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

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These examples of drug prices for generic pharmaceutical drugs have been taken from the leads of articles. 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? 23:02, 23 January 2020 (UTC)

The source:

All of these examples use the same source (chosen for simplicity and because it appears in many articles). The source, the International Medical Products Price Guide, is a database of prices voluntarily reported by some organizations and government agencies that buy or sell drugs in low and middle income countries. For example, a "supplier" price may be reported by a non-profit or a for-profit organization that sells drugs only to health organizations and government agencies in a single country, or one that sells drugs to buyers in many countries. The "buyer" price is most often reported by a government, and sometimes by a non-profit or medical missions organization. The "supplier" prices are usually more relevant than the buyer prices, as buyer prices do not include shipping, handling, insurance, or other costs, and some buyer prices involve unusual circumstances (such as atypical prices from local manufacturers). The database's website recommends the median supplier price as the most reliable option, assuming that enough data points are available. Read more about prices on the database's website.

Each database entry also includes some other information, such as the strength and dosage form of the specific drug for that entry (most drugs are available in different strengths; some are available in both liquid and pill forms; each strength and form gets a separate database entry, search here to find examples) and the defined daily dose (read the article). This database has not been updated since 2015. You can look at some statistics about entries in the MSH database.

Note: The online MSH Price Guide database appears to be down currently. Here is a PDF of the 2014 Price Guide

Three examples:

  • Ethosuximide:
    • What the lead says: The wholesale cost in the developing world is about US$27.77 per month as of 2014.[1]
    • What the source says about:
      • Suppliers: The cited database entry lists one supplier, which offered 250 mg tablets of ethosuximide for sale for US$0.1845 each (100 tablets per package) in 2014, only to organizations in the Democratic Republic of Congo.
      • Buyers: The database has no information about buyer prices.
      • The drug: Each pill contains 250 mg of ethosuximide. The defined daily dose is 1.25 grams. There are no other entries in the MSH database for this drug.
  • Carbamazepine:
    • What the lead says: The wholesale cost in the developing world is about US$0.07 to US$0.24 per day as of 2015.[2]
    • What the source says about:
      • Suppliers: The cited database entry lists twelve suppliers that offered 200 mg tablets of carbamazepine for sale in packages ranging from 100 to 1,000 pills each in 2014. The lowest price reported by these 12 organizations was US$0.0138 per pill, and the highest price was US$0.0372 per pill, with a median price of US$0.0185 per pill, down 5%. The High/Low Ratio was 2.70.
      • Buyers: The cited database entry lists three governments plus the Central American Integration System. The lowest price reported by these four organizations was US$0.0155 per pill, and the highest price was US$0.0480 per pill with a median price of US$0.0202 per pill, down 9%. The High/Low ratio was 3.10.
      • The drug: Each pill contains 200 mg of carbamazepine. The defined daily dose is 1 gram. There are five other entries in the MSH database for this drug for 2015.[3]
  • Diazepam:
    • What the lead says: The wholesale cost in the developing world is about US$0.01 per dose as of 2014.[4]
    • What the source says about:
      • Suppliers: The cited database entry has no information about supplier prices.
      • Buyers: The cited database entry lists two governments that reported buying 10 mg tablets of diazepam in 2014. Both governments report a price of US$0.0100 per pill, so the lowest, highest, and median price are identical, and the High/Low ratio is 1.
      • The drug: Each pill contains 10 mg of diazepam. The defined daily dose is 10 mg. There are two other entries in the MSH database for this drug in 2014,[5] and three for 2015.[6]

Background[edit]

Drug price availability
Drug prices vary according to a number of factors, including strength (e.g., how many milligrams per pill), formulation (e.g., pill or liquid), manufacturer, country, wholesale vs. retail, what the patient pays vs. what the health program pays, prices before rebates and subsidies, etc. Even within the category of wholesale prices, there are multiple measurements. Many prices are kept confidential, so there are few sources available. Additional information about drug prices can be found at Category:Drug pricing.
Example articles
You can see several hundred examples of how drug prices are being presented at User:Colin/ExistingPrices.
Related discussions
There was a previous RFC related to drug prices in 2016. Recent discussions on what advice we should give in guidelines include a long thread at Wikipedia talk:Manual of Style/Medicine-related articles#Product pricing and another at Wikipedia talk:WikiProject Medicine/Archive 130#MEDPRICE. This RFC was written at the direction of the community in this discussion and mostly developed at WT:MEDMOS.
This is a marathon, not a sprint
The next goal is to update the Wikipedia:Manual of Style/Medicine-related articles to include advice on when and how to present information about prices and pricing for drugs. It is likely that there will be at least one more RFC related to this subject area. Everyone's ultimate goal is to build great encyclopedia articles about pharmaceutical drugs.

Discussion[edit]

Main question:

Do you think that the content in the examples above complies with Wikipedia's standards for verifiability, due weight, no original research, what Wikipedia is not, and how to write a lead section?

This is a request for your comments, not just a vote! You don't need to "support" or "oppose" anything. Please feel free to ask questions and to respond to this RFC broadly. If you think the text in our articles could be improved, please tell us how you would improve it. If you think an example shows a good feature, please tell us why it's good. Understanding your thought process and what matters most to you will directly help us develop a solid proposal for updating WP:MEDMOS and will ultimately help us improve articles about drugs.

We're going to try to keep comments about the same general subject area together. Don't worry: you don't have to stick tightly to the subject! We know that these areas overlap significantly, so just put your comments in whichever section you think is closest. You can put all of your ideas in one section, or you can put different comments in separate sections.

Comments about verifiability and original research[edit]

  • Unless there's some background I'm missing, the ethosuximide example appears grossly inappropriate. Is a single price from one supplier to one country really being given as the cost for the entire developing world? Is there some reason to believe that price is typical or representative? And why the four-figure precision? Even before we think about over-extrapolation, fluctuations in the US exchange rate alone make $27.77 misleading on account of overprecision. Adrian J. Hunter(talkcontribs) 07:33, 24 January 2020 (UTC)
  • I agree with Adrian. Unless the drug is specific to one or a small group of countries, or there is a negotiated price for a drug (eg a charity, producer or grouping has negotiated a wholesale price, which in itself is relevant to mention in my opinion), I think it's misleading and inappropriate to give a single number as the cost of a drug. It's misleading, because this is the wholesale price, which is not relevant to readers who will be expecting the consumer price. It's highly likely to vary between countries, and regardless of what a source may say I am extremely doubtful that there is a meaningful single stable price for drugs that should be included in the lead, particularly one that readers, who are likely from English speaking and therefore developing to developed countries. --Tom (LT) (talk) 21:56, 24 January 2020 (UTC)
  • What calculation leads to the example for carbamazepine? Since the database appears to be a series of examples, unless it’s exhaustive I don’t think you can infer a range from that without original research (the extremes of a sample are not the extremes of the entire population). Also, "the developing world" is an ambiguous category, and even if a specific classification can be decided on, it will change as development status generally improves over time. Sunrise (talk) 00:40, 25 January 2020 (UTC)
    • Sunrise, the calculation used for daily prices is , rounded the nearest penny. In this case, that means five times the price of the lowest price in the linked database record (a seller price) and the highest price (a buyer price). I don't know why this particular record was chosen and not the other five, but it might have been based upon professional experience (e.g., the most common pill size), or it might have been the record with the most buyer/seller prices listed (or maybe something else that I haven't thought of). I wonder, if some editors wanted to use this database, what advice would you give them on what to put in the article? WhatamIdoing (talk) 03:41, 28 January 2020 (UTC)
      I see, so it’s supposed to be the price of the defined daily dose. I don’t think calculating that is original research in itself, since it’s just determining the value for a different amount. But the conversion to a range is definitely OR as it suggests an assumption not supported by the source: that the minimum and maximum values in the database are the minimum and maximum values overall. After that, an even greater amount of OR is required to describe this information as “the wholesale cost in the developing world”.
      For your question, in general I’d say not to use it at all, and one of the minimum requirements for making an exception would be to use it in combination with a more reliable source. If you’re specifically asking what kind of statement the source is able to verify, without considering any issues outside V/OR, then it would be something much narrower. It would have to be indisputable and without containing any extrapolation, or in other words something closer to the sample quotation I gave as part of my comment in the “neutrality and due weight” section (which is admittedly somewhat exaggerated for effect, but not by much). It should probably include a direct reference to the defined daily dose as well. Sunrise (talk) 08:13, 31 January 2020 (UTC)
  • I am confused why the first two entries in this section are nothing but blank starting statements. Are the originators of this RFC so insecure that they feel they must control the inputs of everyone who comments? Verifiability and original research have little in common as it pertains to the supposed examples. Are you asking whether we can verify original research or verify content or whether verifiable information is being used for original research. Also is there a particular reason you kept the one users's, who bludgeoned the discussion to start this RFC's, original research in the opening prose. Anyone thinking this RFC is a neutral representation of current content should look at the discussion that lead to this RFC. Be careful it will take hours.AlmostFrancis (talk) 04:47, 25 January 2020 (UTC)
    • @AlmostFrancis: your comment is a confusing mix of substantive comments and process complains. I suggest you separate the two. I am confused why the first two entries in this section are nothing but blank starting statements. Obviously, they are an attempt to encourage people to engage in discussion behavior, rather than in voting behavior. --JBL (talk) 02:18, 26 January 2020 (UTC) Addendum: AlmostFrancis cannot respond to this comment, having been topic-banned for incivility. --JBL (talk) 21:47, 27 January 2020 (UTC)
  • About 25% of our articles give a developing world cost per dose.[1] The source does not give a cost per dose, nor say what is a typical dose (the amount of a drug one takes at one time), so any such cost is unverifiable. Most drugs treat several conditions and there are lots of common doses, which vary with indication and patient characteristics (age, weight, health).
For example, with diazepam we give the cost for an untypical 10mg tablet dose, a tablet strength that isn't available from any suppliers to the developing world. The correct typical dose for diazepam for anxiety is 2mg three times a day taken long term.[2] In the UK this costs the NHS £0.027 per dose, which is meaningless to our readers if you don't know the "2mg three times a day" treatment plan (forbidden by WP:MEDMOS). For emergency treatment of a prolonged seizure then the typical adult dose of 10mg is give and then repeated after 10 minutes if required. This is not a pill, but given either by injection or per rectum, costing £0.55 or £1.50 per dose.[3] There is no one cost per dose. -- Colin°Talk 11:41, 26 January 2020 (UTC)
  • About 30% of our articles give a developing world treatment cost per day or month.[1]. The source does not give the cost per day or month, nor does it suggest a treatment plan ("take two 50mg tablets twice a day for seven days", or "take one 100mg extended-release tablet a day and come back to see me in six months") so we are unable to verify which tablet strength to cite, how many to take, how often, and for how long.
These costs are derived by an editor using the defined daily dose (DDD) combined with an arbitrary choice of tablet strength and assumptions about dose frequency and treatment duration. The DDD is a calculated metric designed for drug usage statistics not treatment cost. It isn't guaranteed to divide by any available pill size, or correspond to a dose anyone is typically or ever prescribed. The WHO say that using this for detailed cost analysis is an abuse of the metric, and the only valid use they suggest is to compare the cost of two different formulations of the same drug. Our source does not use the DDD to give the treatment cost of a drug, so neither should we. -- Colin°Talk 11:41, 26 January 2020 (UTC)
  • We give a "wholesale cost in the developing world", an International Reference Price. The source Guide says "buyer" prices should not be used as reference prices.[4] Instead, the WHO recommend taking the median of many "supplier" prices to make a reliable reference price.[5]:41 A third of our drug articles have no suppliers, and another third only have one or two suppliers:[1] for these drugs, the majority, the Guide is not a reliable source of "wholesale cost in the developing world". -- Colin°Talk 11:41, 26 January 2020 (UTC)
  • See PriceMistakes for examples of drugs where original research, unsourced data and misuse of WHO metrics has led to clear errors. 20% of our prices are simply wrong, even ignoring all the other issues. -- Colin°Talk 11:41, 26 January 2020 (UTC)
  • Doing basic math isn't OR. But extrapolating from, say, wholesale price in one country to per-dose price globally obviously is OR.  — SMcCandlish ¢ 😼  20:51, 2 February 2020 (UTC)
  • WP:NOTOR says simple calculations are not original research; the formula stated by WAID (above) seems like a relatively simple and direct mathematical calculation that reasonably educated readers can be expected to quickly and easily reproduce. I'd suggest that, if at the close of the RfC price information is to remain somewhere in the article, any agreed upon formula(s) should be stated within MEDMOS to allow for consistency and verifiability. Little pob (talk) 13:21, 3 February 2020 (UTC)
  • In trying to figure out what to write about verifiability, it has come to my attention that prices in the U.S. vary vastly, even among similar people in the same location who merely have different insurance plans. Here is an example taken from a NextDoor.com poster. How can we purport that anything is verifiable when the facts are that the contracts are mutable without notice, and often are changed without notice to prey on the dependent in proportion to their ability to pay? EllenCT (talk) 21:46, 7 February 2020 (UTC)
  • Just simple math isn't OR. It is certainly not OR to say that in the equation "x + 3 = 4", x must be equal to one. But this is well beyond basic math. It's taking wholesale database figures (which may or may not have any bearing on what a consumer actually pays), a listed average dose, and doing the math to say "Oh, this is the price." That goes far beyond basic math, into presuming that the price is worldwide, is static, that the wholesale price particularly matters on a per-dosage basis, that the "average" dose really is average and there isn't substantial variation, so on, so on.... That is OR. Seraphimblade Talk to me 02:09, 9 February 2020 (UTC)
  • Yes, complies with verifiability and original research policies Adding medical price information in the demonstrated way is in alignment with Wikipedia's policies on verifiability and original research. In my view, the objections are not about Wikipedia presenting this information, but instead, the objections are critiques of the source material from the subject matter experts. We have identified the best drug pricing information that the world has to offer and we cite the sources. I acknowledge that the best sources in the world, including the governments of the United States, the European Union, The United Nations' World Health Organization, the entirety of the pharmaceutical industry, the best funded universities, and the sum of all NGOs and nonprofit organizations try to curate medical pricing information and frequently fail to produce quality data. However, it is not our place as Wikipedia editors to say that the best data sources in the world are too poor to include in Wikipedia. Instead, we recognize when we have found the best information which exists and then we find a way to include that in Wikipedia. I agree with critics that the best the world has to offer in this space is often low quality, but it is not our place to exclude the best available information on that basis. The fastest and most efficient way to become even better is to normalize the current practice, then in that context, consider the many options we have to present prices in ways that are even more integrated with the sources. Blue Rasberry (talk) 16:06, 11 February 2020 (UTC)
    It's our responsibility as Wikipedians to assess references, and reject them if they don't meet quality or other policy-related requirements. --Ronz (talk) 02:41, 12 February 2020 (UTC)
    We most certainly can, and most certainly do, decide that a reference's quality is not up to par and we won't use it. If that is the only reference available for a particular piece of information, that information will not be included. We aren't just looking for "the best information available". If the best information available is still unreliable, we don't use it. Seraphimblade Talk to me 06:57, 12 February 2020 (UTC)
    Bluerasberry I think you have got "data" and "information" confused. The MSH price guide is a great source of primary data, and nobody is suggesting the data itself might be unreliable. But as you know, you can't test a new statin on five patients for a year, record that none of them got heart attacks or strokes, and conclude your new drug should be universally prescribed. "Wonderstatin prevents heart attacks" is not acceptable information to present on Wikipedia, even though for sure John, Sue, Leslie, Peter and Karen all had no heart attacks and took that pill. There's a statistical process and judgement of experts required to turn data into information, and often they will conclude the data is too limited or flawed for one to make any conclusion. Presenting the data in a way that is wrong, unjustified or misleading actually contributes negative information. Would you agree? As an encyclopaedia, we should be based on secondary sources of information, which we then summarise. We don't actually have any sources that comprehensively give "the price of a drug" or even "the affordability of a drug". -- Colin°Talk 08:50, 12 February 2020 (UTC)
Colin As a default, I think that we should present the data in the manner that the authoritative available sources present the data. Wikipedia is not censored to withhold data which the Wikipedia community of editors deem dangerous. Wikipedia's very existence and coverage of drugs and medical topics its itself radical. Even to this data, there is consensus among experts that no one should get any drug or disease information from Wikipedia, as the reviews in "health information on Wikipedia" make clear. WP:Otherstuffexists, Wikipedia uniformly gets criticism, and among all the dangerous things we do like discuss side effects and interactions, a presentation of price is relatively tamer content which we can publish. We have sources which present price and Wikipedia can deliver this content with quality as good as or better than the original sources or the sum of sources. Your argument has not convinced me. Blue Rasberry (talk) 18:12, 23 February 2020 (UTC)
Bluerasberry the "Wikipedia is not censored" argument is kind of like Godwin's law. One you find yourself arguing to include trivia and colossal quantities of meaningless and misleading data rather than limited pertinent information because WP:NOTCENSORED, you've lost. Game over. -- Colin°Talk 18:29, 23 February 2020 (UTC)
  • I find the segmentation of this RFC so off-putting that I have had a hard time figuring out how to weigh in. And considering the amount of typos I make, I'm sure I'll end up with hundreds of edits on this RFC for having to respond in multiple sections rather than all together in one place.
    Well, by now, a lot has already been said, so I will just indicate what I agree and disagree with. Adrian J. Hunter and Tom (LT) explain the "grossly inappropriate" use of the sources at ethoximide; this is typical of what was found during RFC formulation for all of the 530 examples of existing drug prices; no example surfaced during RFC formulation that IMO did not contain OR and V issues. I think Sunrise and Little pob miss the OR/CALC problem in that these samples are not simple math, and I agree with Colin, SMcCandlish, Seraphimblade that the number of assumptions that go in to crafting these numbers is well beyond simple math, not only using inaccurate assumptions, but also involving SYNTH. To produced these numbers, the editor who inserted them had to make assumptions (incorrect in every example I've looked at) about how to use defined daily dose, which condition is being treated, what drug formulation is being used, what dosage is being used (incorrect in the case of chlorthalidone), and much more. The length of these discussions alone and the number of problems raised by different editors demonstrate the extent of SYNTH/OR; if experienced Wikipedians can't sort and agree on these, how do we expect an average reader to? EllenCT explains part of the V problem that resulted from the incorrect use of databases to generate these numbers: databases that weren't intended to be used as they have been used here, and don't contain the kind of analysis being done in Wikipedia articles or in fact any meaningful analysis.
    During RFC formulation, we spent six weeks examining not only the three samples given here from the MSH database, but many others from the several other databases used in or contemplated for drug articles so far, such as Drugs.com, the British National Formulary, NADAC, and Hamilton, Richart (2015), Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition, Jones & Bartlett Learning. IMO, no example surfaced that could be shown to meet core policies NOR,WEIGHT and V (so that we could use that example to suggest how to handle NOT and LEAD). With three archives of discussions, I can produce only a few of those discussions, to give examples of the problems:
  1. NOR sample discussion
  2. Chlorthalidone example
  3. Carvedilol

It has been claimed that there are only small rounding errors, but the problems are much greater with examples of 100- to 1,000-fold errors. Chlorthalidone is a drug commonly prescribed at 12.5 mg daily for hypertension, and at various other dosages higher than 25 mg for diabetes, and yet our article chooses to present 25 mg. Why? Based on what condition? Going to a database and picking a dosage, a condition, and assuming that the Defined Daily Dose can be used (it can't) is fantasy. It's not just WP:CALC or simple math (multiple dosage x 30); it's that one cannot go to these databases and pick one record to use, nor is it meaningful to attempt do so. This is already well summarized by Colin [7] but to his list I would add the vagaries of health insurance pricing and discount suppliers as mentioned by EllenCt.

Bluerasberry suggests that Wikipedia should use the best sources available to the industry. That kind of thinking represents a blatant violation of Wikipedia's core policies, and one that would be, indeed has been, soundly rejected in our top content. Some industries/topics don't typically have the kind of sourcing that complies with Wikipedia policies, and that's why they are under-represented among featured articles; the Food and drink category comes to mind. We don't lower our standards because sources don't yet exist to meet them; I shudder to think where this kind of thinking could lead if applied to other content areas.

