from that phrase. What is it actually supposed to mean? (And why did you make up a rule that editors can't have a normal discussion in this RFC? This isn't ArbCom, with clerks to keep editors from talking to each other. WP:RFC says that normal talk-page rules apply to RFCs. That means that anyone can reply to comments in any section.) WhatamIdoing (talk) 23:02, 30 March 2020 (UTC)

Right. SandyGeorgia (Talk) 23:22, 30 March 2020 (UTC)

Comments by Seraphimblade

First, "everyone is to put comments in their own section" is not how an RfC works, unless by mutual agreement of those formulating the RfC. (For clarity, I don't agree.) Secondly, we already had this RfC and already had an answer. We are not going to keep having them. Pricing information goes in articles in accordance with WP:NOPRICES; that being, only when secondary sources substantially discuss, not just briefly mention, such information. There is certainly not enough discussion in secondary sources here to go in the lead, and there really isn't enough for it to go in the body either, just price directories and very brief, one-liner mentions. Seraphimblade ^{Talk to me} 23:27, 30 March 2020 (UTC)

RexxS, it is certainly important to read sources rather than, say, just looking at the number of times certain words appear. As an example, two of those nineteen instances of "price" appear in the name "Matthew Price", and have nothing to do with the price of anything at all. So far as when price is discussed in conjunction with simvastatin, that occurs only briefly, for a single paragraph. That does discuss the price drop after the medicine went off patent leading to its recommendation as a replacement for higher-cost drugs, and I see nothing wrong if the body of the article mentions that fact. However, it does not say the drug is "relatively inexpensive", only less expensive than a few possible alternatives. The rest of the mention of price are not about simvastatin in particular. Seraphimblade ^{Talk to me} 19:07, 1 April 2020 (UTC)

Comments by RexxS

@Seraphimblade: I'm sorry, but I can't believe anybody could read through Modernizing the World Health Organization List of Essential Medicines for Preventing and Controlling Cardiovascular Diseases and conclude there is "certainly not enough discussion in secondary sources here to go in the lead, and there really isn't enough for it to go in the body either, just price directories and very brief, one-liner mentions." It makes clear that simvastatin is the representative example of the therapeutic class of statins for the WHO EML, and the pricing is discussed both generically and in particular multiple times (23 mentions of "statin" and 7 mentions of "simvastatin"; 36 mentions of "cost" and 19 mentions of "price").

@Seraphimblade: Okay then: 16 mentions of "statin" alone and 7 mentions of "simvastatin"; 36 mentions of "cost" and 17 mentions of "price", if you want to hit-pick. That simply isn't your "briefly mention". If you do read the whole article, you'll see it is completely devoted to how statins became part of the WHO EML and the relationship of that to pricing, with simvastatin being chosen as representative of all statins. The entire thrust of the article is that the price fall in statins, of which simvastatin is the representative, made them affordable relative to other drugs on the WHO EML. You'll note that "affordable" crops up in three separate paragraphs and a table. The whole article is about improving global access to drugs such as simvastatin. Simvastatin is specifically mentioned in Table 1 "Simvastatin ... generic production reduced costs significantly" as well as three times in the section on "Additions Statins (2007)". It is then mentioned again in Table 2 "Cost and cost-effectiveness ... Cost is not always a barrier to entry; generic competition can lower drug prices ... Addition of simvastatin ... following generic production". That's not a brief mention by any stretch of the imagination. In fact, the addition of simvastatin to the WHO EML is the central theme of the article. Of course, the phrase "realtively inexpensive" doesn't exist exactly in the article. We don't create articles by gluing together phrases from sources. But it is a fair summary of how the article considers the cost of simvastatin, and I defy anyone to claim otherwise. --RexxS (talk) 19:52, 1 April 2020 (UTC)

@Sandy: the World Health Organization List of Essential Medicines is described as being "used by member states to determine their national essential medicine lists and policies and to guide procurement of medicines in the public sector" and is discussed in the context of "low-income countries", "low- and middle-income countries", and "high-income countries". We shouldn't be interpreting a secondary source, only summarising its conclusions. Venezuela has been a member of WHO since 1948, so the conclusions should apply to them as much as to any other member state. --RexxS (talk) 18:55, 1 April 2020 (UTC)

Discussion

@Doc James: Previously you wrote, That is not a numerical price. Is that still part of your rationale or not? --Hipal/Ronz (talk) 22:01, 30 March 2020 (UTC)

And how is it relevant (whether or not a price representation is “numerical”) ? SandyGeorgia (Talk) 23:53, 30 March 2020 (UTC)

How to run an RFC

Let's put this meta-discussion in a separate section, to avoid any confusion.