To the idea that we can find a way to somehow fix these errors, no. Suggestions like "use a range" involve the same kind of OR we are rejecting. The fundamental flaw in all 530 articles – using a database that has no meaningful content or analysis,to synthesize content – cannot be fixed. Verifiable means a reader can go to the source and find the content, sometimes involving simple math. We do not have that here in any of the 530 cases; this is beyond simple math, and there is no way to present content based on this database without incurring that problem. SandyGeorgia (Talk) 17:10, 18 February 2020 (UTC)

  • In my original dispute at Ivermectin (edit | talk | history | protect | delete | links | watch | logs | views) and related articles, it never crossed my mind to look at basic verification and original research problems. Clearly there is OR to further a POV not in the sources, and furthering a POV contradicted by the sources as far as it comes down to using the database as recommended. --Hipal/Ronz (talk) 19:49, 21 February 2020 (UTC)
  • Wikipedia is not like a book authored by known experts in the field, reviewed and edited by other experts, and released by a publisher with a reputation to hold. As such it has developed policies that help us determine whether and what to write about facts by relying on what such experts and reliable sources are already discussing and saying. We do this to protect ourselves against those who seek to push a POV and are here for advocacy purposes. And advocacy is certainly a repeated feature of some pro-price editor's comments. We also do this to protect ourselves against incompetence, no matter what editors may claim about their real world professions or qualifications. And incompetence with basic statistics, math calculations, and correctly reflecting real-world prescribing practice are repeated features of the hundreds of prices in drug articles. We have our core policies to stop editors over-reaching what our sources say, from making claims the sources do not support. Violating not just WP:NOTPRICES but WP:V and WP:OR and WP:LEAD are also repeated features.
These problems are not unique to the MSH Price Guide. As WIAD notes, the Drugs.com retail prices are suspiciously high and do not factor in common discounts and coupons: nobody pays them. The NADAC wholesales prices (a website that doesn't even allow editors to link to the one drug) are even more dubious, their value determined by some commercial/political game unrelated to what pharmacies pay, and are often higher than retail prices. The BNF NHS wholesale prices are so comprehensive one doesn't even begin to know which to select, but ultimately quite irrelevant to patients, who don't pay them or any amount related to them. Further the BNF does not list the details of commercially secret discounts agreed by the NHS for high-cost treatment, so its use to calculate such a treatment would unfairly give prominence to the fantasy list price that Big Pharma wish to make public. GoodRX also combines extensive variety of prices with variety of retailers, generating a multitude of possible prices based on what big chain-store is near you in town. None of these sources claim there is one dose, one treatment plan, one indication that best represents a "cost" patients or hospitals might incur to be treated with the drug. Any attempt to use them to claim such fails verification and requires original research. -- Colin°Talk 17:46, 23 February 2020 (UTC)

Comments about neutrality and due weight[edit]

  • I don't think this belongs in the lead, per WP:LEDE ("introduction to the article and a summary of its most important contents") and WP:UNDUE ("depth of detail...prominence of placement"). It's just one loose fact, not generally a defining characteristic of the drug or a summary of substantial article content (no secondary ref to help place this idea in context, etc.). If the topic of pricing of a certain drug is covered in substantial detail in the article (for example, highlighted as an example by secondary refs for differences of US vs foreign, or sudden markup by manufacturer, or in comparison to other treatments for a medical condition), I could envision mentioning that topic there (but again, probably not the single value). DMacks (talk) 09:43, 24 January 2020 (UTC)
  • For anything but the most basic information, using only a database as a source isn’t much better than having no source at all. Even passing mentions in stronger sources are not generally sufficient to support inclusion, because they give no indication of the information’s importance; the price itself has to be the subject of discussion. A database contains no context or analysis, and is only usable in the first place if there’s no doubt about accuracy. However, to actually ensure that, the examples above would have to be much more specific, because these are prices for specific times and places, and even specific transactions ("in year A, according to the records in database B, company C sold D doses of drugs to group E for a price of F in currency G, which includes insurance and transportation charges but not handling fees or taxes"), and it rapidly becomes clear that the weight is insufficient. Considering only questions of weight, I suppose one could argue that a price is in fact basic information (similar to molecular weights or chemical formulas), meaning a database citation would be acceptable, although the argument is significantly weakened by the issues with inaccuracy and the fact that the value isn't constant. If it's accepted regardless, perhaps it might not be so out of place to include prices in an infobox entry attached to an appropriate caveat, but even then a sentence in the lead (or arguably even a sentence in the body) is far more weight than it should be given without support from stronger sources. Sunrise (talk) 00:40, 25 January 2020 (UTC)
  • What does neutrality have to do with due weight in these examples? Are you claiming that the entries are not neutral in some way, and if so could that be pointed out? Due weight is a better question. Not the question that was asked but a better question. I think an RFC based on what would be due weight would be useful but based off of these three examples is pointlessAlmostFrancis (talk) 04:57, 25 January 2020 (UTC)
    Weight violations are a type of neutrality violation; WP:WEIGHT is a subsection of WP:NPOV. Sunrise (talk) 12:24, 25 January 2020 (UTC)
    Indeed. I think sometimes people forget it's not part of WP:NOR, since the phrase comes up there, too, as a cross-reference in a least a spot or two.  — SMcCandlish ¢ 😼  22:10, 3 February 2020 (UTC)
  • Only rarely should something like prices be in the WP:LEDE. An exception would be if the price itself deserves much-higher-than-normal weight, such as a medication whose price was prominent in the news for an extended period of time, such as some new "you are cured of your chronic disease" medications that cost 6 figures for a treatment that takes less than a year, or some drugs whose price increases have put them in the news (insulin, emergency inhalers, to name two). Likewise, if a drug saves many lives because it is very cheap, that might be a reason to put the price, or at least the fact that it has a very low price ("because of its affordability, xxxx has been widely used in the developing world and has been estimated to have saved xxxx lives since it became available in year.") I'm sure there are other case-by-case situations where the price or change in price over time would belong in the lede, but those are the exceptions, not the rule. davidwr/(talk)/(contribs) 20:36, 27 January 2020 (UTC)
    Perhaps another way to put this is that "the price of X is Y" is not by itself encyclopedic, but sometimes there will be something encyclopedic to say about the price of X. --JBL (talk) 21:45, 27 January 2020 (UTC)
  • This entire page is WP:TLDR ergo off-putting to many who are not into such exercises. As a spitball diagnosis though this info as well-meaning as it may be doesn’t seem neutral or lead-worthy as yet. It would need to be more global in presentation, and the prices likely compared to similar or even all drugs, “it is the most expensive foo”. Gleeanon409 (talk) 06:39, 28 January 2020 (UTC)
    • Don't feel that you need to read every comment to participate! Even if you don't have strong opinions about the examples, general comments on how you think our policies should handle pharmaceutical prices will be helpful in understanding the community consensus. Thanks for participating! Wug·a·po·des 20:12, 28 January 2020 (UTC)
  • Information about prices of medications are critical to human health. Médecins Sans Frontières (Doctors Without Borders) writes "Secret medicine prices cost lives" while the World Health Organization states "costs will always be important in managing policy related to drug supply, pricing and use" and lists cost per defined daily dose (DDD) as one possible cost metric. We contain plenty of information for different audiences such as "molar mass" and "melting point" and Simplified molecular-input line-entry system. Price is critical for an entire area of medicine (cost benefit analysis and public health) plus approximate prices are useful for both health care providers and patients. Doc James (talk · contribs · email) 06:23, 30 January 2020 (UTC)
    • I strongly prefer the Defined Daily Dose approach broken out by markets in which the drug is most and least expensive, optionally with historical trends, to attempts to try to pin down the cost of a single dose, which seems fraught with both NPOV and WEIGHT issues. But even then, wouldn't it be better to state the total cost of the drug over a typical course of treatment for drugs that aren't taken for the rest of the patient's life? EllenCT (talk) 08:28, 30 January 2020 (UTC)
    • James, the WHO do indeed list cost per defined daily dose as a metric. Your link says "the cost per DDD can usually be used to compare the costs of two formulations of the same drug" Most other uses they regard as "misuse", as explained in our Defined daily dose article and any research use of this metric should be done by experts who understand and explain its limitations, rather than by Wikipedians. It is ironic that the only use of the cost per DDD that the WHO encourage, is to compare the price of formulations of the same drug: different formulations have different treatment costs, and yet our articles all arbitrarily pick one formulation and strength and unspecified indication and claim this is representative of the treatment cost of the drug as a whole.
    EllenCT a "cost per day/month" or "treatment cost" are all valid costs to consider for presentation to readers, and I agree are more useful to our readers than the cost of a "dose" or a "tablet". But let's not call that the "the Defined Daily Dose approach", which is the original research method used by James to calculate this from database records that only give the costs of specific individual pills sold by individual suppliers. I agree that total treatment cost could be useful for certain indications, and also we should consider whether the disease article is more appropriate to discuss treatment cost if notable. -- Colin°Talk 09:30, 30 January 2020 (UTC)
    • The importance of drug prices to human health sounds like a good reason for getting our content right. However, "it's important" doesn't necessarily seem to translate into obvious action about when and how to use the information in this database. Are we improving human health by saying that the price in the developing world is the single price that was reported by a seller that only reaches 1% of the world's population? Or are we maybe making things worse? WhatamIdoing (talk) 02:13, 31 January 2020 (UTC)
      These are not "single prices" but rather approximate prices. And yes approximate prices are useful. Doc James (talk · contribs · email) 09:54, 2 February 2020 (UTC)
      User:Doc James, the database record gave a single price. Not a single price in the article, but a single price in the source. I am asking you whether you think that claiming the price at which one (1) single non-profit organization offered a drug for sale, only during one year, and only to accredited healthcare organizations inside the Democratic Republic of the Congo, and (this is the important point) calling it the price "in the [entire] developing world" (rather than, e.g., "in the Democratic Republic of Congo" or "in one country in Africa") is good. I don't want you to tell me that WP:ITSUSEFUL to have some price in general. I want you to tell me whether you think it's okay for Wikipedia to claim that a price is "about $27.77 per month" for 80% of the people living on this planet, when the database record says that the listed price is only for 1% of the people living on this planet, and the only supplier listed is (according to my spot-check) consistently in the lower half of prices in that database. Are you happy just assuming that the price is the same for the other 79% of people, and that this single charitable organization is representative of all the suppliers? Or should we maybe adjust the text in that article to be a little more precise? WhatamIdoing (talk) 01:45, 3 February 2020 (UTC)
    User:WhatamIdoing we can adjust that one to that one country. Many of the prices apply to more than 130 countries in the developing world however.
    If the concern is around how we summarize this source, I imagine we can fairly easily come to a solution. However some appear to be proposing we remove all price information or all price information not covered by the Western popular press, well then we will continue to disagree.
    This database is a perfectly suitable source and one the many others reference. Doc James (talk · contribs · email) 01:48, 3 February 2020 (UTC)
    This RFC is about how/when to use this one database as a source, and not whether price information should ever be included. So far, people have pointed out some problems, but I don't remember seeing a single person saying that the carbamazepine record (which is one of the best in the database) is unusable, and absolutely nobody has said that the "Western popular press" is the only acceptable source of information about prices. Multiple editors have given examples of articles that they believe must include price information, which is the opposite of "proposing we remove all price information". If they are telling us that we have screwed up the ethosuximide information (and it appears that they are telling us that), then that doesn't mean that the only option left is a newspaper. That just means that we fix our mistakes. WhatamIdoing (talk) 16:53, 3 February 2020 (UTC)
    James says "Many of the prices apply to more than 130 countries in the developing world". Ozzie10aaa also says "IDA Foundation sells to more than 130 LMIC". The IDA Foundation do indeed claim to supply health products to 130 countries, but it is not clear how many countries are offered their full catalogue of drugs, and how many state healthcare and non-profit NGOs actually procure from IDA. Examination of procurement costs by WHO/HAI suggest hospitals and governments do not typically achieve an efficient price (typically paying multiples of such). In many countries where drug availability from state healthcare or non-profit NGOs is poor, the IDA price may be quite irrelevant: organisations like IDA do not sell to the private, for-profit, pharmacies that patients are forced to use. The IDA prices are "exclusive of VAT (sales tax), import duties and other taxes, levies or rights, costs of packing, costs of loading and unloading, and costs of transport and insurance. Moreover, IDA shall be entitled to charge administrative and handling expenses. Minimum order value USD $5000 and IDA shall be entitled to determine a minimum order quantity." The reality is we have been taken in by believing a simplified sales boast actually refers to reality on the ground, and by naively assuming a sales catalogue of "guideline" prices represents anything close to what developing world countries actually pay. -- Colin°Talk 17:33, 23 February 2020 (UTC)
  • Agreed with several of the above that prices generally do not belong in the lead or infobox (i.e., I would support removing a parameter for this from any applicable i-boxes – WP:NOTPRICE basically demands it). Price-related information might belong in the lead only in cases where much of the notability of the subject surrounds real-world controversies about pricing.  — SMcCandlish ¢ 😼  20:54, 2 February 2020 (UTC)
    • User:SMcCandlish where is the consensus for WP:NOTPRICE? Or is it simple that someone added it one day and because it stuck? Prices are in the infoboxes of a lot of FAs such as Wii. Not in any medication articles that I am aware of. Doc James (talk · contribs · email) 04:54, 3 February 2020 (UTC)
      I have no idea what the origin is of this recently recurring fallacy (I've seen three editors try to use it this week alone, all to zero effect) that if you can't find an old RfC on something that's in a WP:P&G page that it must have no consensus and you can ignore or remove it. WP doesn't work that way, and we all (except, apparently, a handful of people) fully understand that. See WP:CONSENSUS. If something's been in a P&G page for years, it has consensus by definition. If you think consensus has changed and the P&G material hasn't been updated to reflect that shift, and thus the "rule" in question should be changed or deleted, you know where WP:VPPOL is, or can propose a change more locally at the talk page of the P&G page in question. P&G pages are not like obscure articles where someone can inject something for years without anyone noticing or caring. Policies are watchlisted by a zillion people, and are operationally used (and tested as to their sensibility, usefulness, agreement with other P&G material, etc.) on a daily basis.

      It's very unlikely that there hasn't been plenty of consensus discussion of NOTPRICE being included in WP:NOT; everything gets hashed over there; 57 archive pages worth of it. If there are other infoboxes that need cleanup to comply with NOTPRICE, then fix those, too. See WP:OTHERSTUFFEXISTS. Wikiprojects (the sources of most topical infoboxes) are notorious for ignoring policies they don't like (especially ones that get in the way of their topic-cruft geekery) until caught out and corrected. If it's so overwhelmingly common – despite all the arguments presented in this page – that WP as a community really does want to include lots of price/cost information (in infoboxes even), then a proposal or remove or change NOTPRICE would actually be called for (though I would wager real money on the outcome with confidence).
       — SMcCandlish ¢ 😼  05:57, 3 February 2020 (UTC); rev'd. 06:09, 3 February 2020 (UTC)

      Here you go: [8], and that's just a one-word search on prices; there will be other discussions found with other search terms. Cf. WP:You can search, too; it took about 20 seconds.  — SMcCandlish ¢ 😼  06:13, 3 February 2020 (UTC)

    Xbox articles mentions prices from various countries in various currencies. Wii is another example. These two consoles are not even available in most of the countries and are luxury products! Medicines are equally (maybe even more) important than gaming devices and affect people directly. --AbhiSuryawanshi (talk) 06:05, 3 February 2020 (UTC)
    WP:OTHERSTUFFEXISTS. That X number of other articles/infoboxes are making the same mistake (ignoring the same policy and its rationale) doesn't mean this one should be permitted.  — SMcCandlish ¢ 😼  06:09, 3 February 2020 (UTC)
    • I actually want to jump in here; video game consoles have price information because it's covered in RS and because RSs make a point of comparison between the varied hardware available, one item of which is always the price. (See also the generation series of articles e.g. Eighth generation of video game consoles.) That is not broadly true here (else we would not be having this discussion, I suspect). --Izno (talk) 15:25, 3 February 2020 (UTC)
      Sure, though that doesn't make it infobox and lead material at the console articles; we have a generalized problem of "tech gadget" boxes being totally festooned with almost every detail someone can find a way to cram into an infobox (cell phone ones a probably the worst). It defeats the purpose of infoboxes just from a "firehose of trivia" perspective, even before any V, NOR, NPOV concerns are examined.

      There are really four questions to ask in a let's-get-specific followup RfC. I think we need to be careful here to separate "Should we include price-related info in the article body at all?" from "Should we treat price info as vital lead-section information?" from "Should we treat price info as key tabular data for the infobox?" from "Should we build tables (as MOS:SALs or MOS:ELISTs) of comparative drug-price data?" They're four separate things that each have their own angels and devils. I think the answers are: to the first two, "It depends on the specific case in question, but generally only in unusual cases"; to the third, "Hell, no"; and to the fourth, "Probably not, unless we can come up with a way to do this without POV and OR problems", which is highly dubious. This topic area, as you point out, is simply not like video game consoles.  — SMcCandlish ¢ 😼  22:01, 3 February 2020 (UTC)

  • Agree with the WP:LEAD arguments made about not having the only mention of price in the lead section (with the possible exception of stub articles). In my opinion, en.wikipedia should not be ignoring it's own policies just because it's of benefit to the other language wikis when they translate the lead sections of "our" content – I don't think even WP:IAR would support that argument. I'm not (yet) convinced by the other stuff arguments; as all the products mentioned so far have recommended retail prices. Little pob (talk) 13:36, 3 February 2020 (UTC)
    Sure, but that's already covered by MOS:LEAD. A lead section is a summary of the key points of the article, not a place to store unique facts not found elsewhere in the piece (at least not after the skeletal stub stage). Otherwise the lead is simply improperly written, and material needs to merge into the body, then the lead re-summarize the entire revised thing, with newly re-applied WP:DUE weight. That's true across all topics.  — SMcCandlish ¢ 😼  22:05, 3 February 2020 (UTC)
    I feel there may have been a miscommunication on my part; but for the sake of clarity, you're preaching to the choir on this point. Little pob (talk) 10:45, 4 February 2020 (UTC)
again I think adding the price of essential medicines is responsible because it's an important information for readers and with regard to the developing countries, I think adding the range of prices is helpful because the poverty is very common so many patients ask physicians about the price to decide whether they can buy that medication or they can search for a cheaper alternative and sometimes they refuse the treatment because it's unaffordable for them. For reliability of information we can use the formal resources in that countries. For example the website for Jordanian food and drug administration provides details about the prices of medicines. Regards--Avicenno (talk) 19:33, 6 February 2020 (UTC)
  • Thanks for your comment, Avicenno. Would you use this database, which is wholesale prices (the patient usually pays much more), or would you recommend looking for other sources instead? If you used this source, what would you say in an article like Diazepam? Feel free to skip down the page to one of the sections on the three examples, and suggest the text that shows what you'd like to see in an article. Sometimes an example is worth more than a description. WhatamIdoing (talk) 00:42, 7 February 2020 (UTC)
    This RFC is difficult to parse. I guess what initially comes to mind is, what is our goal, it is to "provide the sum of all human knowledge". Do prices of essential medicines for those in the developing world advance this goal? Yes definitely. The rest can be figured out afterwards. Policies and guidelines are here to help us achieve this goal, nothing else. Can some of the wording of the current content be adjusted and improved? - sure certainly. However if we reach a decision where the price of insulin in the United States can be included as it is supported by newspaper articles but the prices of essential medicines cannot as it is only supported by an NGO affiliated with the World Health Organization we will have reached the wrong conclusion. EMsmile (talk) 01:54, 7 February 2020 (UTC)
    I agree with you, EMsmile, about what our policies should enable. I'm a little uncertain about saying that the price of a drug in one or two countries should really be considered the "sum", rather than the "addends", of human knowledge. Did you get a chance to look around at a few of records in this database? WhatamIdoing (talk) 00:04, 8 February 2020 (UTC)
  • Only in tremendously exceptional cases should pricing information be in a lead. That's not "never" (there are indeed drugs for which the price of them is in itself a very notable factor about them), but it should be quite rare. To appear in the body, the price should be discussed, as opposed to mentioned, by reliable sources as something significant. In most drug articles, as with most articles about products, pricing should not appear at all. Seraphimblade Talk to me 02:12, 9 February 2020 (UTC)
  • Pricing information defines the drug The main reason why we should include price information is because we know from thousands of sources that drug pricing is fundamental to understanding drugs. That should be sufficient reason, but the further explanation is that the price of a drug determines whether a patient can access it. There is room for discussing how we present price, but it would be a great error to omit price information entirely. The most essential part of price to communicate is whether a product is for typical people or only the rich. Wikipedia does not presume that its readers are all wealthy and able to access any option, and instead must anticipate that most readers live in an economy where prices define their choices. The sources we cite for prices publish the prices for this reason, which is why we cite them, and why Wikipedia should include prices.
The information which Wikipedia presents about what conditions a drug treats, etc., is irrelevant if the drug is not affordable to a person. In the case of Low and Middle Income Countries (LMICs), we know that a lot of households make less than US$1500/year, but in India for example, most people have access to high speed Internet and English language is ubiquitous. It is no longer a fantasy to imagine that Wikipedia is a global and universal encyclopedia, as the Wikimedia Foundation makes the claim that Wikipedia has more than 1 billion unique visitors every year. We also know that health information on Wikipedia is among its most popular content. It is not WP:Due weight to have a complicated explanation about the precision of prices. We have to decide what is the right way to report things, but one model might be to categorize and communicate drugs as roughly costing US$0.01, $0.10, $1, $10, or $100. Whether a drug is $0.01 or $10 will frequently mean the difference of whether a person can access it, and since we know people read Wikipedia to inform their general options, we can be sure that people will only talk with their doctors about the options they can afford to purchase. Even for a wealthy country like the United States, it is basic information to want to know whether a cancer treatment will cost $1000 or $100,000, and Wikipedia would be just as in error to not make that distinction. If Wikipedia neglects to include prices, then that would be a violation of neutrality, because in that case we would be designing Wikipedia for the small subset of wealthy people in this world who do not have to worry about the price of health care every time they have a health issue. Neutrality and matching source focus means including prices. Blue Rasberry (talk) 16:27, 11 February 2020 (UTC)
Pricing information is important, not a specific price. --Ronz (talk) 02:44, 12 February 2020 (UTC)
Pricing/prices
 

Pricing in general is clearly important, and I earlier pointed out Medication costs, Prescription drug prices in the United States, Prescription charges [9].

We generally don't use references that don't mention a specific item to determine weight within an article about a specific item. (That's a horribly convoluted sentence, but I hope it makes sense.) So, while prices are important, that doesn't mean we've met NOTPRICE criteria for an article about a specific medicine unless we have a source clearly showing the importance of prices for that specific medicine.
Prices may not exist in a form that is suitable for encyclopedia articles at all, as all the discussions are indicating.
To answer the question of this subsection: No. Encyclopedic prices don't appear to exist.
Meanwhile, I think a good case could be made for giving extra weight to pricing information when it's available: Information about the ranges in pricing and the many factors involved.