Doc James apparently wants to have a voting-style RFC on the disputed sentence above. He apparently wants it to be very easy to count up the votes, because he has chosen, from the multiple formats of RFCs described at Wikipedia:Requests for comment/Example formatting, the style most commonly used for WP:RFA and other pure votes.

Perhaps the choice that is causing the most disagreement, however, is that he apparently does not want anyone to reply directly to anyone else's comments, as evidenced by repeatedly moving multiple other editors' comments to "their own" sections. This is not normal for a talk-page discussion, nor for an RFC. (WP:RFC says that normal talk-page guidelines apply; the normal talk page guidelines say things like "Cautiously editing or removing another editor's comments is sometimes allowed, but normally you should stop if there is any objection" and "Thread your post: Use indentation as shown in Help:Using talk pages § Indentation, to clearly indicate to whom you are replying, as with usual threaded discussions.", both of which IMO are not be followed. Good luck to anyone trying to figure out what this refactored comment is a reply to.)

I am pinging several uninvolved editors – User:Redrose64, User:Giraffedata, User:Mandruss, User:Blueboar, and User:SmokeyJoe – chosen because they are currently active at WT:RFC and routinely answer questions about RFCs in general, to see if anyone uninvolved in the dispute would be willing to decide whether Doc James' preference for limiting/separating discussion should be respected, or if Doc James should respect the normal talk-page guidelines by not refactoring other people's comments to prevent direct discussion. IMO the important point here isn't what the decision is, but that it's settled one way or the other, so that we won't have so many edits rearranging where people put their comments. WhatamIdoing (talk) 00:04, 31 March 2020 (UTC)

Yes the issue is that the discussion style otherwise can be intimidating to some editors. We did lose one long term contributor during the drafting stage last go round. Doc James (talk · contribs · email) 00:08, 31 March 2020 (UTC)

I think it is unfair and inappropriate of you to imply that User:Tryptofish is intimidated by discussions on wiki. Yes, he decided to (mostly) stop editing. Yes, he was probably right that the narrower RFC wouldn't solve the problem, and he's welcome to put a big "I told you so" on my talk page if he wants to. But you should not be implying that he is intimidated by discussions, or that he would support your effort to keep people from directly replying to other editors in this RFC. WhatamIdoing (talk) 17:58, 1 April 2020 (UTC)

Thank you very much for that acknowledgement. On the other hand, Doc James is right about how I feel, although how I feel is unrelated to the formatting of RfC response sections. --Tryptofish (talk) 18:33, 1 April 2020 (UTC)

• I was pinged.

Posing a well defined, narrow question, is very efficient if it is a simple yes/no question. The RfC initiator getting to define the scope of the RfC can be a problem. Limiting to a false dichotomy is the danger. That's in addition to asking the wrong question. A yes/no RfC may be good and efficient, but I suggest that it should be considered abandoned if in the course of discussion it is rejected that it is a good yes/no question. For some time, I have been advocating a step for multiple editors, at least two, to agree that the posed question is well put. I think this could be applied here: do other's agree that the question is well put? If not, how would the question be improved. This should be done before people start answering the question.

Each individual commenting in their own section is, I think, a proven effective way to manage a many-participant discussion. I think it is particularly good when there are multiple questions of varying importance, or an open scope. For a yes/no question, I don't see it being so helpful. If multiple participants are asked to keep their formal contributions in separate sections, there needs to be another place for threaded discussion. Threaded discussion is the best way to resolve little problems, such as misunderstandings.

--SmokeyJoe (talk) 00:58, 31 March 2020 (UTC)

User:SmokeyJoe Well that is the issue... We can not even agree on what is a fair question. Doc James (talk · contribs · email) 01:05, 31 March 2020 (UTC)

Well then, that suggests a pre-RfC on agreeing on a fair question. --SmokeyJoe (talk) 01:10, 31 March 2020 (UTC)

I never saw even an attempt to formulate a fair question, or any question, before this RFC was launched. Of course we can’t agree if we don’t try. SandyGeorgia (Talk) 07:18, 31 March 2020 (UTC)

We spent months trying to come up with a reasonable question for the last RfC. Folks went ahead despite objections from a number of people. Doc James (talk · contribs · email) 18:02, 1 April 2020 (UTC)

That is not the case at all. Besides that TWO neutral admins had to approve the launch. Besides, we are talking about this RFC, not that RFC. There was no attempt to formulate an adequate question for this RFC regardless of your views on the community-wide RFC. SandyGeorgia (Talk) 18:24, 1 April 2020 (UTC)

At minimum you have to preserve context; that should be obvious.

The intimidating to some editors argument seems a bit weak. First, Wikipedia editing in general is necessarily not very well suited to the easily intimidated. And I don't see how a reply is more intimidating when it's physically closer to what it replies to. WP:BLUDGEON and WP:BADGER are different issues and should be dealt with as behavior problems.

I've seen lots of editors try to separate discussion from !voting, and I've felt that was legitimate and constructive. I've been known to try it myself, back before I was old, tired, and apathetic. Things get very cumbersome when you have five screenfuls of discussion between adjacent !votes. And yes, counting !votes is a part of consensus assessment. While I don't see closers complaining about this a lot, I do see a chronic severe shortage of closers and this could easily be a contributor to that.

My current take on this is to let it be until the replies under a given !vote become too long, and then move them while preserving context (if you have the energy). A separate subsection for each subthread is probably preferable to throwing all such moved subthreads into one section (particularly if that section also includes other discussion). Thus the section heading would be like: ====Replies to !vote by WhatamIdoing====.

How long is "too long"? I don't know, but you weren't there yet in my judgment.

I haven't really addressed the question of the Survey format, and that's a whole separate can of worms probably best handled in a public venue. ―Mandruss ☎ 01:12, 31 March 2020 (UTC)

I have never seen it tried, but it occurs to me that the same benefit could be achieved with far less effort by collapsing the extended replies to a !vote. It would be have to be made very clear that the reason for the collapse was not that they were off topic or otherwise inappropriate. ―Mandruss ☎ 01:39, 31 March 2020 (UTC)

• I guess I don't know what "Everyone is to put their discussion in their own section" means. How is discussion owned by one person? Isn't that like saying, "the sound of the right hand and left hand while clapping is to be played through separate speakers"?). I looked for examples of Doc James moving discussion around, but didn't find any easily., but maybe this is why I had trouble making any sense out of the page when I read it.

If it means that Editor A's reply to Editor B's comment should go in a section with all Editor A's other replies to everything, rather than directly under Editor B's comment, then that must be truly bizarre and unreadable and I'm against it. Replies, including any rebuttal or augmentation of a comment, should go directly below and indented from the subject comment.

If it means there shouldn't be any discussion - just monologues - I'm against that too.

There is a common RfC format where there is a "survey" section that is not supposed to have any replies or even original argument (though in practice people often can't help themselves) and then anyone who is moved to comment on a survey response starts a discussion in the "threaded discussion" section, and I'm OK with that. Maybe that's the compromise that's needed here. Bryan Henderson (giraffedata) (talk) 02:44, 31 March 2020 (UTC)

Bryan Henderson (giraffedata) "Everyone is to put their discussion in their own section" seems to mean that when Hipal reads Doc James' vote and asks a question about it, that Doc James moves that question to a different section, and that when SandyGeorgia removes her username from the section heading that Doc James immediately puts her username back in, that when I ask him a question about his statement, he separates my question from the sentence I'm asking about (and incidentally edit wars again over the location of Hipal's comments – that's happened at least three times so far), and that when SandyGeorgia asks another editor a question that Doc James moves her question out of what he calls the "voting section". None of these are lengthy exchanges. Some of these are already in the ==Discussion== section, but he's insisting, over the objections of at least four editors, that their comments must be placed only in separate subsections of the ==Discussion== section. WhatamIdoing (talk) 17:47, 1 April 2020 (UTC)

User:WhatamIdoing This is a long standing technique to try to inhibit involvement in RfC. Discussions go in the discussion section. Sure Sandy can adjust her section heading to whatever they want. Doc James (talk · contribs · email) 18:01, 1 April 2020 (UTC)

I agree that moving people's comments around and not letting them talk to each other inhibits their involvement in RFCs. So why are you doing that?