--Ronz (talk) 20:09, 9 December 2019 (UTC) at WT:MEDMOS Archive 11

User:Ronz, I'd love it if you'd explain your distinction between pricing and prices. I think that's important. WhatamIdoing (talk) 05:26, 12 February 2020 (UTC)
Wish I had time to dig through by past comments: I gave the example of Pyrimethamine (edit | talk | history | protect | delete | links | watch | logs | views). There's lots notable about it's pricing (the US price gouging and context around that), and even some notable prices (the before and after costs in the US, maybe some prices elsewhere in comparison). The point is that prices are simply data points, while pricing is the context. We shouldn't be presenting data without context, or removed from the context that makes the information noteworthy in an encyclopedia article. --Ronz (talk) 16:13, 12 February 2020 (UTC)
I dug Ronz's comments about pricing vs. prices out of archives. SandyGeorgia (Talk) 16:30, 12 February 2020 (UTC)
  • As explained by Ronz, discussion of drug pricing warrants mention in articles about drug pricing, but discussion or individual drug prices in these examples are not in accordance with DUE. Based on these three examples, in addition to the total 530 examples, I have seen no reason to set aside core policies (V, OR, DUE) for drug prices. WP:NOT does a fine job of explaining under what circumstances drug pricing should be in articles, and WP:LEAD also explains when they should be in leads; both of those hinge on due weight and coverage in reliable sources. In none of the 530 examples should this text be either in the articles nor in the leads based on the databases used. Drug pricing is important at the global level; DUE weight for the individual drug prices pulled from a database has not been established by coverage in other sources or meaningful discussion of those prices. Hence, I disagree with James's reasoning (beyond the misapplication of defined daily dose, as explained by Colin).
    I agree with DMacks on depth of detail and prominence of placement, davidwr on rarity of pricing info belonging in the lead, Gleeanon4909 (not neutral or lead-worthy), SMcCandlish (not in the lead or infobox, remove parameters), Izno (explains that some articles that do have prices are within the bounds of WP:NOT policy), Little pob on the importance of respecting our LEAD guideline, and Seraphimblade (rarely in the lead, and usually not at all).
    I only partially agree with Sunrise (who says having a database as a source isn't much better than no source, but on LEAD and infobox, cites other examples like chemical formulas which are static and don't change based on a multitude of factors like formulation, dosage, for what condition, in what country, based on insurance or not, the presence of corruption in governments and in customs of developing countries, etc)
    Avicenno makes no attempt at presenting a rationale grounded in policy; their post amounts to BECAUSEILIKEIT and they believe adding prices helps right great wrongs. (If we have a source for prices in Jordan, great, but it would still be UNDUE to discuss drug prices in Jordan based on yet another database source, not to mention, impractical to globalize our drug articles to include every country.)
    EMsmile raises a good question, but such is the heart of NOT; it is not our job, we are an encyclopedia. In fact, the Jordan example highlights quite well what is likely to happen in lower and middle income countries: local apps similar to Goodrx.com will be developed, and be much more relevant to each country than anything an encyclopedia can or should provide (can we factor in coupons available at goodrx.com?). As WAID intimates, this is an "addend" to the sum of all human knowledge. We are not the yellow pages.
    James asks where the consensus for NOT is; I will address that in the appropriate section, but SMcCandlish aptly dispels that "recurring fallacy", along with the other OTHERSTUFFEXISTS faulty arguments. Blue's position amounts to ignoring policy to right great wrongs; an encyclopedia is not for advocacy. It is to summarize what other reliable sources have covered in a way that is meaningful. Information on drug prices is meaningful when sources have discussed them, not just listed them in a database.
    Discussion during RFC formulation uncovered multiple issues (beyond these three examples). Wikipedia often claims a price for "the developing world" that may be based on one country only or data too limited to be useful for any purpose. (Anyone who thinks Costa Rica represents the developing world should look that up.[10] There are actually examples that have one data point, Costa Rica, which claim to represent the developing world.)
    IMO, our policies as written explain what kind of coverage is needed in reliable secondary sources for WEIGHT, not databases or prices guides, and the direction given there is adequate, functional, and what we should be aiming for in an encyclopedia (which is not a price guide, and not here to right great wrongs). We shouldn't be using databases at all, much less outdated ones. Relevant previous discussions:
  • I also want to specifically address LEAD. Leads of articles are the window through which most of our readership views Wikipedia content. Leads are supposed to summarize the most important content in the article and compel the reader to want to know more. Information should not be in the lead unless it is DUE and based on text covered in the article. Even though WP:LEAD is not policy, rather guideline, they are so important that they have a hallowed position in the Featured article criteria. That 530 articles have so casually set aside LEAD , and have not even done that with useful or meaningful accuracy, should be sending off alarms for everyone. Shoving information into leads to advance a POV or for advocacy is the hallmark of novice editing, and we should never casually overlook this guideline.
    Summary, stick to our policies and guidelines written, all 530 samples violate our policies and guidelines. SandyGeorgia (Talk) 21:05, 18 February 2020 (UTC)
  • While pricing of drugs is definitely important enough to justify the multiple articles we have on the subject, the importance of pricing carries no weight to individual drug (or other) articles without secondary sources that demonstrate due weight for the specific articles. Likewise, such material belongs in the lede only if such weight is clearly due. The examples given, with the primary sources, are not due any mention at all, let alone in the lede. --Hipal/Ronz (talk) 20:00, 27 February 2020 (UTC)

Comments about what Wikipedia should include[edit]

  • I don't think WP:NOT per se should be used as an a reason to exclude pharmaceutical prices. To me, the approximate price of pharmaceuticals is self-evidently encyclopedic and a matter of public interest, as are the price of oil, the price of carbon, and even the price of a Big Mac. WP:NOTCATALOGUE has a vital maintenance role, preventing Wikipedia getting spammed with ephemeral information about which vendor sells what product for 10% less than the competition, or who's got a sale on right now!!!. Such practical concerns need not stop us citing globally relevant information from non-commercial secondary sources.
Obviously this is moot in cases where we cannot convey pricing information without contravening WP:VERIFIABILITY or otherwise misleading readers. Adrian J. Hunter(talkcontribs) 07:36, 24 January 2020 (UTC)
  • I do think the drug price is a notable topic deserving inclusion in an article. Additionally as I mention above, things related to drug prices can be notable and deserve mention, such as: notable agreements to lower or fix prices, notable criticism about price variation of a specific drug between countries or produces, notable coverage of extortionate increases or extortionate prices, or prices in relation to the prices of inferior or fake versions of the drug. Normal procedures should apply to this, ie. notability determined by coverage of these issues in reliable sources, and normal procedures should apply to coverage in the lead - viz. likely not in most cases --Tom (LT) (talk) 22:01, 24 January 2020 (UTC)
    • User:Tom (LT), would you recommend putting this kind of information in the ===Economics=== subsection of MEDMOS's suggested ==Society and culture== section? WhatamIdoing (talk) 04:43, 28 January 2020 (UTC)
      • My take on this RfC was that it was in general form soliciting feedback about drug pricing, which I have answered above, ie. notable information about price should be included, and very notable information in the lead. I worry getting too deep into the specifics will be a diversion from the intended RfC. My general feeling to your specific question is that if it's more than a sentence about the price, "price" should probably be the heading of that subsection (if it is indeed mainly about price), because it is the term most readers will be looking for as a heading, whereas "economics" is, to me anyway, quite obtruse and I am in favour of direct and simple headings where possible. However I do think this question is better addressed in a follow-up RfC or following comments where this can be discussed in more detail, rather than at this venue. Am happy if you or someone else refactors this comment somewhere else on the page. --Tom (LT) (talk) 08:10, 28 January 2020 (UTC)
  • A price can be the direct subject of analysis, as described in Tom’s comment, in which case it is encyclopedic. However, the implication from the examples seems to be that the price should be included automatically, cited only to a database. Including these prices in such a manner, including the examples given above, makes Wikipedia seem more like a commercial catalogue and thus undermines our status as an authoritative reference work. One of the purposes of WP:NOT is to prevent this; in such cases the information should be included in Wikidata instead. Overcoming NOTPRICES in this sort of situation requires a strong overriding argument based in another policy, or otherwise WP:IAR.
As a separate point, in one part of the long pre-RfC discussion, I saw one argument regarding deaths caused by medical misinformation, which would certainly fit the criteria for a strong IAR argument. However, by the same analysis, damage to the encyclopedia’s reputation itself causes deaths because people have to be willing to believe the information in the first place (and that would affect all the rest of the information in the same articles, as well as everything else that has important implications anywhere on Wikipedia). So there is a potential "more harm than good" issue that needs to be resolved. Furthermore, while medical misinformation is certainly a major problem, I refer to the comments in the other sections: I'm not convinced that using prices in the manner described above wouldn’t just cause even more harm by contributing to that misinformation instead. Sunrise (talk) 00:40, 25 January 2020 (UTC)
  • I am inclined to include pricing information for pharmaceuticals because unlike commodities they are routinely manipulated by manufacturers, sometimes in the same markets and geography, which makes them inherently noteworthy. However, I'd prefer that we cover the worst abuses in Medication costs, Prescription drug prices in the United States, and similar articles, rather than merely spreading noteworthy pricing information out only among individual drugs' articles. EllenCT (talk) 07:45, 30 January 2020 (UTC)
    • I think some of the generic small-molecule drugs function as commodities, or at least something similar. ("Biolgics", like insulin, aren't always interchangeable in the way that, say, aspirin is.) This is a bit outside the scope of this initial RFC, but one of the sources I've been interested in estimates the price to manufacture the active ingredient for a drug, giving the costs per kilogram and per pill for many generic drugs. For example, diazepam costs US$131 per kg to make, and when you make them up into pills, they think the manufacturers will generally charge in the vicinity of 1.2¢ or 1.3¢ per pill (depending on the amount of active ingredient in the two strengths). I have wondered whether manufacturing costs might have more utility (and be less subject to market manipulations) than "two governments got this price once" or "one non-profit sold for that price six years ago". It seems like the manufacturing costs would put a floor on a drug's wholesale price, because the manufacturers won't make a drug if they can't recoup their costs. WhatamIdoing (talk) 02:45, 31 January 2020 (UTC)
  • "I don't think WP:NOT per se should be used as an a reason to exclude pharmaceutical prices." – More to the point, it can't, when they're encyclopedically relevant and they are accurate per WP:V and are not some editor's guestimations, per WP:NOR. However, WP:NOT#PRICE, WP:NOT#INDISCRIMINATE, WP:NOT#NEWS, and other aspects of that policy can certainly be used to disapprove of automatically including alleged price information. Price information that is actually reliable should be included when pricing is an integral part of the encyclopedic "story" of the drug in question.  — SMcCandlish ¢ 😼  20:57, 2 February 2020 (UTC)
  • I think we need to be very careful in how we include drug prices. If we can accurately represent them with the important nuances and caveats to ensure the reader understands what the prices represent (and what they don’t), I’m okay with including them. But we do the reader a disservice by oversimplifying things just to come up with a convenient number or range. I completely understand the sentiment, and I don’t believe that we should be blanket-excluding prices, but providing the necessary context in a sentence or two within the lead will be exceedingly difficult (and any more than that would be violating due weight). Assuming we can adequately source one, I would prefer a pricing section; not all drugs will have enough data for this, and that's perfectly okay. If reliable sources don't discuss prices for a particular drug in enough detail to ensure we can cover it appropriately, perhaps it isn't significant enough to include. CThomas3 (talk) 05:28, 3 February 2020 (UTC)
  • Aside from the exact manner and location for their inclusion, I argue:
    1. Price information for drugs is both notable and valuable for an encyclopedia article (whether those prices are are uniform or varied across geography or time). there' a big difference between $2 per dose and $ 2000 per dose - and I think that is inherently notable.
    2. Four significant figures isn't relevant or useful (possibly even one sig fig would be appropriate), since such fine precision isn't the useful part.
    3. There are clearly reliable sources for such cost information and ways to paraphrase those in prose. Otherwise we're weirdly close to saying that no WP:RS exists to support an answer to the question "How much does this cost?"
    4. This sort of price info should also be on wikidata with locations, dates, level of approximation, and references.
    5. Peripherally-relevant: There's plenty of precedent for including price info in Wikipedia to give context, even in articles for which the price is less notable: example 1; example 2
  • T.Shafee(Evo&Evo)talk 10:12, 3 February 2020 (UTC)
    • Cthomas3, Pratik.pks, T.Shafee, these are great comments. WP:MEDMOS current recommends an ===Economics=== subsection (part of ==Society and culture==). Would you rather have a ==Prices== section?
      The OTHERSTUFFEXISTS examples aren't perfect analogies. The manufacturer's list price for cars and consumer electronics is extensively covered in the normal reliable sources for those subjects. Passing mentions are routine, but comparisons and categorizations are typical ("This Car is priced to compete against Their Car in the entry-level sports car category"). Sources about drugs usually aren't dealing with brand-name products that have a single manufacturer (and thus have no potential for a single list price), and they usually care more about whether it works than what the price is. OTOH, sometimes we have even better sources than one might expect, such as a UK NICE analysis that tells us not just what the UK price is, but also how many months of healthy life that money could buy. WhatamIdoing (talk) 16:45, 3 February 2020 (UTC)
      WhatamIdoing, I've been pondering your question off and on over the last several hours, and I'm not sure I have a definitive answer for you. I would endorse using the "Economics" (or perhaps "Economics and pricing") section if that's what the community ultimately opts for, but to me they seem like two different (albeit related) things. Economics feels to me like we should be getting into R&D, production costs, patient affordability, insurance coverage, etc., especially given that it is a subsection of "Society and culture". Pricing, on the other hand, should probably stick to a discussion of prices for particular formats, strengths, dosages, etc. in various countries/regions and any relevant history/comparison. Perhaps all this could be done in one section, but it does seem like potentially a lot of material for some well-covered drugs. CThomas3 (talk) 03:34, 4 February 2020 (UTC)
      Thank you for spending so long thinking about this, Cthomas3. There are some estimates of the cost of manufacturing the active ingredient for some drugs, and I could see that fitting into the ===Synthesis=== subsection of the recommended ==Chemistry== section (it would normally be a single sentence: "The manufacturing costs have been estimated at approximately $25 per kilo"). I agree with you that R&D costs are more ===Economics=== than ===Prices===. The WHO/Health Action International Project on Medicine Prices and Availability has a system for evaluating affordability. Many of these drugs, rather than being described as "wholesale price of US$3 per month" could be described as "considered affordable in most countries according to WHO/HAI metrics". (This would require some legwork, because there are sources for this, but the sources tend to be incomplete (like "Wonderpam is affordable in these 46 countries", rather than a database of all drugs × all countries). WhatamIdoing (talk) 21:25, 4 February 2020 (UTC)
  • To me it makes no sense to have prices, in a global encyclopaedia. Prices are different from here (Portugal) to Spain, over the border, and both within the UE, how can we presente a "common price"?... Prices change fast(er than a article should be updated). Consumer price information is not any of WP's goals. Obviously we should have broad categories, wheter it cheap enough to be used without much restrictions, or a "luxury". - Nabla (talk) 18:44, 3 February 2020 (UTC)
    • Nabla (and anyone else), do you think that Wikipedia:External links to this database would be a better use for it, rather than trying to turn it into sentences/paragraphs in the article itself? WhatamIdoing (talk) 21:25, 4 February 2020 (UTC)
  • Drug prices should be included in the lede and body. This is the same as including other content such as the safety of a drug. Readers want to know about this information and may want to compare prices to other similar drugs. Prices are critical context for understanding drugs and treatment. QuackGuru (talk) 14:57, 5 February 2020 (UTC)
    • QuackGuru. Which prices do you mean? Wholesale, retail, list or discounted? Per pill or per dose or per day or per month? WP:DIRECTORY says "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". Our treatment costs are calculated using the Defined daily dose, a WHO metric that WHO says: it is usually not valid to use this metric to compare costs of different drugs or drug groups". In displaying absolute prices, Wikipedia most becomes unstuck. Is diazepam really 40 times more expensive in the US than the developing world? At phenytoin we give the price of a dose in the developing world and a month's treatment in the US. This is common, mainly because our drug databases do not give treatment costs, only costs for 5mg pills or 20mg pills. Are our readers comparing patient (retail) prices or healthcare (cost effectiveness in a population) prices? Wouldn't it be better to find a source saying "Drug X is as effective as drug Y and much cheaper" or "Drug Y's greater expense is only justified for patients with Z", or "Drug Z is unaffordable in the developing world" than trying and failing to insert random numbers of dollars and cents into the leads of our articles. -- Colin°Talk 15:32, 5 February 2020 (UTC)
      • We should include drug prices, especially when drug prices vary in different countries. I would try to at least include retail prices where available in the lede and body. If the lede gets too long a section in the body can include wholesale, retail, list and discounted prices. I would include drug prices in the lede first if it is only one short sentence. QuackGuru (talk) 15:52, 5 February 2020 (UTC)
        • QuackGuru We don't have a source of retail prices for developing world (except in rare circumstances for individual countries). The retail price in the UK is either £0 or £9 typically for a month's supply. For the US the Drugs.com retail price is a list price that nobody ever pays. The GoodRX site offers discounted coupon prices updated daily for a large set of possible stores and the price depends on how big a bottle of pills you buy and whether you have a Costco or Wallmart near you. Why should Wikipedia reproduce Drugs.com or GoodRX when those consumer sites already provide this information with accurate and up-to-date prices?
For diazepam, is this retail price for a treatment course, a monthly ongoing cost, a 10mg pill or a pack of 120 10mg pills? Should we include 2mg, 5mg, 10mg tablets; 2mg/5ml oral suspension in sugar and sugar-free; 10mg/2ml solution for injection ampoules; 2.5mg, 5mg, 10mg rectal tubes? Do we include the treatment costs for anxiety; muscle spasm; tetanus; insomnia; drug-induced dystonic reactions; acute anxiety and agitation; premedication; sedation in dental procedures carried out in hospital; conscious sedation for procedures, and in conjunction with local anaesthesia; status epilepticus... and many more. What about paediatric vs adult dose prices? There is no One Price for a drug. -- Colin°Talk 16:20, 5 February 2020 (UTC)
It depends what each source states. I don't have an objection to including prices on different doses or on different age groups. If more than a few sentences are added to the lede then it should be repeated in the body. QuackGuru (talk) 21:11, 5 February 2020 (UTC)
Well, we're only here at this RFC to talk about one source, the IMPPG, so perhaps you would see what this source says about Diazepam, and then go down to #Diazepam section of this page, and write out what you think could be correctly written from that source, without any original research or undue attention at all (if anything; some editors think it's not the right kind of source to use at all). There are general information pages available from the website's home page if you need help figuring out what it says. WhatamIdoing (talk) 06:30, 6 February 2020 (UTC)
I agree with WAID that if QuackGuru wants developing world wholesale prices, they should explain and show how it should be done with this source in the other section. But this section is for "Comments about what Wikipedia should include" and we are "Wikipedia article writers", not "source factoid inserters". That involves discovering what the literature says about developing world prices for that drug, and thinking about what information might be useful to our readers wrt developing world access, affordability and cost-effectiveness compared to other options. It is only by doing that, that you can consider if this source (IMPPG) is offering anything usable or useful. Let's not put blinkers on and think only "I have this source, what facts can I insert from it". That's now how we write encyclopaedic articles our readers will enjoy reading and find useful. -- Colin°Talk 08:11, 6 February 2020 (UTC)
  • The policy "Wikipedia:What Wikipedia is not" does not apply here The main reason why that policy does not apply here is because we know many sources say that price is one of the fundamental characteristics of understanding a drug. Beyond that, Wikipedia has a policy, "What Wikipedia is not", WP:NOT, and a section in that policy, "Wikipedia is not a directory", and a paragraph in that section, "Sales catalogues". This does not apply because this text is about 15 years old, and was written by people in 2005 who were imagining the 1990s, and the context of this entire section is about the era when companies printed database data on paper and distributed them in paper books. That was just the state of media then, and the policy is talking about including that kind of content into Wikipedia, which of course makes no sense. Now, several generations of technology later, databases mean something other than paper guides. Admittedly, Wikipedia does not have policy on how to match with databases, or how we should manage our infoboxes, or what to do with 10,000 drugs with a range of prices in various geographical regions. However, just because technology is challenging to discuss does not mean we ignore generational changes. We could, for example, put price information into Wikidata, then have the price display in the infobox of a drug. From Wikidata we could update prices regularly as one dataset instead of as 10,000 individual edits to 10,000 Wikipedia articles, and Wikidata also has the ability to do currency conversion or even show different prices for different regions depending on user account settings. I am not saying this is easy or that we have a process in place, but if we agree that Wikipedia should show prices, then we have options for managing that which are more flexible than citing the paper books which established the text at WP:NOT. Also about WP:NOT - I know it is a "Wikipedia Policy", and policies are supposed to be our most established rules, but the reality is that most Wikipedia policies are whatever anyone drafted 15 years ago, and they never got discussed. If anyone checks the archives there, it is not the case that the "sales catalogue" policy had community discussion, and instead almost all of that entire ~10-pages of "What Wikipedia is not" text got adopted as a block without discussion. The Wikipedia policies are not dogma and we should not be using them to halt discussion when people want to talk through a practice. Blue Rasberry (talk) 16:43, 11 February 2020 (UTC)
Bluerasberry, you suggest "put price information into Wikidata, then have the price display in the infobox of a drug". Can you also answer the questions I asked QuackGuru just above, starting "Which prices do you mean....". I think it quite important we keep the discussion grounded. Can you indicate what prices and what sources and how you get there while following policy. -- Colin°Talk 21:45, 11 February 2020 (UTC)
@Colin: Okay, I will answer those questions. Here are your questions, repeated:
  1. Which prices do you mean? Wholesale, retail, list or discounted?
    When the data is available, all of those.
  2. Per pill or per dose or per day or per month?
    When the data is available, all of those.
  3. Why should Wikipedia reproduce Drugs.com or GoodRX when those consumer sites already provide this information with accurate and up-to-date prices?
    Wikipedia should include price information because Wikipedia is a summary of the information which other reliable sources report. Since price has a place of importance in other sources, price merits inclusion in Wikipedia. I am not aware of any reason to exclude content from Wikipedia based on the availability of competing media products.
  4. For diazepam, is this retail price for a treatment course, a monthly ongoing cost, a 10mg pill or a pack of 120 10mg pills? Should we include 2mg, 5mg, 10mg tablets; 2mg/5ml oral suspension in sugar and sugar-free; 10mg/2ml solution for injection ampoules; 2.5mg, 5mg, 10mg rectal tubes?
    When the data is available, all of those. The conversation could go in different ways. One conceivable direction is that we report that the price of diazepam is "generally affordable", another is that its price is "$" (out of a possible "$$"), another is that its price is $0.25-$10.00, another is that we have a drop-down menu which personalizes the display, and another option is that we just show one price which is a hyperlink to an explanation of how we presented it. The point is that we can identify what the best available sources outside of Wikipedia do, and it is acceptable for Wikipedia to adopt any of those options. We know that lots of sources publish prices, and we know they have differences in quality, precision, and how they present the data. There should be no expectation that Wikipedia requires a higher quality of content than what actually exists. Any reliable source which has published a drug dataset is an acceptable baseline for quality which we in Wikipedia can accept. From that baseline, we publish prices, then plan about how to improve Wikipedia's quality even more.
  5. What about paediatric vs adult dose prices?
    When the data is available, both of those.
For me, again, the important question is do reliable sources publish present drug price as relevant information about drugs. It seems obvious to me that they do. On what basis or Wikipedia policy do you expect that we need a higher quality of information than what is acceptable in this field? Under what circumstances would you accept the available price data? Blue Rasberry (talk) 23:02, 11 February 2020 (UTC)
WP:NOT, which you're rejecting outright, as well as WP:V, and WP:OR in the examples given. --Ronz (talk) 02:48, 12 February 2020 (UTC)
@Ronz: Yes confirmed, I reject that WP:NOT applies in this situation because that policy applies to last generation paper catalogs and was written to describe the media environment of 15+ years ago before the advent of digital databases in Internet publishing.
In my view, I think it is WP:OR to pass judgement that Wikipedia requires a higher standard of quality than what exists in the published sources. I fail to understand the argument that the sources which are state of the art in a field and professional practice can be of too low quality to include in Wikipedia. If it is good enough for professionals in the medical sector then why is it not good enough for Wikipedia? I feel like WP:V is on my side and I am avoiding WP:OR, whereas you are arguing to use OR to dismiss V. Blue Rasberry (talk) 20:33, 16 February 2020 (UTC)
But WP:V doesn't stand alone, as WP:NOT and WP:POV repeatedly point. Misusing information, taking information out of context, and presenting information in a new context are all problems here, as multiple editors have gone at great length to explain. --Ronz (talk) 20:52, 16 February 2020 (UTC)
Bluerasberry, your argument about WP:NOT being dated doesn't make sense on a wiki, nor does it correspond with facts. The MSH Price Guide dataset existed since 1986, though one had to visit a library rather than a web browser, and was certainly online in 2001. Another huge dataset at Online Mendelian Inheritance in Man existed since 1966 and online since 1987. The early Guardian editor C. P. Scott famously noted: "comment is free, but facts are sacred". -- Colin°Talk 23:12, 16 February 2020 (UTC)
Face-surprise.svg Blue Rasberry (talk) 03:03, 17 February 2020 (UTC)
To the extent that the argument here is that WP:NOT is inaccurate (or outdated, or otherwise does not contain what it "should" contain), it cannot be valid because any discussion to that effect on this page cannot lead to anything more than a local consensus. The issue would need to be raised in a separate discussion, probably an RfC, at WT:NOT. If the argument is generally accepted, then it should be relatively straightforward to gain a consensus to correct the policy. Sunrise (talk) 04:06, 17 February 2020 (UTC)
"The main reason why that policy does not apply here is because we know many sources say that price is one of the fundamental characteristics of understanding a drug." - I really can not agree with Bluerasberry more on this issue. Furthermore I feel there is a strong public benefit argument here that adds further strength to the assertion that drug prices of this nature should be added. The free access to basic knowledge on this issue is just too compelling for me to take the WP:NOT argument seriously. However the public benifit argument should likely live esle where on this page.--Discott (talk) 18:13, 17 February 2020 (UTC)
Thanks for this comment, Discott. How would you use this source? The website seems to be down for me at the moment, but most of the content for these records is at the top of the page. What would you recommend that editors write? Would it be only in the WP:LEAD, in a separate section, somewhere else? Would you use WP:INTEXT attribution for the database (different databases will have different 'answers')? A solid example often goes a long way towards building consensus. WhatamIdoing (talk) 00:59, 18 February 2020 (UTC)
WhatamIdoing/Discott I left a note at the top of the page. For now, you can access a PDF version of the catalogue here. --Colin°Talk 08:57, 18 February 2020 (UTC)
  • We've already got that. Wikipedia generally should not include prices, with some exceptions. If reliable sources extensively discuss (note, that does not mean "frequently mention") a drug's (or other product's) pricing, that's a notable thing about it and the article should reflect it. However, if the price is just mentioned in passing, or can only be extrapolated by mathematical operations on limited data from databases, well—that type of variability and uncertainty in pricing is exactly why we generally exclude it. So, we should include it if and only if reliable sources extensively and in-depth discuss the drug's pricing and why it's significant. (That would also include discussion of substantial price hikes or decreases and the significance of those events.) We've already got a perfectly good policy for this; just follow it. Seraphimblade Talk to me 08:35, 12 February 2020 (UTC)
  • To the handful of editors advocating for inclusion of this information because they say drug prices are inherently important, I believe that Ronz's quote during the RFC formulation summarizes well an important distinction: drug pricing may be important overall, should be discussed in general articles, but only in specific drug articles when V, OR, WEIGHT, NOT and LEAD are met. If the sources don't exist, we can't synthesize information from databases. I am broadly in agreement with SMcCandlish, CThomas and Pratik.pks, Nabla (have I asked whether anyone has considered corruption in this drug data … speaking as someone who lived in Venezuela and knows), and Seraphimblade.
    The problem with including prices from these databases is amply demonstrated in the rebuttal to QuackGuru’s position. On DiScott’s position, see Ronz’s pricing vs. price. Bluerasberry’s position deserves paragraphs of rebuttal.
    All of our core policies (except BLP, which came later) were written 15 years ago. This is not a reason to reject them now, and Colin aptly addresses that. If we are to reject them, it needs to be done in a general RFC starting with general discussion at WP:NOT (as explained by Sunrise); not in a drug pricing RFC that few editors are even going to look into.
    There may be a credible reason to deviate from NOT policy for drug prices, but I haven't seen it during these discussions. The ideas that "Big Pharm wants to suppress drug prices" and “providing drug prices aids people in lower and middle income countries” leads us straight to, we are not here to right great wrongs, and there are many websites where consumers and governments can seek drug pricing that are more relevant to their country or situation. I am in agreement with Tom (LT) on notability when specific issues are covered in reliable sources (not a database list with no meaningful content). I fully agree with Sunrise, but would expand on their second paragraph: not only has this five-year-long foray into a “pilot” to include drug prices been a timesink. It has been one that has additional consequences to the rest of our medical content, which is scarcely maintained as our limited editors are spending time chasing these kinds of issues. There is, as Sunrise says, more harm than good in this venture. Perhaps if our basic medical content was anything but dismal, I might understand branching out into experiments, but we have few editors, and their time is not well spent on this drug price venture.
    There seem to be two basic arguments for ignoring WP:NOT policy for drug prices. One is based on OTHERSTUFFEXISTS; the other claims that NOT is no longer valid because it was written 15 years ago, or that consensus has changed and there is broad support for prices in articles. I think both of these are faulty arguments and inaccurate statements.
    Regarding OTHERSTUFFEXISTS arguments, there are thousands of articles tagged on Wikipedia as POV or UNDUE or having OR; that most of our content is poor is not a reason to disavow the policy. We shouldn’t disavow NOT because some articles breach it, and many of the examples given are actually compliant with NOT.
    On another fallacy, we frequently see advocacy for drug price inclusion compared to the price of oil. That's a general article (not product specific), and crude oil pricing depends on internationally recognized benchmarks, and even considering the oil industry uses standard price benchmarks, we don't find prices in the individual crude oil articles. (Speaking as former oil and banking executive.) Oil is a commodity; the behavior of drug prices is not comparable. There are too many factors affecting drug prices, and this has been well covered by others on this RFC. Hence, I disagree with Adrian J. Hunter on this point.
    Added to the lack of any substantive evidence that WP:NOPRICES is broadly rejected today, computer-generated data on all drug prices on Wikipedia raise questions about the claim that a broad pricing dispute exists at all, or that we have any basis for ignoring NOT. Virtually all of the 530 existing prices in the leads of drug articles were added by one editor, while around two dozen editors attempted to remove those prices. A summary of the accounts attempting to follow policy, but reverted on these articles, typically by the same one or two editors:
    • 6 IPs
    • 7 Student editors (now all gone)
    • 13 Active editors, who besides Ronz, Seraphimblade and Kashmiri (who have weighed in on the RFC or formulation) include Pol098, Jorge Stolfi, Surtsicna, Gprobins, Jrfw51, Garzfoth, Pol098, Zefr, D A Patriarche, David notMD, and Mparagas18
  • That is; at least 26 editors attempting to remove what was instated and maintained by basically one editor. The other argument claims that NOT is outdated because of the number of discussions listed at the essay, WP:PRICES. I see no evidence of support for diminishing our pricing statements in NOT in any of those discussions. When there is support for price advocacy, it is invariably coming from the same very small handful of editors, going on five years now.
    The incorrect statement, Wikipedia has no specific policy on presenting prices of products was inserted into an essay at Wikipedia:Prices four years ago, and redirects were edited to point to the essay instead of the existing policy page.[11] [12] (We have no way of knowing how many editors saw and believed that statement.) Bluerasberry indicated on this RFC that the insertion of the 530 prices was part of a "pilot”. [13] To the extent this "pilot" has been going on since 2015, and has not gained broad traction, I submit that the pilot did not succeed, and has turned into a disruptive time sink. It is time for a moratorium on the whole NOT/drug price matter; five years more than enough time for a failed "pilot".
    SUMMARY: no reason to ignore NOT policy; drug prices can be included when they comply with V, DUE, OR, NOT; all 530 drug price samples breach policy, and the issue should be taken up more broadly at WP:NOT rather than in an RFC which has gotten very little attention because few editors pay attention to pharm articles. SandyGeorgia (Talk) 22:17, 18 February 2020 (UTC)
  • I'll give a perspective on why leaving prices out of Wikipedia articles is generally the right thing to do. It's kind of funny that cell phones and video games are given here as an examples of a type of product for which Wikipedia can reliably give prices. There are MSRPs for cell phones, but in Canada at least, many people don't pay the MSRP - they pay through some kind of scheme in which they sign a contract with a wireless provider and get a phone for "free". Pricing is more complicated than MSRPs. Apps are another thing in which manufacturers make their product free initially so that it gets lots of reviews, and then they jack up the price. Pricing is more complicated than what sources say because the easiest thing for a manufacturer to change is the price of its products, and prices are set by people whose job it is to change them in order to maximize revenue.
In enterprise software, many product reviewers don't even try to say what the price of a product is because it's going to depend on things like whether the developer makes you pay for annual maintenance, on how much support and staffing the product requires, plus who your salesperson is and whatever discounts you manage to negotiate with that person. Some software product reviewers have gotten experienced enough with this stuff to know that if they say what they think the price of something is, it will probably be wrong enough that it's better to say nothing than to mislead the reader. That is the choice we have to make as well, knowing that if we get this stuff wrong (keeping in mind that pricing is the easiest thing for a manufacturer to change), we will be misleading readers.
That said, there is a difference between the price of enterprise software and personal desktop software, or between the price of a luxury car and an economy car. A manufacturer can easily change the price of something, but generally not to the extent of changing it to an entirely different price category. So I could see some merit in price categories, e.g. cheap and expensive, if we have sources that use those categories. Unfortunately, we don't seem to have sources that use those categories and it's generally not a good idea to make up categories if those categories are not used by the sources. Clayoquot (talk | contribs) 23:34, 24 February 2020 (UTC)
P.S. As for the price of carbon and the price of oil, these are commodity prices that are not dictated by manufacturers, so manufacturers can't change them on a whim as they do with products. Clayoquot (talk | contribs) 23:36, 24 February 2020 (UTC)
Clayoquot, I think your comparison to enterprise software is useful because it is an example of a price that is negotiated rather than a list price that every customer typically pays when they add to their online shopping basket. The External reference pricing article explains some of this. It isn't a great article, but one can see that drug prices are negotiated by countries. US is crap at negotiating with drug companies, whereas the UK is pretty good (that may soon change), and there is a lot of variety in approach and outcome. I also agree with you that many of us would like some way of indicating cheap, moderate or expensive drugs. Those categories' definitions however are often closely aligned with one's opinion of affordability which seems to vary extremely from one country to another. It also varies with how uncommon the need for treatment is, how serious the condition is, and how effective the medicine is: a drug considered a "cheap" cancer treatment would likely be "expensive" if widely used to prevent a minority of heart attacks, or for the treatment of athletes foot. I also agree with you that we have have not found any comprehensive source that would offer those categories, perhaps because it is more complicated that we would wish. -- Colin°Talk 08:44, 25 February 2020 (UTC)
  • From the perspective of someone who generally edits in the domain of video games, broadly, I think that pricing information about medicine is a crucial aspect that Wikipedia should cover about drugs due to their influence on health outcomes, accessibility, etc. I'd go so far as to say it's more crucial in this field than it is for video games and game consoles, so my position would be that any guideline that develops should probably narrowly focus on drug prices and not try to override larger policies that broadly discourage price information elsewhere on Wikipedia where it's not necessary. Yes, it's noteworthy that average video game prices jumped by $10 with the launch of PS3/Xbox 360 and also that the PS4 outsold the Xbox One due in no small part to its cheaper price. Listing every local price for every individual video game is not warranted. Axem Titanium (talk) 20:54, 25 February 2020 (UTC)
  • Wikipedia is not a sales catalogue, nor a venue for addressing the world's problems concerning the need for simple drug price information. --Hipal/Ronz (talk) 20:06, 27 February 2020 (UTC)