(I disagree that it's a long-standing technique; I can't remember any RFC ever that had one person edit warring with multiple other editors over the location of their [the other editors'] comments.) WhatamIdoing (talk) 20:28, 1 April 2020 (UTC)

Threaded discussion within the "votes" section is not standard. Doc James (talk · contribs · email) 23:30, 1 April 2020 (UTC)

Perhaps you could share your definition of "not standard". It's quite commonplace in my experience. Do you need me to provide examples? How many examples would suffice? The only case for refactoring that is when a subthread becomes too long, and a handful of short replies is not too long. ―Mandruss ☎ 23:52, 1 April 2020 (UTC)

We have a discussion section for discussion. The arbcom requirements of "threaded discussion is not permitted on most arbitration pages" IMO would be useful here. Doc James (talk · contribs · email) 00:23, 2 April 2020 (UTC)

Well, maybe "IYO" it would, but "YO" is not the only "O" that matters. Seraphimblade ^{Talk to me} 00:35, 2 April 2020 (UTC)

I don't think banning threaded discussion is useful in an RfC discussion. I do think having a section in which threaded discussion is banned is often useful. There's a whole other issue of whether the problem of someone not respecting that ban can be corrected by someone else moving his comments elsewhere. Bryan Henderson (giraffedata) (talk) 04:05, 2 April 2020 (UTC)

User:Giraffedata I think that would be fair. Doc James (talk · contribs · email) 04:38, 2 April 2020 (UTC)

• One problem with a lot of “Yes/No” survey type RFCs is that they get bogged down when proponents of one side or the other rebut the comments they disagree with (which then leads others to rebut the rebuttal, and so on). Each comment becomes a mini-RFC of its own. This “need to rebut” (or counter rebut) is why some editors end up repeating the same arguments over and over and over again.

The more efficient system for these RFCs is to have one section for the “survey” (with each editor explaining their rational as best they can) ... and ANOTHER, separate section for questions, rebuttals, additional comments etc. (The closer would obviously read both sections.)

That said... there is another (rarer) type of RFC - the more open ended “What should we do” type RFC. These are not necessarily looking to resolve a dispute, but to generate ideas to overcome an obstacle and move forward. These are better formatted as a single discussion rather than a “survey”... (although reformatting the more interesting ideas into separate sub-discussions can be helpful in later stages.)

For really complicated issues, you may need to use BOTH formats... and hold multiple RFCs... 1) an initial survey to find out whether the current language has consensus, 2) if not, a second, more open ended RFC to generate ideas for what to replace it with, and 3) a follow-up survey to choose between suggestions. Blueboar (talk) 16:48, 31 March 2020 (UTC)

Based on the comments above I withdraw my request for comments being in sections. People can do threaded discussion as they wish. Discussion within the support / oppose votes in my opinion is still not appropriate. But that I guess requires a wider discussion. Doc James (talk · contribs · email) 07:15, 3 April 2020 (UTC)

The entire RfC should be withdrawn. On the support side, it's almost nothing other than voting. This is not consensus building. --Hipal/Ronz (talk) 16:15, 3 April 2020 (UTC)

I agree that it is not building consensus. We shouldn't have jumped straight to a vote on whether to include a specific sentence. I'd love to have content about pricing in this article. But that specific sentence has problems. It's too bad that the RFC was written as "This somewhat confusing sentence, originally added with a source that doesn't technically support it: just vote yes or no", instead of something that would have encouraged editors to write a good sentence. I hope that if editors try to improve the sentence in the future, that they won't have this RFC thrown back in their faces, with some claim that the sentence is already perfect. WhatamIdoing (talk) 16:24, 3 April 2020 (UTC)

Yes I agree it would be nice to have discussions on the presentation of prices based on avaliable sources. Some appear to argue that any presentation of prices is impossible.[7] And appear to believe that the prior RfC came to that conclusions despite the fact that it did not. Thus we are here. Doc James (talk · contribs · email) 17:19, 3 April 2020 (UTC)

Thus we are at ArbCom, and this RfC will be evidence there. I urge you to withdraw it. --Hipal/Ronz (talk) 17:35, 3 April 2020 (UTC)