Comments about the Manual of Style[edit]

  • I think the complexity of drug pricing means, if it should be included, it should be as a section or subsection, certainly not in the lead. For comparison, coverage in articles about stable foods is inconsistent (eg milk - subsection, bread - no section; rice - section) --Tom (LT) (talk) 22:01, 24 January 2020 (UTC)
    • I agree that drug prices (unless exceptionally notable) should not be in the lead (if they appear at all). Kaldari (talk) 03:52, 26 January 2020 (UTC)
    • Any price mentioned in the lead should be a summary of a discussion/exposition in the body of the article. The discussion in the article should establish the notability of the price, complete with verifiable sources and enough context to establish due weight and ensure that the information provided is not ambiguous or potentially misleading, just like any other content in the lead. · · · Peter Southwood (talk): 06:00, 28 January 2020 (UTC)
      I think Kaldari means staple foods. But why would we include pricing information on such topics? We don't usually seem to do so. We're more likely to do so when the foodstuff is a major, globally traded commodity, like rice. Milk is an odd exception; "the price of a gallon [or liter or whatever] of milk" has a certain popular-culture usage as a barometer of local or regional economy, and whether a politician knows the average price in their region is taken as a sign of whether they are of-the-people or an out-of-touch aristocrat; and so on. When it comes to a one-size-fits-all prescription, I think we'd find it completely impossible to establish a convention that articles on foodstuffs should routinely be including price-related information.  — SMcCandlish ¢ 😼  21:31, 2 February 2020 (UTC)
  • If there are many reliable sources focusing on the drug's prices (e.g. insulin) then a summary should appear in the introduction. If the drug is successfully on the generics market and uniformly inexpensive, then the price probably isn't noteworthy at all. If the drug is only expensive in some markets but not others, that's worth a mention in the article body. EllenCT (talk) 07:48, 30 January 2020 (UTC)
    • EllenCT, the three examples here are common generic drugs. The first isn't exactly cheap (a retail price of maybe $50–75 after insurance/discounts in the US), but the other two are fairly cheap ($10–20 retail in the US). Would you include any information about prices for those drugs anywhere in the article? WhatamIdoing (talk) 02:27, 31 January 2020 (UTC)
      • @WhatamIdoing: I like the way the intros for ethosuximide and diazepam conclude with coverage of their prices, because they are so different -- around an order of magnitude between prices in the US compared to the developing world, which is absolutely noteworthy but not really a matter of style. For carbamazepine since the article doesn't have that disparity, I probably wouldn't put it in the intro. However, the question of which of the sections price information should go in is certainly a style guide issue and might be part of the underlying problem here, because, well, it doesn't go into any of the sections prescribed (sorry) by the style guide -- so maybe we need to add a section on "Availability" to the style guide for medications? And that also brings up the fact that all three of those articles are in violation of WP:LEAD because their pricing information is in the lede but not the body of the article. Frankly I've always been a little suspicious of that requirement, but heaven knows plenty of editors have yelled at me for violating it over the years. EllenCT (talk) 06:32, 31 January 2020 (UTC)
        • I like unexpected and counter-intuitive findings, too. The bigger story with ethosuximide seems to be that it's not usually available for purchase in developing countries. The price claimed there was from a single supplier, offering the drug for sale only to one country in Africa, for one year. They didn't claim to sell it in other years, and nobody else in this database claims to have either sold or bought it at all in recent years. The US "wholesale" prices are actually Medicaid National Average Drug Acquisition Costs, which are not exactly normal, unbiased, unmanipulated wholesale prices. GoodRx says that people can buy that drug at retail for less than the NADAC price. I suspect that you're as suspicious as I am when the retail price is cheaper than alleged wholesale one. WhatamIdoing (talk) 07:31, 31 January 2020 (UTC)
        • EllenCT, I thought I'd list a few datapoints on ethosuximide:
        • So that looks like a retail price that's the same as, or sometimes cheaper than, the wholesale price; a retail price that's 2.5x the wholesale price (approximately the markup you'd expect from everyday retail establishments: the price of food in a sit-down restaurant is usually around 3x what the ingredients cost, and clothing stores aren't losing money when they run "50% off" sales); and a for-profit wholesale price in the US that's 3x the wholesale price from a single non-profit selling to recognized hospitals and clinics in the Democratic Republic of Congo. I don't think it's unreasonable to expect that US prices (for most things) will be higher than prices in the developing world. I'm a little uncertain that we should be reporting the Drugs.com price rather than the GoodRx price, and the juxtaposition of a wholesale price against the higher retail price might mislead readers into thinking that the US prices were 8x the developing world prices, when they're probably "just" 3x different (and that difference might be largely explained by differences in cost of living and differences in what's being reported [i.e., before vs after all discounts and rebates are accounted for]).
          Finally, I just found the article on the median price ratio, which might also interest some editors here. WhatamIdoing (talk) 18:35, 31 January 2020 (UTC)
        • EllenCT, you are not the first to comment on the 40 cent US price of diazepam compared with the low 1 cent cost in the developing world. Wikipedia has been misleading readers since this edit in December 2015. The US price is actually a retail list price for 30 tablets from Drugs.com. The NADAC as of 2014 filtered for diazepam has a wholesale price of 2.2 cents for 10mg, which isn't IMO nearly so notably different from 1 cent. GoodRx offers me a coupon price for 120 10mg tablets from Costco for less than 10 cents each. -- Colin°Talk 20:45, 31 January 2020 (UTC)
  • Almost all of the above is off-topic for the section it is in. To address it anyway: I concur with EllenCT's "If there are many reliable sources focusing on the drug's prices (e.g. insulin) then a summary should appear in the introduction. If the drug is successfully on the generics market and uniformly inexpensive, then the price probably isn't noteworthy at all." As for "If the drug is only expensive in some markets but not others, that's worth a mention in the article body." – That's only going to be the case when multiple independent reliable sources, with a global perspective, are covering the matter in-depth. It's not sufficient that, say, 4 newspapers in Bolivia complain about the price of something in Bolivia. There could be all sorts of reasons for a price being unusually high or low somewhere, most often governmental interference. If The Times of London, The New York Times, Al Jazeera, The Times of India, Le Monde, and Asahi Shimbun all devote coverage to the pricing of that drug in Bolivia and their coverage converges on at least a semblance of a consistent account, then we have a good reason to include it.  — SMcCandlish ¢ 😼  21:31, 2 February 2020 (UTC)
  • On-topic: If I may provide actual comments about the Manual of Style, I'll say that while whether to include pricing information is, on a case-by-case basis, mostly going to be a factor of the interplay of other WP:P&G pages (NOT, NOR, V, RS, MEDRS, NPOV, etc.), it's entirely reasonable for MEDMOS to summarize the gist, and to [probably – I can't 100% predict the outcome of this RfC] discourage including pricing information without good reason, especially in the lead and double-especially in a context-devoid infobox. It's common and well-established that topical MoS pages are not 100% confined to style and grammar matters, but also include topically specific elements of content guidelines, naming conventions, good versus poor sourcing guidance, and other "rules". WP:NOT#BUREACRACY, WP:WIKILAWYER, WP:CREEP and other principles apply here. We do not want a sprawling, confusing proliferation of stand-alone style, naming, content, sourcing, and other guidelines on every topic category! We may have a compelling rationale to have, say, WP:MEDRS and WP:MEDMOS as separate pages (for length alone, if nothing else), but if we needed stand-alone "NCMED" and "MEDCONTENT" pages we would have evolved them a long time ago. And in fact the opposite is happening; various unnecessarily topical guidelines have been merged, and others are slated for merger (e.g. WP:NCCOMICS into a section at WP:MOSCOMICS). Such a merger is already in the case in medicine; WP:NCMED redirects to MOS:MED#Article titles. The only sphere in which the community is routinely tolerant of additional topic-specific guidelines is WP:SNG, and even that is rare (there are only 12 of them). Frankly, it would be completely harmless and probably helpful to merge these into their respective topical MoS pages for centralization (and I would bet real money that any attempts to create new ones would either fail outright or lead to such a merger). So, the existence of some of them as separate pages isn't a strong rationale for creating more things like a medicine-specific content guideline. If this RfC concludes with anything concrete, MOS:MED is where to put it, probably with a cross-reference at WP:MEDRS and where ever else pertinent, like WP:WPMED.  — SMcCandlish ¢ 😼  21:31, 2 February 2020 (UTC)
  • Best place is infobox, second best place is lead, elsewhere is an acceptable compromise The Manual of Style accommodates the content, and not the other way around. Once we recognize that price information for drugs is essential, then we mold the Manual of Style to include that in the way that best serves readers. In my opinion, the best way with the least work and most precision is putting this information in Wikidata with intent to publish from there into Infoboxes. We in English Wikipedia still have difficulty with Wikidata. Assuming that Wikidata worked, then the ideal place to put 10,000 prices for 10,000 drugs, which have a range of prices and regional variation, is in Wikidata. Whatever path we choose to present prices, semi-automation is necessary to maintain all this content, whether that means special bots in Wikipedia or routine dataset management in Wikidata. Wikidata's design is explicitly to manage content like this and make it easy for non-technical people to engage. If we put prices in Wikidata then ported them from that database to infoboxes, then that would be the system with the most quality control, easiest updating, and most personalized relevance to the reader. The Wikimedia Foundation brings in US$120 million a year and Wikidata is one of its major investments of probably 10% of budget. That amount of money spent every year forever is definitely changing the nature of Wikipedia. Besides the money, Wikimedia Foundation people are regularly intermingling with outreach recruiters from Google, Facebook, Amazon, Microsoft, and Apple, including bringing them to Wikipedia conferences, and we already know that Siri, Alexa, etc answer questions with Wikipedia content. There is no chance of Wikipedia having a future without managing datasets. What is up for discussion is whether the present Wikipedia community will develop the policies about using datasets, or whether the generation which corporate tech is grooming will propose those policies and spend infinite money forever to persuade Wikipedia and everyone else to adopt their ways. There are some major challenges and ethical considerations in the space of data integration and use, and among them all, publishing the datasets of the global health industry is a lot more empowering to consumers than what is going to come next. We have a lot of great contributors who have been patient to do experiments, move slowly, take in community comments, and seek external expert nonprofit and academic participation in how to best present prices in Wikipedia. The main reason why we should accommodate this kind of information in the manual of style is because reliable sources already present this information, and Wikipedia's style follows that precedent. Aside from that, and strategically, many people inside and out of Wikipedia take medicine very seriously, which means that if we choose price of drugs to be one of the cases we use to develop data policy on Wikipedia, then we can be assured of moving slowly, getting good community participation, keeping control in the community and for the consumer and user, and also define the conversation about having good walls and barriers with the corporate sector who are already looking at Wikipedia as something to be devoured in Web 3.0 / the Semantic Web. Steady discussion is timely and not to be deferred to some unknown next option. Blue Rasberry (talk) 17:04, 11 February 2020 (UTC)
  • In none of these 530 drug articles is there any indication that drug price information should be in the LEAD, and yet in many cases where one would expect to find drug prices in the lead because of significant reliably sourced coverage of pricing issues (think, Epipen), none was found. So, while important drug articles with serious pricing issues are neglected, we have given undue weight and added misleading drug prices to leads.
    Regarding WP:MEDMOS, it has become bloated in numerous sections, not always in compliance with other, broader guidelines (eg WP:MEDLEAD vs. WP:LEAD). WP:NOTPRICE is sufficient and until/unless it is changed or rejected via a broader RFC looking at NOT more generally and involving more of the community, no further discussion of prices needs to be included at MEDMOS. There is nothing new to say, and WP:CREEP is already a problem at that page.
    LEAD should be respected as written in terms of whether prices are added to leads. This applies to infoboxes as well. Prices in infoboxes are impractical, misleading or useless for the number of reasons elaborated by others on this page.
    WAID has asked about suggested sections for drug prices in MEDMOS. First, we should remember that MEDMOS has suggested sections, and specific drug articles may vary. But when it is appropriate to include drug pricing information, I would prefer to see it in a separate Economics (or pricing if necessary) section moved OUT of Society and culture, and included beneath the Manufacturing section. The problem is, sometimes pricing will be related to Manufacturing. That's why guidelines give a SUGGESTED order; articles will vary. I would not be opposed to some eventual discussion of a way to include an External link, but as of now, I don't know what we would link to.
    I am in broad agreement here with Kaldari, Peter Southwood, EllenCT, Colin, and SMcCandlish. As discussed elsewhere, Bluerasberry has not indicated how it is possible to add meaningful pricing data to an infobox, considering the number of variables that affect drug pricing. Add if "many people inside and out of Wikipedia take medicine very seriously" well, we would then see all of this effort going into our dismal article content, rather than into defending a fait accompli on drug pricing "pilot" that is not policy compliant. The loss of valuable editor time to content creation because of this issue is not insignificant; this has been going on for five years, I have only been involved for three months, but this is exhausting and demoralizing when there is content to be built and corrected and updated. SandyGeorgia (Talk) 22:40, 18 February 2020 (UTC)
    SandyGeorgia "Bluerasberry has not indicated how it is possible to add meaningful pricing data to an infobox" It has been approximately the same arguments with the same answers for 5 years. I find your reaction dismissive. I feel comfortable saying that there are two sides to this, and I wish you would avoid saying that there is only one side, which is yours, and that all the responses to your questions amount to no valid response. I give responses which are meaningful to me and a demographic which I represent. You have a harsh tone and create a negative environment when you dismiss people's contributions and use aggressive language. 😢😟 "dismal " "not policy compliant" "loss of valuable editor time" "exhausting and demoralizing" "issues are neglected", "we have given undue weight" "added misleading"
    Both sides could use arbitrary insults and hostility to the other side. It is not productive to speak this way. You do nothing to improve your argument by being aggressive and hostile. The conversation here is not improved by shallow insults toward the other side's perspective, and if you wished, you could communicate without continually belittling the existence of other views. 😞 Blue Rasberry (talk) 18:40, 23 February 2020 (UTC)
    One of the main goals of this RfC was to attempt to settle the content dispute so that perhaps behavioral problems could be set aside. I'm afraid BATTLE comments like the above show that some parties have been unable to focus on content. --Hipal/Ronz (talk) 19:04, 23 February 2020 (UTC)

Comments about drug prices or statistics[edit]

This is the section for comments that are more focused on the subject matter than on Wikipedia's policies and guidelines.

  • The prices of pharmaceuticals vary over several orders of magnitude. Just in the US, Kalydeco apparently costs $25,000/month, while aspirin costs <$25/month. Perhaps much conflict could be avoided if the proponents of including pricing could focus on conveying the order of magnitude of a drug's cost. Is it in the same ballpark as Kalydeco or as aspirin? Trying to give exact pricing runs into issues with overprecision and whether particular known prices are representative. From this perspective, I think the example given for diazepam is fine, being an order-of-magnitude estimate to one significant figure. Adrian J. Hunter(talkcontribs) 07:38, 24 January 2020 (UTC)
    • Also drug prices vary even in the same country on the same drug Dq209 (talk) 13:43, 24 January 2020 (UTC)
      • Agree with your point; a single number is almost meaningless. That is because what is discussed above is the wholesale price which is the price of the drug sold to businesses. As I mention above it is confusing and misleading to use the wholesale price without any context, for the very reason you mention. There is usually a lot of variation between this and the prices charged by businesses or end distributors to /consumers.--Tom (LT) (talk) 22:08, 24 January 2020 (UTC)
      • Disagree that we should use a database to do even more original research to produce a range, when we can't even produce meaningful numbers. As to the overprecision, we should be reporting what reliable sources report, using their analysis and precision, not our synthesis and OR from a database. SandyGeorgia (Talk) 23:03, 18 February 2020 (UTC)
  • As far as I can tell, the prices are more likely than not to be misleading. Adding specific qualifiers or putting together numbers from several different places or times doesn’t materially change this, because there are at least hundreds of possibilities. Per Adrian, a "which order of magnitude" estimate is reasonable, but nothing more precise than that. Also, I'll repeat that all of this has the same exception that sources that directly analyze the price are a separate issue. However, if e.g. certain medicines are important specifically because of their low (or high) price, which I can certainly believe, then it should be easy to find a source that simply says that and use it directly. A generic statement about medicines from a certain category would probably work for that and could be copied across multiple articles. Sunrise (talk) 00:40, 25 January 2020 (UTC)
    • Agree with "more likely than not to be misleading"; disagree with should make the problem worse by trying to get an order of magnitude. We have multiple examples in these discussion where we were off by a factor of 100 or even 1,000. SandyGeorgia (Talk) 23:03, 18 February 2020 (UTC)
  • would be ok with just reflecting the "order of magnitude"...the price has been stable over the last 20 years, the one supplier IDA Foundation sells to more than 130 LMIC at the stated price...IMO--Ozzie10aaaa (talk) 02:29, 26 January 2020 (UTC)
    • No, we haven't been able to do that with any accuracy either. SandyGeorgia (Talk) 23:03, 18 February 2020 (UTC)
  • The most obvious cost to offer readers is treatment cost for a named indication. Either for complete treatment or an idea of ongoing costs for lengthy treatment. Giving the cost of an arbitrary pill or dose isn't meaningful if you don't know how many pills to take, how many times a day to take that dose, and for how many days. The problem is, our drug database sources simply do not contain the information needed to work this out, and our medical guideline forbid giving dose or treatment plan information to our readers. And that's assuming it even makes sense to talk of one treatment cost, for a drug with multiple indications and multiple patient types.
Even if we were able to source a single treatment cost for a drug, some have suggested offering a ballpark figure (Adrian J. Hunter). The $0.01 for diazepam is an illusion: it isn't a ballpark figure but just the result of the two buyer prices being the same "$0.0100" price. Rounding to 1 significant figure, for example, still gives the illusion of precision to a tenth of the price: $0.06 appears twice as expensive as $0.03 when in fact both prices may have huge error bars and fluctuate by that amount in a few years. Newspapers can collapse multiple prices into one by saying "cost as much as $25,000" or "cost as little as $0.20" or cherry pick with "can cost $100" and do so to make a case about how expensive or cheap a drug is. Unless citing such a source, we can't do that, so how could Wikipedia give a ballpark figure that the reader knows is a ballpark and understands how imprecise it is? -- Colin°Talk 11:50, 26 January 2020 (UTC)
    • Agree; we do not have the data to do this, and we should leave the analysis to reliable sources. SandyGeorgia (Talk) 23:03, 18 February 2020 (UTC)
  • I agree with some of the above responses that the best thing for a medication article to do is give the reader a general idea of price: cheap, expensive, etc. A Wikipedia article is not really good at giving actual prices at the granularity that would be needed to be relevant to the reader. I think it might be feasible to provide links to good sources for medication prices, to aid the reader if they do want to get an idea of what cost they'd pay for a medication. And of course if there is encyclopedic stuff to discuss about a medication's price (like "this drug is really expensive and people have complained about that") that should be discussed in the article body. --47.146.63.87 (talk) 21:31, 26 January 2020 (UTC)
    • I don't think we are able to give readers a general idea based on a database, and we fool ourselves by thinking we can say whether any drug is cheap or expensive in any given country, because that information is relative to what average wages are in that country. Right now, people are dying because they can't afford drugs that cost pennies in Venezuela. Those same drugs may be affordable in Costa Rica. SandyGeorgia (Talk) 23:03, 18 February 2020 (UTC)
      • The database we're discussing in this RFC definitely can't do that, but sources using the WHO/Health Action International Project on Medicine Prices and Availability method could. WHO/HAI standardizes the notion of affordability across countries by describing the price in terms of the number of days' pay the drug costs a minimum-wage employee. That would let editors write a sentence or two about whether a given drug is available and affordable. For example, PMID 31824316 says that generic insulin is often unavailable, that brand-name insulin is often considered unaffordable under the WHO/HAI system, and that non-insulin diabetes drugs are generally available and affordable. This is more work than looking up the same thing over and over in a database, because most of these sources only address a single drug in a few countries, or a handful of drugs in a single country/single part of a country, but it addresses the point that $1/day could be okay for me and a painful or even impossible expense for others. This approach would also address the recurring theme that when editors say that prices should be included because they're important, they really care about retail prices. WhatamIdoing (talk) 18:08, 19 February 2020 (UTC)
        • I'd find WHO/Health Action International Project on Medicine Prices and Availability much more helpful if it told me what the 50 countries were (long document to get through, and I can't find them). All I can find is a grouping for Central and South America, which could be very misleading; I need to see the specifics to know what meaningful statements we can make about this. I agree these kinds of sources are infinitely more useful than the databases used in the 530 articles, but worry still about how much we can generalize to all other drugs, all regions based on sources like these. That is, if we are so convinced we can right great wrongs and help people in LMIC by adding drug prices to articles, in Central and South America, the people who are most in trouble right now in terms of drug affordability are Venezuelans; in Venezuela, chavismo corruption and Cuban interference in medicine are much larger factors that overshadow any data the WHO can produce, and prices in the most troubled country of that region have nothing to do with drug prices in most of the rest of that region. (For that matter, it is unlikely the WHO can even get true data out of any country run by chavismo and Cuba, which include(d) depending on the dates of those studies, Bolivia, Ecuador, Nicaragua, etc. Guess what: they lie for political reasons, or withhold data.)
          And how did PMID 31824316 come to choose those 17 countries? At PMID 31824316, we have a well-sourced conclusion for one drug for those 17 countries. Specifically, are they assuming Costa Rica= Venezuela, for example? SandyGeorgia (Talk) 18:39, 19 February 2020 (UTC)
          • I think the WHO/HAI availability and affordability assessments are far more useful than raw numbers we can't grok and fanciful wholesale prices few nations pay and no patient pays. The actual project, documented in this this hard to use database seems to be finished and I can't find a study past 2015. Many focused on one country or even just part of a country. However, as WAID notes, other people continue to perform such studies using their methodology. It is hard to see how affordability studies on one country from 5-20 years ago can easily be used in drug articles other than somewhat arbitrary examples with DUE problems, but they may warrant inclusion in the articles on the country and its healthcare. The studies that looked at a class of medicines may be more usable for us. I encourage everyone to read some of the reports at HAI reports to get a feel for the drug access and affordability issues facing people in the developing world. -- Colin°Talk 18:48, 19 February 2020 (UTC)
            • If the dates in that study are as you state, adding data from this source will do zero to help the most troubled people in the region (Venezuela), and will also be grossly misleading, meaning we do more harm than good by using a source like this to generalize. Things have been bad in Venezuela for 20 years under chavismo, but things have been MUCH worse since 2018. Crisis in Venezuela#Health care. SandyGeorgia (Talk) 19:03, 19 February 2020 (UTC)
              • You would have to be careful about which papers you choose, and how you represent them. There are countries that might be considered WP:DUE by default because of their size (i.e., China and India), or because they're English-speaking countries and therefore the content is likely to be relevant to readers here (e.g., US and UK), but what you can say, and whether you can say anything, would depend significantly upon what the source says. You couldn't write that "it is considered an affordable drug in Central and South America" unless the source itself makes that generalization. If they've only studied a few countries, the most you could say would probably be "considered an affordable drug in <names of those few countries>". Anyway, this is a bit off-topic, since this RFC is really about the one database. Excluding the one database entirely (which I believe is your preference?) doesn't mean that excluding all possible drug-price content from articles. It would just require finding better sources. We might end up with better content, too. WhatamIdoing (talk) 20:01, 19 February 2020 (UTC)
                • We can agree there ... but I raise this as it reinforces a point made somewhere in the RFC (I believe by Sunrise) that we could be doing more harm than good. Venezuela is the best case in point in the Western hemisphere. The content in all 530 articles right now is probably doing more harm than good vis-a-vis Venezuela drug affordability. Old data is misleading, no medicines are affordable, in the biggest crisis the Western hemisphere has ever seen. If we aren't helping them, we are fooling ourselves about helping people generally. SandyGeorgia (Talk) 02:22, 20 February 2020 (UTC)
  • Again, I would strongly prefer that we focus on expanding articles such as Medication costs and Prescription drug prices in the United States to show industry patterns and practices rather than merely including a price in each drug's article. If inclined to do the latter, editors can be far more helpful to the reader by providing more information, such as the locales where the drug costs the least and the most, and historical price trends, than a single price. EllenCT (talk) 07:58, 30 January 2020 (UTC)
    • YES! And how about we also add information to all the drug articles where there truly are pricing issues? SandyGeorgia (Talk) 23:03, 18 February 2020 (UTC)
  • How often is such data available? Am I wrong to think that a lack of data on prices may sometimes reflect less a lack of interest by MEDRS/RS sources than a lack of solid information, in some cases caused by purchasing confidentiality agreements? I have heard of transparency initiatives seeking the prices paid for medications by major (government) buyers. If, in a few years/decades' time, there is more reliable data of this sort, and more discussion of it, this may be grounds to change what we present. I understand that cost ranges for generic drugs are sometimes researched and discussed by the WHO; certainly for some vaccines this is the case (for some vaccines, the cost per dose may even be extensively reported it the general media over time; polio vaccines, for instance). Exceptionally expensive medications must be specially approved in some countries (like the UK), which may generate large amounts of media coverage. I don't think, subject to correction, that anyone is arguing that the prices of medications is never of encyclopedic importance, or that any source can be cited for it, or in favour of generalizing beyond available data. So more solid discussion of prices in reliable sources might resolve much of the contention. HLHJ (talk) 07:42, 31 January 2020 (UTC)
    • Maybe the prices aren't available because there is too much variability in them to provide anything meaningful, outside of the US where we have goodrx.com, and Britian, which has the BNF. SandyGeorgia (Talk) 23:03, 18 February 2020 (UTC)
  • I have to agree with "the prices are more likely than not to be misleading. Adding specific qualifiers or putting together numbers from several different places or times doesn’t materially change this, because there are at least hundreds of possibilities" (i.e. the opening points that prices for different drugs vary to widely in the same country, prices for the same drug vary too widely by country and even, at the retail level, within a country). Some kind of order-of-magnitude data seems reasonable, yet how easily with average reader make sense of it? I'll return to my consistent theme throughout: if the RS are not dwelling on the pricing, then WP should not either; if they are, then they're already providing the sourced information for us to present. Whether that magically produces as cross-article system of comparable figures (hint: it won't) is completely immaterial. WP is not a price-comparisons database.  — SMcCandlish ¢ 😼  21:37, 2 February 2020 (UTC)
    • SMcCandlish (and anyone else), about your sources "dwelling on the pricing", I wonder whether you think it's enough to have source dwell on the price of pharmaceuticals in general, or specifically on that drug. Consider a (very) common drug for cardiovascular health: Do I need to find a source that dwells on:
      • the price of a (specifically) 20 mg simvastatin pill?
      • Or the price of simvastatin?
      • Or the price of statins?
      • Or the price of lipid-lowering drugs (e.g., statins plus fibrates and others)?
      • Or the price of drugs for cardiovascular conditions?
      • Or the price of drugs in general?
    • What's the most general category that you'd consider appropriate in that list, if I wanted to add some content about price to Simvastatin? (I'm talking about "price" here, as in dollars-and-cents; if you think of "pricing" as having more to do with gross profit margins, then that's a conversation for another day.) WhatamIdoing (talk) 02:01, 3 February 2020 (UTC)
      I would say "the price of simvastatin", since that's the subject. It need not be specific pill sizes, per the principle that basic math isn't OR. All the rest, though, appear to be highways straight to OR land, and it would be pretty much gaming the system to conclude that "the price of drugs in general" or a broad class of them is sufficient, when the general consensus in here seems to be that there's an OR problem in even leaping from wholesale prices of a particular drug to retail dosage prices. A source that focused on "the price of statins" and explicitly included simvastatin would appear to be good enough; if it did not, we cannot be certain that the research behind that article included that specific drug or even knew of it its existence, so we're right back to OR. Anyway, I also addressed this in my comment at #Other concerns, below.  — SMcCandlish ¢ 😼  03:51, 3 February 2020 (UTC)
      Okay, it sounds like you might accept one source that says what the price is (e.g., this database) plus another source that says something like "The price of statins, including simvastatin, is Terribly Important™", and use those to both verify (the first/database source) and justify (the second/non-database source) the inclusion of a statement like "Simvastatin costs US$1 per fortnight" (or whatever the price actually is). I think User:Doc James is also willing to combine sources (i.e., the source saying that it's terribly important doesn't have to be the same source used to get the numbers) but is suggesting that we could use a more general source (towards the other end of the spectrum, somewhere in the vicinity of "drugs for cardiovascular conditions" or "drugs in general") to as the "justifying" source. But it sounds like that wouldn't work for you. Am I understanding your view correctly?
      If you (or anyone else who's willing to share an opinion) don't mind taking it one step further, does the "justifying" source need to specifically say "the price is Terribly Important™ to _____ population" or "in these countries", or do you think it would be fair, once we've got a source saying that it's important, to provide a reasonably full description of the price. For example, if the source says the price matters in Africa, does that only justify mention of African prices, or would it be enough to provide a more comprehensive description (e.g., "the price in Africa is approximately X, and the price in industrialized countries is approximately Y". WhatamIdoing (talk) 20:18, 3 February 2020 (UTC)
      Right; the specific figure (a moving target over time anyway, thus requiring different sourcing over time) and the importance-to-the-world of the price (which may itself be a moving target – controversies usually are not perpetual) are discrete facts. My larger theme here is that WP:NOTPRICE and various other concerns indicate that just a source saying "The price of statins, including simvastatin, is Terribly Important™" probably isn't good enough. If we have a policy of avoiding price information (never mind that various wikiprojects mostly into technology products like cell phones and video games have been skirting it), then we'd need in-depth coverage of the matter is multiple sources that aren't just advocacy pieces (primary sources). Is there a real world consensus that an injustice is be? Is there a real-world consensus that there's a big controversy going on? Is there a real-world consensus on anything about the pricing and its importance, that rises to an encyclopedic level? One of the main issues here is that a lot of people (including organizations) are convinced that pretty much all drugs are overpriced, so it's probably not going to be the case that for any given drug we can't find some source somewhere making noise about its cost.

      We need to be certain we're dealing with signal not noise. And even if we are, that still doesn't make it an infobox matter or necessarily a lead-section matter (at least as to specific numbers). There's a slice of editors here who are just intent on getting numbers into the lead and infobox, and they're not providing a good rationale for doing so. It's generally going to be sufficient to note that orphan drug X has attracted controversy and media attention because various people are going to die or be miserable without it, insurance generally won't cover it, and no one but the rich could afford it themselves. That's an encyclopedic point; what the exact price was this month is trivia. Another encyclopedic poinpt might be that the cost of a drug is subsidized in, say, the US, but is up around orphan drug prices in some other places. Follow that with details like: "For example, in Zimbabwe as of 2015, the wholesale cost of the drug was 700% higher than in Canada. Between 2000 and 2011, a scandal in Ecuador involved the government and national pharmacy chain Drogomatico colluding with Germany-based XYZ GmbH, sole supplier of the patented drug, to fix consumer prices around around 4 times the cost to Americans and Europeans". Or whatever. But it's tied to particular time frames and reported facts, and blurred out to broadly comparative estimations, not specific dollar/pound/yen/whatever numbers. The data need not be directly comparable, and not something we build a table out of, but just what the sources are actually telling us, and telling us consistently and in enough depth that we know it's WP material, which we then massage into WP material that doesn't need monthly updating.

      That's my take on it. I'm being too wordy and general in this for it to translate easily into "The guideline should say exactly 'foo'", but this is a rather sprawling discussion that seems aimed getting to some general principles, so I'm hoping this contributes to a directional push, to drafting something specific we can !vote on in a followup RfC. This isn't a topic I gnash my teeth over; I'm just approaching it like any other with a high risk of PoV and OR problems (and maybe in this case some MEDRS ethical concerns, like whether we could be unduly affecting patient decisions).
       — SMcCandlish ¢ 😼  21:10, 3 February 2020 (UTC)

I completely agree with SMcCandlish's general take on this. I have run out of energy to reply to WAID's queries, but generally I think we are chasing our tails here to try to turn a sow's ear into a silk purse. Our existing policies tell us how to write content. We can't use databases to do it. We should be writing articles based on policy and guideline. SandyGeorgia (Talk) 23:03, 18 February 2020 (UTC)
  • Blue Rasberry claims drug price is a defining characteristic of a drug. I agree with others that price is if anything, a textbook example of a characteristic that is not defining. When the UK made contraceptives free of charge, it did so for social reasons: the drugs themselves didn't become free to manufacture or purchase for the NHS. "In 1988, Mr. Roy Vagelos, former CEO of Merck & Co., and one of the team of scientists who developed the drug, promised to donate as much Mectizan (ivermectin) to control river blindness in Africa as would ever be needed".[6] This was a moral decision to help eliminate a dreadful disease, but clearly also a limited one as the company does not give away all its medicines. The donation of free ivermectin isn't defining of the drug, but rather more defining perhaps of the character of that former CEO. In 2011, BBC reported "Scotland has joined Northern Ireland and Wales in abolishing prescription fees - leaving England as the only part of the UK to charge for them". This is something a relatively rich country can afford to do, yet other similarly wealthy countries do not, leaving the the sick to pick up the cost of their own recovery, or to have been individually wealthy and foresighted to have high quality insurance coverage. The highly notable extortionate price of Insulin in the US is not caused by any inherent quality of the drug: "The US is a global outlier on money spent on the drug, representing only 15 percent of the global insulin market and generating almost half of the pharmaceutical industry’s insulin revenue". Rather it simply reflects the worst of relying on market forces and "lax [US] regulatory environment around drug pricing: They are doing it because they can". Insulin is merely a pawn in a game, not itself the cause of a crisis. The biggest determinant about what you pay for nearly all drugs, and whether you have access to them, is where you live. -- Colin°Talk 18:10, 23 February 2020 (UTC)

Comments about the specific examples[edit]

  • Examples are mostly irrelevant I see little value in discussing these or any particular examples because there is no one advocating for this kind of price information to be in Wikipedia in the long term. The plan has always been that this price information is a pilot, and after we discuss the multiple major social issues around managing this, then we plan for a next set of development processes which include tools, more collaboration, policy development, and better control over this content. English Wikipedia has certain policy constraints, like avoiding the use of bots and automation, which have an origin in Wikipedia being almost unfunded for its first 10 years of existence. Now money is better and software development is ongoing, and also Wikipedia has gone from being fringe to being arguably the single most influential media outlet in existence in terms of its reader and pageview count. These drug price examples are a proof of concept of what a few volunteers can do with no funding, no technical development budget, and no institutional partnership. This price information is not the best imaginable, but it is the highest quality content available from the most reliable sources, so by including it Wikipedia is doing the best it can with its current model of citing sources. I recognize that critics say they can imagine better ways to show prices, and I can also - with automation - but Wikipedia proof of concepts have to start somewhere. Our starting point is the standard of quality of external sources that we cite, and our next step is to publish something which is better than that. We start in the constraints of our rules, so here we are, with compliant content which is the best the world has to offer and with lots of room for critique and improvement.
No one wants to do things this way forever, and I would prefer to direct conversation to how Wikipedia should present prices rather than how it does so right now. As soon as possible, we should go to a next phase of experimentation, which might include modeling out some automated maintenance of drug price information in 1, 10, or 100 articles. The technical aspects of this are relatively inexpensive. The more challenging and resource intensive aspects of this development are creating cultural products to explain the relationship between Wikipedia and data, collecting ongoing community feedback, seeking out university and appropriate community institutional collaborations, and growing the conversation between Wikipedia and expert organizations which publish price data. This is a good place for idealism. Blue Rasberry (talk) 17:28, 11 February 2020 (UTC)
Along with your statement above that a long-standing policy (WP:NOT) does not apply because this text is about 15 years old (which is a strange argument indeed), this is the first mention I have heard that:

The plan has always been that this price information is a pilot, and after we discuss the multiple major social issues around managing this, then we plan for a next set of development processes which include tools, more collaboration, policy development, and better control over this content.

Who put this "plan" in place, where and when? Who is the "we" you reference? It sounds like you are saying that some individuals had a specific plan to ignore policy and use Wikipedia as an experiment. Please clarify the who what and where on the plan you are discussing. Since all of the data under discussion was added by only one editor, while several dozen tried to remove it, the idea that this was part of a plan is curious indeed, particularly considering there was edit warring against multiple editors to keep the planned "pilot" in place. SandyGeorgia (Talk) 00:10, 12 February 2020 (UTC)
@SandyGeorgia: The policy being 15 years old is not the problem; the problem is that the policy being 15 years old means that it governs a time before the advent of dataset publishing on the Internet. It is a policy referring to paper information in manuals and describing the futility of expecting anyone to transcribe datasets from manuals into Wikipedia. Over 15 years things have changed and we have new automated processes available.
I have communicated with you in already my view of the experimental nature of these price experiments in WP:PRICES, which you have edited. You are present in the documentation. I would credit you as one of the architects of the current system as its current design is much based on compromises to your wishes and requests. "We" includes me and you. Blue Rasberry (talk) 20:54, 16 February 2020 (UTC)
Ethosuximide
PriceUS$27.77 wholesale per month in Dem Rep Congo;[note 1][1] $95.97 US NADAC price per month[note 2][2]; £9 UK NHS retail price per month[note 3][3]
Ethosuximide
Wholesale prices
Developing worldUS$27.77 per month[note 1][1]
US NADAC$95.97 per month[note 2][2]
Retail prices
US Drugs.comUS$160 per month[note 3][3]
Ethosuximide
Dose and strength
Defined daily dose1.25 grams[1]
Strength250 mg per pill
Wholesale prices
DRCUS$0.02 per 250 my pill (2014)[1]
US NADAC$0.64 per 250 mg pill (2019)[2]
Ethosuximide
WHO/HAI affordabilitynot affordable in many countries[6]
Bluerasberry, I love that you're willing to show up and advocate for your views even when it looks like most editors (so far) disagree with you. Being unafraid to advocate for other perspectives is really important to Wikipedia, because it helps us root out lazy assumptions. Thank you for joining this conversation.
I hear that you don't think the current article content matters from a long-term perspective. However, I'm guessing that you'd be unhappy if someone blanked all of it with an edit summary that says "Lane says nobody wants this experimental content anyway", and even if we all agreed with you, we would still need to figure out what can be done between today and the future you envision. So in between, do you care? (Am I wrong, and it would be okay to just blank all of that "experimental" content?) Can you give me any examples of how you'd like to see us use (NB: the next words are the most important ones) this specific database to create content for an article today?
So, for example, Doc James has said above that he thinks that Ethosuximide shouldn't say it's the price for the whole developing world, and instead should say it was the wholesale price offered in the DRC. Would you rather say it's the price for the entire developing world? Would you rather say it's the price in the DRC? Would you use this source to say something else? Would you not use this source, and instead find a different one?
If you would like to see this content in an infobox at the end of this month (remember, not in the future we're all working towards), then what would that look like? Here's a few fake infoboxes with ethosuximide information. If others agreed that this would be suitable for an infobox, what do you think the infobox would say? (NB that the last item can't be sourced to this database, so that's an example of dumping this source in favor of a different one.) WhatamIdoing (talk) 06:01, 12 February 2020 (UTC)
@WhatamIdoing: Thanks for your concern about me. I see myself as speaking with the established majority advocating for prices. You, others, and I have been having this same conversation about drug prices in infoboxes since 2015.
The drug prices which we have in the articles now is one option competing with these boxes that you formatted. For as long as the present system is the best way that anyone can propose, I advocate to keep the prices in their present form. If we find consensus for a better way, then we shift to that way.
You asked for examples of how to use a medical price database. The best examples that I would have chosen are the least expensive and most expensive drugs on the WHO Essential Medicine list. Perhaps that is aspirin and nivolumab. Aspirin costs US$0.01 and the cancer drug costs about US$10,000. Wikipedia should communicate the information that one of these drugs is financially easy to access and one will be difficult to access. Comparing those two drugs might have been easier than the examples here, because there is so little variation in price for them.
Again, I like those infoboxes a lot. I think the solution will include considering those boxes you made as examples. Blue Rasberry (talk) 02:43, 17 February 2020 (UTC)
Lane, I can't see how saying that "Aspirin costs US$0.01 and the cancer drug costs about US$10,000" helps me decide what to put in the article about Ethosuximide. Right now, I think I can source a statement that gives a dollars-and-cents price in the DRC. I think I can source a statement that says that it's not available in the developing world[14] (i.e., so the dollars-and-cents price doesn't matter, because you can't buy it anyway). I can't source a general "price in the developing world". I can't source manufacturing costs. Is your view basically that whatever can be included about prices should be, and you don't care about little details like the math being wrong in that sentence, or whether it says "the developing world" when it ought to have said "one country in Africa, only for one year"?
I also don't think the dollars-and-cents entries in an infobox scales. Imagine what that would look like for a drug with multiple formulations and multiple strengths. You could have 50 data points there, and not a simple list (multiple countries, some international suppliers, multiple formulations, multiple strengths – and all with their own datapoint that some people think is "The One True™ Price"). WhatamIdoing (talk) 04:27, 17 February 2020 (UTC)
@WhatamIdoing: My position is that making prices accessible is normal and that all sorts of media sources do this. Wikipedia editors might criticize the various sources, but these sources are good enough for medical professions to use and recommend. It is not Wikipedia's role to expect a higher standard than what is commonplace.
You or anyone else can find criticism with any existing source. I confirm your assessment of the complexity of this, but an omission of price would be a Wikipedia editorial judgement outside the norm of the field. There are lots of possible design options, practically none of which we have ever considered, which would make Wikipedia equal to or better than the available sources in the field. Blue Rasberry (talk) 18:20, 23 February 2020 (UTC)
If you are correct, and it's actually true that providing information about prices is "normal", and "the norm of the field" (which field is that, by the way?), and "all sorts of media sources do this", then why can't I find a source that actually tells me how much ethosuximide costs outside the US? A nice little newspaper article saying that it costs X in most of Africa, and Y in most of Asia, and Z in most of South America is exactly what I'd love to have. I feel like I'm getting a bunch of handwaving from you in the WP:SOURCESMUSTEXIST range, when I'm telling you that I actually did the search, and I actually did not find any of the "normal" sources that you keep alleging "all sorts of media" are supposedly doing. So if they're actually doing it, could you please give me a link or two to demonstrate that? WhatamIdoing (talk) 04:44, 24 February 2020 (UTC)
@WhatamIdoing: No one is making the claim that a high quality comprehensive dataset covering all drug prices in all places at all times exists. What I would like for you is some description of your expectation of quality. There are the sources which exist, and the non-existent platonic ideal of the perfect drug price list, and Wikipedia is able to have some level of quality between those two. So far as I know, no one on the opposition has ever described what level of quality is acceptable, other than to say that the sources which experts recommend and use are of too low quality. I claim that we have some data on prices, and there are models for presenting price data to the general public for media consumption; and I argue that this is good enough for Wikipedia; but I make no claim that this data is perfect.
Fields which normalize price sharing include consumer advocacy, public policy, and practice of medicine and pharmacy in context of patient access to medication. I expect that you can find the academic papers for physicians and pharmacists talking about how price affects patient access to treatment, so I will skip that for now and share non-academic examples.
consumer advocacy - Consumer Reports, 2016, "Is there a cure for high drug prices?". This article and the organization in many publications advises consumers to learn about drug prices from their physician and to consider generic alternatives. See the section "What Consumers Can Do" for price discussion. This article also suggests GoodRx as an information source. The point of my sharing this is that Consumer Reports as a major consumer advocacy organization communicates that patients should have access to price information when making purchase decisions about drugs. I used to be meta:Wikimedian in Residence at Consumer Reports from 2012-18, which I think you know, but I want to disclose my relationship in this conversation.
public policy - I am unable to speak for the world but I know a bit about New York and my beautiful Bushwick, Brooklyn in NYC. The Consolidated Laws of New York includes a public health law subsection, and one of the mandates is Section 278, "Prescription drug retail price lists". Check it out for yourself, but it says "The department shall make prescription drug retail price lists of pharmacies... available to the public in a database on its website at all times... The website shall enable consumers to search the database for drug retail prices... The website shall accommodate reasonably anticipated and actual public use of the database." They offer a tool called Prescription Drug Prices in New York State. This service is an example of how a government designs a public health environment to promote patient access to drug prices. This is not a professional database, but a public service for common people with no health background or specialized knowledge of any kind. New York City is a global media capitol and this is the standard of quality which New York sets for itself. I assert that if sharing prices in this way is good enough for this diverse population, then sharing information of this level of quality should be good enough for Wikipedia. I acknowledge that ethosuximide is not on this list, but also, the service consciously has decided to publish only the prices of the 150 drugs which people here commonly uses. They still provide this media even without completeness or perfection of data, and I feel that if Wikipedia similarly had data gaps then our quality would still be as good as or better than other comparable sources like this one.
Response? Blue Rasberry (talk) 21:21, 24 February 2020 (UTC)
"So far as I know, no one on the opposition has ever described what level of quality is acceptable, other than to say that the sources which experts recommend and use are of too low quality." While I'm not sure I would characterize anyone as "the opposition", I think you've misunderstood. The discussion/dilemma is about Wikipedia policies and guidelines, specifically V, OR, NOT, WEIGHT, and LEAD. The acceptable text will comply with those policies and guidelines. The idea that the data is somehow "high quality"-- because someone in the industry thinks it is-- is not the issue at all. It's how we have used (misused) the data. SandyGeorgia (Talk) 23:06, 24 February 2020 (UTC)
User:Bluerasberry, right now, the level of quality that I'd like is approximately "national newspaper" or "business magazine". I see prices as business information and do not believe that MEDRS-style sources are needed. The problem has never been the reputability of this database. The problem is that none of the sources actually make claims about what these drugs usually cost in any given region. (Other editors seem to care mostly about post-discount/post-insurance retail prices rather than wholesale prices, but speaking for myself, I'm good with manufacturing costs and wholesale prices.)
To stick with this one example, Healthline's website says that 120 pills of generic ethosuximide pills (250 mg) in the US might have a retail price of US$155 (as of 2016), although the source is loaded with statements about prices changing regularly and every pharmacy having a different price.[15] (This is the most common adult dose for a 30-day supply; it is also 80% of the defined daily dose for a 30-day supply.) That's not a good source, but it might be barely good enough for me. But where are the similar (or hopefully better) sources about other countries? We've got a statement right now in that article that the drug has a wholesale cost of about $28 per month in the developing world. The source we have does not say that: not the "about $28 per month" part, and not the "in the developing world" part. We've also got a US NADAC price in the article of about $96. Now, what about the other 96% of the world's population?
Imagine that everyone agreed with you. Imagine that including information about drug prices was considered extremely important by All True™ Wikipedians. Pretend there was no opposition whatstoever. Now what? What exactly would you put in Ethosuximide about prices? Take one of those "models for presenting price data to the general public for media consumption" you were talking about and some of those allegedly extant "sources which experts recommend and use", and give me a worked example that wouldn't deserve a {{globalize}} tag or a complaint that you're misrepresenting the wholesale price from one non-profit that only serves accredited healthcare facilities in the Democratic Republic of the Congo as being "the" wholesale price in the entire developing world. Just write it out, complete with sources, exactly like you want to see it in the article. This is "show", not "tell" time. I've already heard you say that all these great expert-oriented sources and models exist. Now I want to see you turn them into content that you believe is suitable for an encyclopedia article. And if you make the attempt and discover that it can't actually be done for this drug, then please come back and tell us that, too. You'd be in good company: I tried, and I failed. WhatamIdoing (talk) 03:17, 25 February 2020 (UTC)
Bluerasberry, "Aspirin costs US$0.01 and the cancer drug costs about US$10,000." would have more value if (a) those prices really could be sourced to the MSH Price Guide and (b) you explained what "costs" means. One pill, one dose, one day, one month, a course of treatment, per headache. Regular, dispersible, enteric-coated, chewable, rectal suppository, extended release capsules. 75mg, 150mg, 300mg. Band name or lowest-cost generic. Pack of 28, 32, 56, 100, 1000. Wholesale, retail, discounted, .... Saying that you want them all is not only impractical but simply a cop-out as nobody is advocating we have a price list bigger than the article in the lead section. Being wrong by a factor of 2 or 5 shifts a drug from affordable to unaffordable: it isn't just the megabucks cancer treatments that are unaffordable. You might think that ibuprofen, say, is a cheap drug at a couple of cents a tablet, but I can source that a month's treatment with generic ibuprofen for arthritis pain costs over three days wages in Egypt, making it unaffordable. [7]. That's no blockbuster drug but our "just a few cents" "costs" are actually misleading our readers. --Colin°Talk 11:33, 17 February 2020 (UTC)
@WhatamIdoing and Colin: I see your criticism as being directed toward the reliable sources which professionals in the health sector use. To me, the sources which experts use are good enough for Wikipedia.
The point of the examples I chose was to demonstrate that one drug can cost 100,000 times more than another even in a circumstance where dose, geography, and form should not matter in a price comparison. If a reader comes to Wikipedia and examines two drugs where one is much more expensive than the other, then then I think the reader should have some idea of this difference. We should report the price because other sources do this, and also because sources say that price is one of the basic attributes of health care.
I hear you both saying how challenging it is to report price. I acknowledge that difficulty. We could place ethosuximide between the aspirin and cancer drugs, and this would be useful information. An aspirin costs between $0.001-1.00, ethosuximide costs between $0.10-1000, and the cancer drug costs between $100-100,000. This is correct and useful information as it differentiates all these drugs. This is a simple example and we could even increase the precision if we tried.
What do you think about these three price presentations? Accurate? Useful to distinguish drugs? Wikipedia aligned? Blue Rasberry (talk) 12:32, 17 February 2020 (UTC)
Bluerasberry The professionals use the MSH Guide in very limited ways and make limited claims. Mostly they are using it to demonstrate that in reality, on the ground, governments and patients are paying way way more that the mythical price in a guide. We aren't and don't that that's what makes us look like chumps. It's like we found a five-year-old jewellery catalogue from Poland, chosen a pretty ring on page 65, and are now confidently telling everyone the price of a diamond ring in the EU is €1,299.99. There was nothing ever wrong with the catalogue but everything wrong with what we are using it for.
I hear you want to inform readers that expensive drugs are expensive, and that's pretty easy to do without breaking NOTPRICES because everyone talks about that. What's much harder is to claim a drug is affordable (where? for who) or moderately priced, and we get completely unstuck whenever we try to price things with a number, even a ballpark number. You've got a factor of 1000 range in your aspirin ballpark and a factor of 10,000 in the ethosuximide ballpark, which I have to say is quite meaningless. What costs $1.00? If it is a single 300mg tablet, and I take 10 a day for arthritis, that's $300 a month and totally unaffordable for most. Or is $1 a month's treatment cost and quite affordable in the rich West. I think you need to stop thinking and saying that "a drug" has "a cost" and that "cost" is a meaningful word on its own.
Our readers aren't generally going to compare the price of two random drugs. What is more encyclopaedic is to comment on the relative cost of different treatment options for a condition. Or to comment that certain important anticonvulsants are generally unavailable or unaffordable in many developing nations. Or to say that the high price of a certain cancer drug delayed its approval for the NHS. As an encyclopaedia, we are here to provide information at a summary level, whereas prices of products with barcodes in dollars and cents from one supplier in one country five years ago is just data. -- Colin°Talk 13:23, 17 February 2020 (UTC)
If "the sources which experts use are good enough for Wikipedia", then MEDRS would have to be re-written, because many experts use primary sources and raw data, rather than secondary sources.
More relevantly, do you see any experts using this source to write that the cost of ethosuximide is $28 a month? I don't. If you want Wikipedians to use the same sources as the experts, then wouldn't you also want editors to use those sources in the same way as the experts? If you think this particular source (not just any source that an expert might use) should get used to write encyclopedic content (not any of the other ways that an expert might use that source), then maybe you should look at the source and give us an example of how you think expert would use it. WhatamIdoing (talk) 00:54, 18 February 2020 (UTC)
If Wikipedians were to use the same sources as the experrts, and in the same ways as the experts, then we would have to make sure that those Wikipedians are experts. In some cases this may even be true. In those cases these experts can publish outside of Wikipedia where they are known and recognised by their peers, and provide Wikipedians of unproven expertise with reliable sources they can work from. · · · Peter Southwood (talk): 15:51, 18 February 2020 (UTC)
We already make loads of crazy editorial judgments about drugs. There is no collection remotely like Wikipedia. I do not accept that Wikipedia's period of innovation is over, and even if it were, the worst that we could do is present prices in the way that existing sources present them. Yes, I am in favor of saying that this drug costs $28 a month, because sources do that. With the typical Wikipedia editorial discussion and innovation, we might choose to present this information in another way. My own wish would be to have a gradient like a range, and to communicate low, medium, and high prices. There are many models for high precision, and distinguishing drugs which are approximately $1 versus $30 versus $100+ is achievable. The barrier here is social and not technical or for lack of data. Blue Rasberry (talk) 18:26, 23 February 2020 (UTC)
I am in favor of saying that this drug costs $28 a month, because sources do that.
You say that "sources" (plural) "do that". Please name any two sources that actually give a monthly cost of $28 for that drug. I can't find any. This database gives a wholesale cost per pill from one non-profit to accredited healthcare organizations in a single African country, and an editor has tried to combine that with the defined daily dose to come up with the claim of almost $28. But the actual dose for any given patient ranges from 20% to 120% of the defined daily dose, the DDD is not the most typical dose, and the drug is normally taken in combination with other drugs, which then affect how much of each drug is needed, depending upon which other drugs are being taken. I have not yet found anything except a Wikipedia mirror that claims that this drug costs ~$28 a month. If you have seen such sources (i.e., you're not just making assumptions), then please share the sources you've found. I would be happy to discover that you're right, and that we actually do have sources about this. WhatamIdoing (talk) 05:33, 24 February 2020 (UTC)
  • Examples are mostly irrelevant for different reasons than Bluerasberry indicates; they are irrelevant because we have this many issues on 530 articles, shouldn't be using a database at all, can't turn this sow's ear into a silk purse, and have policies in place already that tell us how to write content. (That many editors expended this much time on what was a "pilot" is alarming.) I will try to add more to each example when I have more time, because there is still more to be said about all the problems in them. Again, no matter how much SYNTH and OR we do to try to make this work, the numbers we are putting into articles are meaningless without context supplied by independent analysis in reliable sources. People are dying for drugs in Venezuela because they don't have pennies. Prices that are incorrectly stated, and not viewed in terms of for what condition and for treatment for how long and how does the cost compare to the wages in the country are meaningless gibberish, and this pursuit has taken too much time away from real content creation. Drug prices vary by too many factors for Wikipedia to be using outdated databases with scores of identified problems, and then trying to do more than simple calculations ourselves to present something meaningful, such that we miss by factors of double to hundred-fold. I do not see any one of the samples as policy-compliant or useful. On the instances that the information is semi-correctly written only because there is only one choice, why would er even want to present such limited and meaningless information to our readers? We tried for six weeks during RFC formulation to find a good example from these databases upon which to base an example, and IMO, we failed to find even one, out of 530 articles. SandyGeorgia (Talk) 23:25, 18 February 2020 (UTC)

Ethosuximide[edit]

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

What the source says about:

  • Suppliers: The cited database entry lists one supplier, which offered 250 mg tablets of ethosuximide for sale for US$0.1845 each (100 tablets per package) in 2014, only to organizations in the Democratic Republic of Congo.
  • Buyers: The database has no information about buyer prices.
  • The drug: Each pill contains 250 mg of ethosuximide. The defined daily dose is 1.25 grams. There are no other entries in the MSH database for this drug.
  • This information does not look useful to me. There is no indication in the text of how the specified value is derived, the price seems over-precise at four significant figures, particularly when one knows it is based on a single and possibly out of date value.
    If a price is quoted for a defined daily dose this must be specified, and linked, as most readers will not have heard of the concept. · · · Peter Southwood (talk): 18:45, 28 January 2020 (UTC)
    • Peter thanks. FYI out of 25 years data, the MSH database only records a single supplier for ethosuximide in 1999 and in 2014 (not 2015). I have read several WHO/HAI reports on price/availability in developing countries and all of them mention that ethosuximide has zero availability. Zero. It simply is not available in the developing world, despite being on WHO's list of essential medicines and a primary choice for treating childhood absence epilepsy. This seems a more important point for the lead, than claiming a four-significant-figure "developing world price" based on that offered six years ago by a non-profit working in the north of the Democratic Republic of Congo. -- Colin°Talk 20:44, 28 January 2020 (UTC)
      • A price for something that is not available is exceptionally useless and misleading. The fact of non-availability is far more important. · · · Peter Southwood (talk): 06:11, 29 January 2020 (UTC)
        • Peter Southwood, I just got an edit conflict, and discovered that you'd made my question for you irrelevant. ;-) It sounds like you would recommend not using this database record at all. There has been relatively little support for this particular use so far. The Carbamazepine example seems to have more potential than this one. Would you (or anyone) like to hazard a list of key features by which editors could identify which records are usable, and which we don't recommend? "Availability" isn't directly mentioned in this database, although a record with a lot of suppliers or suppliers that cover many countries could perhaps be used as a proxy. We could also simply say that it's good to report availability, regardless of anything else we might (or might not) be able to say about prices. (I'm still hoping to get your thoughts about the third example, too.) WhatamIdoing (talk) 06:21, 29 January 2020 (UTC)
          • This particular databate record does not appear to provide anything usable in isolation. I cannot judge whether it might have value in combination with other data as part of a deeper commentary. Availability is relatively tricky. If there is a reliable report discussing availability, as Colin claims for this drug, then it can be mentioned using that source. In other cases it may be a problem of absence of evidence rather than evidence of absence. I have seen some complex maneuvers to work around original research problems on Wikipedia, and a common one is to list the evidence and leave it to the reader to do the math. For drug prices this may not be generally desirable, and certainly not in the lead. I cannot say there will never be a situation where this type of information would be appropriate, but it should not be default include. · · · Peter Southwood (talk): 08:00, 29 January 2020 (UTC)
            • Peter, User:Colin/MSHData provides some analysis and data showing the proportion of records and number of suppliers. Also some stats on the number of suppliers for small number of core drugs that WHO/HAI researched. It seems reasonable to assume that a low number of suppliers to developing world is likely to correspond with low availability, but low availability can occur even without this. Currently, this database has been used everywhere it has a record, whereas I think any continued use needs to be guided by some community-agreed level of the number of supplier records needed to be a reliable reference price. IMO we should, like the source demands, ignore buyer prices. And we should take the median of many supplier prices, rather than quoting the outlier min/max which also has other problems, and then we are at least in agreement with WHO advice. How many suppliers are required? I would say three is a very low bar and should preferably be higher. Do you have a feel for where a threshold might be?
I would encourage the use of other sources such as WHO/HAI studies to get real-world prices and availability instead of this academic value. We also need to remember that every professional publication using this guide only uses it to get the reference price of a specific formulation and strength of a drug to treat a specific indication. We do not do that. -- Colin°Talk 10:58, 29 January 2020 (UTC)
I don't have strong feelings about a specific bar. What one can say depends on the specific information provided by a source, and whether that information is appropriate to the article. More sources may make more information worth including, but not necessarily. There is much greyness in the area. Three suppliers only just allows a median to be identified, and my feeling is that in most cases we would reasonably expect the number of suppliers to be specified, so that the reader is aware of the level of approximation. It is theoritically possible that only three suppliers exist for a drug. That in itself might be worthy of mention. If there is only one manufacturer it would almost always be worthy of mention. Some competence and discretion is required. Minimum, maximum and median may all be encyclopedic in some cases, but probably not in many others. Information that has lasting value is usually more valuable than information that will be out of date in a few months. · · · Peter Southwood (talk): 13:37, 30 January 2020 (UTC)
Peter thanks. I agree that this source must be used with a great deal more care than the current approach, and I think mostly (nearly always) it is probably unsuitable for direct use by Wikipedians. Just to clarify the "suppliers" in this database are are mostly NGOs, are not drug companies or generic manufacturers, and are drawn from a list of 35 suppliers who make their price lists available to MSH. There will be other suppliers who don't have a relationship with MSH, or where manufacturers deal more directly with government agencies. Limited or missing set of records in the MSH database doesn't prove there are no suppliers, just that the guide doesn't list many/any. Similarly the min/max are only the min max of MSH database records for that one pill and year, not for all formulations/strengths and not for the entire developing world and not for all indications and circumstances. A WHO/HAI report into availability, treatment cost and affordability is likely to be more directly useful to us and to our readers, though they are relatively rare and narrow in scope. -- Colin°Talk 15:08, 30 January 2020 (UTC)
That information was not obvious, and makes the use of the data without explanation potentially misleading. · · · Peter Southwood (talk): 09:06, 31 January 2020 (UTC)

Peter, I'm looking at Sunrise's comment at 00:40, 25 January 2020, which suggested (perhaps only half-seriously) that a less misleading formulation might look like "in year A, according to the records in database B, company C sold D doses of drugs to group E for a price of F in currency G, which includes insurance and transportation charges but not handling fees or taxes".

For ethosuximide, I think Sunrise's example sentence would sound like this: In 2014, according to the International Medical Products Price Guide, one organization offered this drug for sale to accredited healthcare agencies in the Democratic Republic of the Congo at a price of about $28 per month." (Actually, does that make any sense? It's not a hospital's worth amount for US$28 per month. Maybe it should say something like "at a price equivalent to a month's treatment for about US$28, assuming the dose was the same as the defined daily dose". Or eliminate the monthly calculation, and say "at a price that would cost them about US$1 per patient per day, using the defined daily dose".)

Does that sound about right? Do you think that's a fair representation of that source? (We don't have many sources for the price of this drug.) And does the list price of a drug, in one year, in one country, from one specialized supplier, feel hopelessly WP:UNDUE, or would you keep it in the article? I'll work out equivalents for the other two examples, and post those below in a bit. WhatamIdoing (talk) 17:24, 31 January 2020 (UTC)

You said it best: hopelessly undue. SandyGeorgia (Talk) 17:56, 31 January 2020 (UTC)
That seems to be about what we could say using that record as the source. Why would we want to? · · · Peter Southwood (talk): 18:49, 31 January 2020 (UTC)

The specific examples both point out the general nature of the problem (i.e., why MOS:MED / WP:MEDMOS should advise against including pricing info except in unusual cases where price controversy is usually part of the RS coverage), yet also are WP:SURMOUNTABLE problems in their specifics (if someone is doing OR at a particular article, undo the OR). So, I'm not sure that dwelling on them one-by-one below will be productive for the overall discussion, which is about the systemic problem that including drug prices in our articles is almost always a poor idea for multiple reasons.  — SMcCandlish ¢ 😼  21:42, 2 February 2020 (UTC)

These three examples seem to be pretty typical, and thus show the general nature of what can/can't be sourced right now. I hope that by the end, we'll have two outcomes:
  1. a clear, very concrete idea of what to do with these three specific examples.
    • Simply to illustrate – and not necessarily the current consensus for any article, much less the one we'll end up with! – I'd be happy if at the end, editors had agreed that the first should be removed entirely because it would be UNDUE even if the other problems were corrected [or that it's okay, and we just need to round to $30 and swap in "in the Democratic Republic of Congo" where it currently says "in the developing world"], that the second is basically okay but should use the median supplier price instead of a range and round more aggressively, and that the third needs should be switched to a record with more datapoints.
  2. some general ideas about what's needed to support prices, so that we can use those to propose a new section in MEDMOS. Those ideas might say things like "databases deal with WP:V but you have to have a non-database source to demonstrate DUE" or "if your price is for a single country, then you have to name that country" or "focus on availability and affordability, rather than prices" or "don't put it in the lead unless you have hundreds of words in the article about prices", but they're general ideas that apply to all articles rather than just these three (or just the several hundred sourced to this database).
WhatamIdoing (talk) 02:26, 3 February 2020 (UTC)
I can buy all that; I guess I just don't much care about any but the last part; individual articles can be patched up without a site-wide RfC, but preventing a constant stream of articles in need of patch-up in this kind of regard is going to need site-wide attention and a decision on guideline wording. FWIW, I support all of your suggested guidance in principle, though some policy wordsmithing would be needed.  — SMcCandlish ¢ 😼  04:00, 3 February 2020 (UTC)
  • This well illustrates the OR and misrepresentation problems. First off, that is not the price "in the developing world"; it is the price in a single country. Also, the "defined daily dose" may or may not be reflected in actual usage. Finally, what good does it do most readers to know the wholesale price? That may or may not mean anything in regards to what they pay at the pharmacy counter. Seraphimblade Talk to me 02:17, 9 February 2020 (UTC)
  • Our articles use secondary sources such as expert analysis or opinions. Medical editors will already be aware of the prohibition against using primary research sources, even though other expert publishers do so. This use of database prices is in fact worse than that, akin to getting hold of the primary research study's spreadsheets of patient data, and making our very own original conclusions independent of the published report.
With Ethosuximide, we don't even have data, we have a single datum that wafted into existence in 2014 and, like a transuranic element, disappeared entirely the following year. The ridiculous precise value of $27.77 per month is actually incorrect as the $0.1845 250mg tablet would be $27.67 for 30 days, or $25.83 for 28 days. But this isn't solved by correct maths, by sticking "about" in front of the value, or by rounding to 1 significant figure as has been suggested. We simply have no idea if this value is representative for any significant figures. Without a variety of supplier prices, we don't know if this represents a low or high or median. For example, the high/low ratio of carbamazpine supplier prices is 4x and buyer prices is 7x. So, the decimal point could easily shift left or right a point. Ethosuximide is not in the core part of the WHO Model List, and has 0% availability in any study of developing world countries.
The most elementary part of statistics is knowing when you can or cannot claim something generally, and this is a clear example of not appreciating that limitation. We can neither use this value to make a claim for the developing world, nor can we use it as an example of a price in the developing world: both require knowing information we don't have. Yet the editor who inserted this value continues here and on the RFC talk, to request it be included somewhere in the article. This represents to me a common and flawed approach to medical editing, where editors do not research the body of literature on an issue (cost, affordability and availability of a drug) but instead come to the article armed already with a source they wish to use and are determined to include. -- Colin°Talk 13:42, 23 February 2020 (UTC)

Carbamazepine[edit]

What the lead says: The wholesale cost in the developing world is about US$0.07 to US$0.24 per day as of 2015.

What the source says about:

  • Suppliers: The cited database entry lists twelve suppliers that offered 200 mg tablets of carbamazepine for sale in packages ranging from 100 to 1,000 pills each in 2014. The lowest price reported by these 12 organizations was US$0.0138 per pill, and the highest price was US$0.0372 per pill, with a median price of US$0.0185 per pill, down 5%. The High/Low Ratio was 2.70.
  • Buyers: The cited database entry lists three governments plus the Central American Integration System. The lowest price reported by these four organizations was US$0.0155 per pill, and the highest price was US$0.0480 per pill with a median price of US$0.0202 per pill, down 9%. The High/Low ratio was 3.10.
  • The drug: Each pill contains 200 mg of carbamazepine. The defined daily dose is 1 gram. There are five other entries in the MSH database for this drug for 2015.
  • My assumption on reading a cost per day with a range, is that the dose is variable or the cost is variable, or both, so the information appears ambiguous. All I get from this is that it was reasonably affordable at wholesale price in my part of the developing world five years ago. I cannot deduce from the available information what it is likely to cost me over the counter today. It is not clear how this information is intended to be of value to me as a reader. If I saw this in a section about pricing or economics it would not bother me too much, though I would expect more detail. In the lead it seems undue. · · · Peter Southwood (talk): 18:45, 28 January 2020 (UTC)
    • Peter, I agree that we need to ensure the cost is both honest and meaningful. This paper on developing nations brings the price of carbamazepine into perspective. Availability in public sector is about 45% (in low income developing nations, about 33%) and 58% in the private sector. Public sector procurement price is about 1.5 times the international reference price (IRP -- median supplier price in MSH Guide), which is actually pretty good. For prices patients pay, in the public sector, this is 5 times higher than the IRP, and 11 times higher in the private sector. The multipliers for phenytoin are even worse (18 and 25 times higher). A month's treatment "cost the lowest‐paid government worker 2.7 and 5.2 days' wages in the public and private sectors, respectively". That's for generics; for originator brands the price is 30 times the IRP. If we are concerned with prices people pay in the developing world, the IRP is simply not remotely representative, and worrying about how many significant figures to show is the least of its problems. Price, availability and affordability are all linked and complex.
Before we excited about using the WHO/HAI research on wiki (and we could use it to make a general point) the data from this paper is from 2003-2010 and only looked at 5 epilepsy drugs for the journal Epilepsia. There are 530 articles with database-sourced drug prices. Only a tiny portion have been analysed to this degree. -- Colin°Talk 20:44, 28 January 2020 (UTC)

For carbamazepine, I'll note that Peter, Sunrise, and HLHJ have expressed some opposition to using a range, so I'll drop that, and use the median price (which the database's website recommends). Using Sunrise's model sentence above, it might sound like this:

In 2015, according to the International Medical Products Price Guide, the median wholesale list price for 200 mg pills of carbamazepine was about US$0.02 per pill in the developing world." (or ...at a cost equivalent to about US$0.10 per day, using the defined daily dose..." or ...at a cost equivalent to about US$3 per person per month, using the defined daily dose...").

This database record is one of the best in the database, so I'd like to see how much we can get out of it without being misleading or crossing any policy lines. It includes one supplier selling to more than 100 countries (at a price very close to the median), so I think "developing world" isn't an unreasonable summary in this case. (Do you agree or disagree?) I'm still not sure what to do about the other five records, each of which have many fewer datapoints. Perhaps just ignore them, because we're using the best? WhatamIdoing (talk) 17:32, 31 January 2020 (UTC)

Does the source mention the "developing world", and does the source define the developing world for this context? Our article on the developing world (a redirect) says thet the "devloping world" is not unambiguously defined. · · · Peter Southwood (talk): 19:02, 31 January 2020 (UTC)
In practice, I suppose it's really "countries sold to by the orgs listed at http://mshpriceguide.org/en/price-sources/?menuNo=6 ". WhatamIdoing (talk) 22:03, 31 January 2020 (UTC)
I assume WAID is referencing my statement about extrapolating beyond available data, with Sunrise's statement that the data are inadequate for giving a range. This is reasonable, but I'd like to be clear that I don't object to giving ranges per se. It won't be possible or desirable in all cases, but ranges can capture useful information. Of course, we could auto-generate drug-price violin plots with a sensible selection of labeled datapoints, to convey more information concisely Face-smile.svg. I'd think the difficulty of expressing the incompleteness of datasets, without adding cumbersome numbers of qualifications to the text, might be met with something like "according to/in limited [sourcename] data", with the details in the reference statement. HLHJ (talk) 20:31, 1 February 2020 (UTC)
  • This is another case where the data is too limited, too ambiguous, too old, and too far removed from actual price paid to be of any practical value, as well as representing some OR in extrapolating to the entire "developing world" from a subset which may or may not be representative. Something like this should not appear in the article at all. Seraphimblade Talk to me 02:20, 9 February 2020 (UTC)
  • Although this drug's database record is, as WAID notes, "one of the best in the database", even if we were to fix the article text to say the text quoted in green writing above, it gives the reader the impression that this is a very low cost drug: just USD $0.02 per pill. But the paper on price in developing nations says a month's supply "cost the lowest‐paid government worker 2.7 and 5.2 days' wages in the public and private sectors, respectively". I have since read that WHO/HAI consider 1 days wages for a month's treatment as the cut-off for "affordable". So to our wealthy first-world eyes, we see cheap 2 cents a pill, but the reality in the developing world is "very much unaffordable" to basic workers. We are misleading our readers through failing to research the topic and presenting any old numbers we have to hand. -- Colin°Talk 13:39, 23 February 2020 (UTC)

Diazepam[edit]

What the lead says: The wholesale cost in the developing world is about US$0.01 per dose as of 2014.

What the source says about:

  • Suppliers: The cited database entry has no information about supplier prices.
  • Buyers: The cited database entry lists two governments that reported buying 10 mg tablets of diazepam in 2014. Both governments report a price of US$0.0100 per pill, so the lowest, highest, and median price are identical, and the High/Low ratio is 1.
  • The drug: Each pill contains 10 mg of diazepam. The defined daily dose is 10 mg. There are two other entries in the MSH database for this drug in 2014
  • Two buyers' prices is not very representative of the developing world, which is not defined in this context, and is ambiguous at best, making reliability of the information open to question. Dose is undefined. Is it a one dose fits all applications drug? (I doubt it). Is the 10mg tablet representative of common prescription? Without knowing how many doses are likely in a course of treatment, the cost of a single dose is not very useful. Is all this clarified in the body of the article? Why would this information be considered due in the lead? · · · Peter Southwood (talk): 08:21, 29 January 2020 (UTC)
    • I've mentioned diazepam elsewhere here, and the answer to all your questions is no. But more importantly, the information you ask is not in the source, which is a big problem. -- Colin°Talk 10:58, 29 January 2020 (UTC)
      • The questions were largely rhetorical, but thank you for answering them anyway, as the answers may provide inspiration leading us to a solution. · · · Peter Southwood (talk): 13:37, 30 January 2020 (UTC)

Following on from the above, for diazepam:

Taking into account all the advice on this page, and the advice from the database about preferring the median supplier price, I think we're back to Sunrise's very narrow suggested formulation again, or omitting it entirely. So with this record, the result might be "The Ministry of Health of Peru and the Essential Medicines Unit of the Dominican Republic reported that they bought 10 mg pills of diazepam for US0.01 each in 2014". Does that sound like a fair description of that source?

However, I'd really like to switch to another record. 2015's 5 mg record has a lot more datapoints, and the suppliers include UNICEF as well as other large organizations. We could then write something that looks more like the carbamazepine example, with a DDD-based daily price of about two cents. WhatamIdoing (talk) 17:42, 31 January 2020 (UTC)

  • Again, extrapolation from dated and ambiguous database figures, without backing secondary sources. Should not appear in the article. Seraphimblade Talk to me 02:23, 9 February 2020 (UTC)
  • See my comment elsewhere for why "The [apparent ballpark] $0.01 for diazepam is an illusion". This is a clear example where the wrong record has been chosen as part of the original research process of determining prices. The number of doses a day is not something that maths can answer, but a product of tablet and drug pharmacodynamics and a choice made by a doctor with their patient. Diazepam for anxiety is generally taken twice a day, so the 10mg tablet cannot be used to achieve a 10mg DDD. Since we do not (and cannot) indicate what dose a patient should take, how often they should take that dose per day, nor do we even indicate this dose is for anxiety rather than any number of other conditions, the price "per dose" is supremely useless. -- Colin°Talk 17:23, 23 February 2020 (UTC)

Other concerns[edit]

  • The problem I see with this is WP:NOTPRICES. Neutral view or not, it cannot override policy.
"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."
Accordingly, I don't see a reason to override policy here. If we're going to include prices (which is an inherently political issue when it comes to medicine with WIDELY varying standards), it's just plain too unclear to be accurate. I can't see a single instance where such a quote wouldn't have to have an in-depth explanation. The only instance I can see its inclusion would be where the price was in the news for some reason (very high or very low). Without addressing this issue at Wikipedia Talk:What Wikipedia is not, neutrally phrased or not, such a change to this guideline cannot override a policy. Buffs (talk) 16:54, 24 January 2020 (UTC)
(Above quote from the general conent policy page section Wikipedia:What_Wikipedia_is_not#Wikipedia_is_not_a_directory item 5:Sales catalogues)
If this RfC establishes that it is desirable to change the policy, a further RfC can be held for that purpose. If there is no such consensus, there will be no need. This discussion has value in establishing whether there is good reason to consider changing the policy, and what, if any, those good reasons would be. · · · Peter Southwood (talk): 08:42, 29 January 2020 (UTC)
  • Comment. [COI statement: I used to do consultancy work for the pharma industry in the area of HIV & antivirals.] Commenting generally here as I find the attempt to channel comments into areas unnecessarily limiting. I have not read any of the previous discussions. Some drug prices are, in my experience, of huge interest to patients and in particular patient advocate groups. They are often the subject of considerable discussion in news-type sources. I don't see why they should be excluded because they are not sourced to meet the medical project's idiosyncratic definition of reliable sources for medical articles, as they are not themselves medical information. There again, there is a problem with the amount of detail that is necessary to convey any real understanding of the real price of a drug. Point information in the infobox is likely to be misleading, and will date rapidly. A couple of sentences in the lead, as in say nevirapine, whilst not precisely undue weight, feels less critical than much of the other information in the lead. In general, a section in the body on pricing might be a better way of conveying the issue, unless there is a cogent reason for including it in the lead. Espresso Addict (talk) 23:20, 25 January 2020 (UTC)
    • Espresso Addict, just to note that nobody has suggested politico/economic data like drug costs should meet WP:MEDRS. Meeting basic core policy WP:V, WP:OR and WP:WEIGHT and not misleading our readers would be a start. The notability requirements of WP:NOTPRICES are very much "mainstream media sources" and not specialist journal papers, drug database records, or documents in the WHO archives, for example. -- Colin°Talk 11:57, 26 January 2020 (UTC)
  • I agree with Buffs: I think that WP:NOTPRICES is the relevant policy and that it applies cleanly to the particular case of drug pricing. There may be individual drugs whose pricing in encyclopedically notable (insulin is clearly an example), but for those drugs one should expect to find many sources addressed to a broader audience, allowing for meaningful coverage on WP; these exceptions are already allowed for in the relevant policy. --JBL (talk) 02:26, 26 January 2020 (UTC)
  • Re overprecision Just a side point, but giving figures like $27.77 is silly; what in the world is the reader supposed to do with the 77 cents? Round everything to two significant figures. EEng 17:30, 26 January 2020 (UTC)
    User:EEng#s agree that is perfectly reasonable. Doc James (talk · contribs · email) 12:15, 28 January 2020 (UTC)
  • Generally: Please don't put price data into Wikipedia. That's not what an encyclopaedia is for. Also generally: I suspect the RfC drafters have indulged in some over-thinking here. The attempts to channel input into predefined areas is inappropriately constraining and the page notice is needlessly hostile.—S Marshall T/C 18:23, 29 January 2020 (UTC)
  • I am astonished that Prescription drug prices in the United States doesn't cover the situation with insulin, although it does briefly discuss epi-pens. EllenCT (talk) 09:02, 30 January 2020 (UTC)
  • Another side point, but if routine calculations are made, it would be good to give the numbers from which they are calculated in the citation, to make them easier to verify. Own essay here, but WP:Contort the citations. HLHJ (talk) 05:58, 31 January 2020 (UTC)
  • I'm going to object somewhat also to the structure of this RFC. That said, I agree that WP:WEIGHT is relevant, and that WP:NOTPRICE is relevant, and that the use of databases to source this data is not in keeping with the expected minimum standards of reliable sourcing on Wikipedia. Never mind inclusion in the lead, unless that's a natural part of the summary of the article (with some decent amount of discussion in the article-proper, attached to reliable sources). Pricing information is okay in some cases, but almost always (and only) because of inclusion in reliable sources noting the price. --Izno (talk) 03:37, 2 February 2020 (UTC)
    I am going to add some context from the video games MOS in addition to my above discussion with SMC etc. I think it reasonable to include, from the VG MOS directly, WP:VGSCOPE #8. In full:

    Cost: The purchase cost of games, products, or subscriptions, including point values for online services, should not be included in articles, unless the item's individual cost is particularly noteworthy. Exceptions are generally made for inclusion of the manufacturer's retail price of standardized game hardware and devices, such as game consoles, on articles about that hardware or comparisons with other hardware, a practice in line with other physical product articles on Wikipedia.

    Readers may consider that as they wish. I generally interpret "noteworthy" in context as meaning "multiple independent reliable sources have commented on the topic of the price of a specific game", meaning that the appropriate WP:WEIGHT is established for the matter. From memory, I do not think I can recall specific video games articles speaking to price (and where so, they have almost never spoke to the specific price). Databases do not establish sufficient weight, in an industry where digital distribution (and associated sales) is the dominant wayt of selling a game. What does that say about medicine articles, which generally have a higher bar set for inclusion of possibly-medically relevant material? I do not think "pro-price" is supportable, whatsoever, unless the same expectations can be met, as a minimum barrier. --Izno (talk) 17:06, 22 February 2020 (UTC)
  • I'm not doing to object to the structure of the RfC, since it's a general discussion to draw in editorial brainpower to work toward consensus (what RfCs technically are actually for, even if we've bent them over time into a yes/no or support option 3 out of options 1–4 voting mechanism). Anyway, WP:NOTPRICE is rather hard to surmount here, when it comes to "auto-including" pricing info in drug articles. NOTPRICE, however, makes explicit allowance for including this information when it's a major factor in the reliable sourcing. So, we basically already have the answer to this entire RfC: don't include drug prices except in the unusual case that the reliable independent sources spend a lot of time on pricing-related coverage of that paticular drug. The policy certainly and obviously militates against the idea of working up a comparative pricing system to include by default in our drug articles, and per WP:CONLEVEL policy, a gaggle of MOS:MED and WP:WPMED and WP:MEDRS regulars cannot override that policy for their pet topic. The NOTPRICE policy itself would have be changed, and we all know where WP:VPPOL is. This is basically irrelevant: "Some drug prices are, in my experience, of huge interest to patients and in particular patient advocate groups". WP isn't written as a tool for NGO lobbyists, nor as a determiner for patients in deciding which treatments they can afford.  — SMcCandlish ¢ 😼  21:51, 2 February 2020 (UTC)
WP:PRICE says "An article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention." So as there is an independent source AND a justified reason for mention the criteria are filled. Nothing needs to be changed to include these details.
All the sources used are independent of the manufacturer AND lots of sources support the critical nature of pricing information surrounding medicines. Sure how we present the prices can be changed / improved. Doc James (talk · contribs · email) 11:27, 3 February 2020 (UTC)
NOTPRICE cannot be read in isolation of our other policies and guidelines on sourcing, some of which include the requirement for reliability. "Justified reason" in context is just code for WP:NPOV, which is one such PAG. Databases do not fall in the scope of reliable sources, especially given the context of WP:MEDRS and WP:RS. --Izno (talk) 15:26, 3 February 2020 (UTC)
WP:PRICE is an essay. BTW in 2016, there was an RFC on the talk page, WT:Prices#RfC: why no prices at all?, which concluded with, "Consensus is clearly that detailed price information should not be included in most cases, including the Mitsubishi Magna page. Most commenters agree there can be exceptions, such as if reliable sources state a specific price was specifically important, but commenters do not believe that is the case here." I note that our articles about cars do not include the MSRP.
Anyway, the language DJ is quoting is not just in the essay WP:PRICE but also in the policy WP:NOTPRICES, but the very next sentence in NOTPRICES is "Encyclopedic significance may be indicated if mainstream media sources (not just product reviews) provide commentary on these details instead of just passing mention." The IMPPG database (subject of this RfC) is "passing mention". It contains no commentary. Also, it's not a "mainstream media source".
The next two sentences in WP:NOTPRICES are: "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." So putting the drug prices into the lead, or body, or infobox, of every drug as a routine matter, cited to a source that only contains a "mention" without "commentary" (meaning, a primary source like a drug price database), directly violates the longstanding global consensus documented at NOTPRICES.
The words on the page at NOTPRICES specifically say that our articles on products should not include pricing of products unless the product pricing has "encyclopedic significance", as shown through "commentary" (i.e., secondary sourcing), rather than "mention' (i.e., primary sourcing).
Sourcing price information to IMPPG violates NOTPRICES. Levivich 19:08, 3 February 2020 (UTC)
Levivich, thanks for your note about "mainstream media sources". Do you see any reason that an academic journal article should be considered worse than a mainstream media source? I don't, and if you don't either, then perhaps we should (separately from this RFC) propose a little adjustment to NOTPRICES to say something like "academic or mainstream sources". There have been whole books written on the price of bread. WhatamIdoing (talk) 20:31, 3 February 2020 (UTC)
WhatamIdoing, wholeheartedly agree. Levivich 20:44, 3 February 2020 (UTC)
To answer WAID, yes there is a reason: the vast majority of academic-journal article material is primary sourcing (it's original research in the root sense of the phrase). If you have a systematic review, that's one thing, but most of the rest of it isn't material we can ever legitimately use for WP:AEIS claims, nor for any claims that may be controversial (which is likely to be the case when it comes to drug pricing). We have a long-standing problem on WP with sciences (including med) editors stubbornly refusing to absorb the fact that their professional preference for primary material (the hot new research results) and disdain for secondary material as either professional-grade but dull and derivative "homework" to slog through, or crappy layman's stuff in things like newspapers, is the exact opposite of how WP is written. The main use WP has for primary research material is providing backup citations for specifics, mostly for the benefit of our more academic readers, after we already have secondary citations for any non-trivial claims made in that same material. (The main additional use for it is providing WP:ABOUTSELF details of research claims that are themselves controversial and reported as such in secondary sources; that is, there is no better source for what exact claims such a paper made than the exact claims published in the paper, just as the best proof of what Trump said in a tweet is Trump's actual tweet). Too many of our articles still violate our sourcing policies and cite damned near nothing but primary research papers, for all sorts of claims never substantiated by anyone else's followup research, much less a scientific consensus in systematic reviews. This is a problem to correct, not a model to emulate. (in quasi-behavioral policy terms, it's a WP:CONLEVEL failure; some sci/med wikiproject people cannot declare their own "counter-consensus" on how to properly source "their" articles, against site-wide policies and consensus about them.) In the end, primary journal pieces may be able to tell us with relative certainty – in the absence of any controversy at all about the claim – some really specific number in a very tight context, but they cannot demonstrate that including that isolated datum passes WP:NOT#INDISCRIMINATE. Only secondary sources can do that, or provide the analysis, evaluation, interpretation, and/or synthesis to relate discrete bits of data like that into a "picture", an "issue", to cover.

To work back up the thread a bit: Izno is correct that databases of drug data are not secondary sources, either; they're tertiary (cf. WP:TERTIARYNOT). This really nailed it: 'NOTPRICE cannot be read in isolation of our other policies and guidelines on sourcing .... "Justified reason" in context is just code' [for those other WP:P&G pages]. Aside from V, NOR, and NPOV, several sections of NOT in addition to NOTPRICE clearly steer us away from programmatically including drug-price information on Wikipedia.
 — SMcCandlish ¢ 😼  21:41, 3 February 2020 (UTC)

Most mainstream media articles are primary sources, too, but that doesn't seem to stop NOTPRICES from recommending them.
Perhaps more relevantly, there are secondary sources that discuss prices among academic publications (not all of which appear in journals; books are the esteemed form factor for some disciplines). It might be embarrassing for Wikipedia's policies to say "No academics, because they're all just primary" and then be shown something like ISBN 9781108476386 (an entire book, published by a university press, on the economic history of trade regulation and its effects the price of bread in the Netherlands) or review articles such as PMID 29169476 (compares the price of two classes of drug treatment and declares one to be a poor value), PMID 30464416 (criticizes the cost-effectiveness of a drug), and PMID 31669499 (says prices have gone down for a class of drugs). If we want secondary source (not just independent ones?), then it should say "secondary" (or independent, or high-quality, or whatever). I don't think it should exclude academic sources just because some of them are primary sources. WhatamIdoing (talk) 01:43, 4 February 2020 (UTC)
Waid, what is it with you and the price of Dutch bread? Craving groninger koek or something? Face-tongue.svgLevivich 02:27, 4 February 2020 (UTC)
Levivich, I think I want something more like Volkorenbrood this morning. Something with seeds on the top so it looks a bit like this, gently toasted with lots of butter. :-D WhatamIdoing (talk) 16:51, 4 February 2020 (UTC)
I think that PMID 29169476 justifies an article on the class of drugs (PCSK9 Inhibitors) noting that their list price in 2017 was more than 100 times the cost of generic statins. But the danger of inserting factoids based on discovering a random article is emphasised by your PMID 31669499 which says that by 2019 they "are now a reasonable or even good value following over 60% reductions in their acquisition price, and the identification of high risk patient groups most likely to benefit". We've seen with the drug prices that they have been inserted automatically to all drug articles, and have not been maintained or even fact-checked by other WP:MED folk for five years. So really we need to encourage editors to research the literature on the relative cost, cost-effectiveness, availability and affordability of a drug or treatment and then write about those aspects to the degree the narrative literature supports such commentary. Not to do OR with drug pill price databases. Because that route leads to what we see on Diazepam where we have for five years wrongly claimed the US price is 40x the international wholesale price. Or Aciclovir where we compare the cost of an unspecified "dose" with the cost of "treatment" and nowhere explain what this is for (it is tablets for shingles, not for cold sore cream). We get that sort of unencyclopaedic mess when editors insert factoids robotically rather than researching the literature on the topic, and judging what should be said, and where, and how.
Assessing the cost-effectiveness of new drugs is routine and with Google and PubMed one can find a paper noting the cost merits of any modern drug. I don't think those papers are sufficient justification to give a price in dollars and cents, or even dollars, and certainly not doing so using OR from a drug database of pill prices to claim a treatment cost. So I don't think that extending NOTPRICES to include academic literature is warranted. NOTPRICES does not prevent us discussing relative cost or discussing affordability of drugs or drug groups or disease treatments using general terms drawn from our sources. And this is all far more encyclopaedic than the routine addition of essentially random-number dated and irrelevant wholesale prices presented as treatment costs. -- Colin°Talk 09:05, 4 February 2020 (UTC)
Colin, How is cost-effectiveness defined in this context? is it in comparison with a specified set of alternative prescriptions or treatments? Something else? Cheers, · · · Peter Southwood (talk): 08:51, 9 February 2020 (UTC)
Peter, I'm not sure exactly what you are looking for. I'm not suggesting editors assess cost-effectiveness according to some definition, and certainly don't want us to tempt readers to compare treatments based on some statistically incompetent wholesale cost figures. I've seen many papers discussing new treatments vs existing ones and most times the new treatments are more expensive (still on patent; no generic) so naturally there will be pressure to consider whether they really are so much more effective or better tolerated to justify that. There's also the extensive work done by bodies like NICE (e.g. Cost-effectiveness analysis) to decide what is first-line or second-line choices, or what expensive life-saving drugs get approved for the NHS. Part of that judgement may include the wealth of a country to afford treatment, and it is likely that adjectives such as "inexpensive" and "affordable" are country-specific. But we could do more to discuss cost (without giving $$.cc figures) in both the drug and the disease (treatment section) articles.
Colin, I wasn't sure myself, which is one of the reasons I was asking. but if with Google and PubMed one can find a paper noting the cost merits of any modern drug, I thought it might have some relevance. What you describe makes sense, and I fully agree that editors generally are not competent to make such analyses, particularly with the database under dicussion. · · · Peter Southwood (talk): 11:51, 9 February 2020 (UTC)
Our example drug Ethosuximide isn't cheap despite being an old drug, but the US and UK still recommend it and can afford it for a relatively rare illness. I assume the developing world can't justify its greater cost over e.g. sodium valproate and therefore it appears to be essentially unavailable. We may not find sources discussing that, though. -- Colin°Talk 10:04, 9 February 2020 (UTC)
  • I see nothing wrong with an RfC which just requests comments; indeed that is their purpose. They do not have to be up or down "support or oppose" exercises. That being said, I agree with the above in that simply following WP:NOPRICES is sufficient, and we don't need any special guidance other than that. If secondary sources extensively discuss (note, that does not mean "often mention") the price of a product, there is a plausible case for inclusion of information about that price in the article. If sources just briefly mention such prices, or especially if one must resort to extrapolating from a simple database or directory entry, leave pricing out entirely. Seraphimblade Talk to me 02:26, 9 February 2020 (UTC)
  • Comment: I commented before that "It seems to me that prices of medications are a[n] important fact about medications." I still feel that way. Flyer22 Frozen (talk) 00:22, 10 February 2020 (UTC)
It's not something I want to debate. My feelings are in that section I linked to. Flyer22 Frozen (talk) 00:25, 10 February 2020 (UTC)

Summary: IMO, all three examples (as well as every example we examined during the formulation of the RFC) violate every policy and guideline listed in this RFC, and the only way to improve these articles is to remove not just these three examples, but all 530 instances of prices similarly inserted by basically one editor into drug articles. WP:NOT is still policy, and until/unless the community overall changes that, these edits should never have happened. In attempting to change policy to accommodate drug prices, I believe we have left behind what Wikipedia is: an encyclopedia and not an experiment or "pilot plan" to further advocacy. The main concern now should be how to go about removing original research from 530 articles.

In more than two months of discussion, no evidence has surfaced of broad support for a change to What Wikipedia is not. This is evidenced by the very small number of editors inserting, and reinforcing, these edits, along with no discussion during the five years previous that resulted in consensus to add prices. My main other concern is that this five-year-long pursuit has become disruptive. I believe a moratorium should be called on drug price advocacy, editing, attempts to change policy or MEDMOS, and that it would be useful for medical editors to turn their focus back towards improving encyclopedic content on articles. The amount of time we have spent on this RFC, to realize that there is a small handful of editors backing this "pilot" is Not Why We Are Here.

I advocated throughout the discussions that we should include examples from all three databases, as they all have the same issues, so we would not have to continue to revisit this problem. It will be disruptive to conduct even more time-consuming RFCs about prices specific to drugs or the medicine manual of style. Further issues should be raised at the talk page of WP:NOT for broader discussion; the only thing MEDMOS needs to decide is what suggested sections should be named (eg, Economics or pricing), and for that, we need not look at any more of these original research examples from databases; we have plenty of policy-compliant examples of valid drug pricing issues, eg insulin, EpiPen, and so on. SandyGeorgia (Talk) 17:49, 23 February 2020 (UTC)

I think we have a small number of editors who are determined to see explicit dollars and cents drug prices routinely in our articles for advocacy purposes. This seems driven by North American concerns about price transparency, a problem apparently resolved by Wikipedia including a dollar symbol followed by random numbers in the lead of drug articles. These advocates have been unable to explain how to achieve their goals while still following core policy. They are unable to agree on what kind of cost to include, so want all of them, as though offering more random numbers increases the knowledge we offer rather than decreasing it.

My recommendation is

  • WP:MEDRS should, like it does for primary research papers, forbid the use of price databases of drug products as sources to make claims about drug prices or treatment costs in articles. This will necessitate the removal of prices from the lead in about 530 articles. However, like EllenCT, WAID and Sandy have commented, hopefully we can then move beyond this fetish with including dollars and cents, and onto researching encyclopaedicly interesting facts about relative costs of treatments, affordability and availability issues in developing countries, and examples of where extreme cost limits use even in developed nations.
  • I don't think WP:MEDMOS need say anything, per SMcCandlish, as the concerns are no different to our WP:LEAD and WP:WEIGHT and WP:NOPRICES P&G already cover. As a community of editors, we already know when prices are exceptionally notable, how to summarise secondary sources in the article body, and how to summarise this (if appropriate) in the lead. -- Colin°Talk 18:24, 23 February 2020 (UTC)

A core of agreement?[edit]

Sorry to start a new thread so late. Given the diversity of reasons given against including prices, I think a simple hypothetical may help delineate how much of the opposition is based on issues that are, in principle, surmountable (eg problems with the way prices are currently being included, deficiencies of the current sources), and how much is fundamental or philosophical (eg concerns about WP:NOTPRICES, WP:DUE, WP:INDISCRIMINATE). Suppose a new source emerged that we agreed was reliable, like a report from WHO, or a book by a respected authority on global health. This source has a line like the following in a table or appendix about a few dozen drugs, without further discussion:

Where available, Drug X retails for ~US$100–200 per treatment course in Africa, making it cost-prohibitive for most patients. Europeans can generally afford it, while in Australia public subsidy sets the retail price to $15 per treatment course, affordable to most Australians.

It's already clear that many contributors would support including this information in the article about Drug X (as would I), but I'm interested in whether such a source would assuage the concerns of Colin, Sandy, SMcCandlish, Nabla, Seraphimblade, Clayoquot, S_Marshall and others. Adrian J. Hunter(talkcontribs) 03:33, 26 February 2020 (UTC)

When/If we ever had a source like that, we could write cited text that complies with all policies. Whether it would belong in the lead would be a WEIGHT question. SandyGeorgia (Talk) 04:09, 26 February 2020 (UTC)
I would be OK with that. This passage would make sense only for drugs for which speaking of "a treatment course" makes sense, e.g. not for drugs like painkillers that are used for highly variable lengths of time and highly variable doses. Presumably, reliable sources would only have a passage like this when it does make sense :) Clayoquot (talk | contribs) 05:06, 26 February 2020 (UTC)
I think there is a danger of examining hypothetical sources. Previous discussions on drug prices made big promises about great sources being available and it turns out they aren't great and folk have had five years to locate better ones, without success. Your example text is not likely to ever be written for three reasons:
  • Affordability studies I have seen do not use USD to express local cost: the relationship between USD and local currency and local earnings is too variable for that to be meaningful (and dates quickly). Some studies split "developing nations" into several tiers from the lowest to the middle income countries, in order to best understand local price in comparison to a reference price in USD, so it is not a trivial undertaking. The WHO/HAI studies take the price in local currency and the wages in local currency and work out how many days wages of the lowest-paid government employee (i.e. minimum wage) it takes to buy one month's medicine. A suggested cut-off for affordability is one day's wages. I don't think we'd get any high-quality source claiming a USD price for "Africa" -- there are lots of countries in Africa and they are at different levels of economic development/income. We are more likely to see such studies giving "days wages" as a "cost" for drugs.
  • Europe is also many countries, with many systems for paying for medicines. What is affordable in Denmark may not be so in Greece or Spain.
  • The Australian example sounds a bit like England where your course of antibiotics would be £9 regardless of the actual cost of the tablets, though certain groups of people are exempt (pregnant women, people with epilepsy or cancer, etc), and in other countries of the UK, prescriptions are free for everyone. And if you need something while staying in hospital it is also free. That would not only be tedious to explain all the time, but doesn't change for most medicines: the cost of prescription medicines is the same for all such medicines, so why write that in every drug article?
The main reason we don't have sources giving a medicine One Price is because reality is more complicated than that. It isn't just that ideal sources haven't been found or might appear next year, it is that Diazepam really does not have one cost per dose, or per treatment (whatever that means). Even an antibiotic can have different treatment costs for paediatric or adult, and the IV formulation you get in intensive care in hospital. I really do think we need to stop jumping from "I want to talk about cost" to "I need a dollar symbol and some decimal digits". It is quite possible to talk about treatment having a high cost, low cost vs another treatment, being affordable or generally affordable in a given country, without $nnn.
We all agree for example that insulin's high price in the US is notable. Have a read of this BBC article "The human cost of insulin in America". Working out the cost in the US is immensely complicated: there isn't even "one insulin" never mind "one price". In summary, the issues are not surmountable: our sources reflect the huge complexity of drug prices and the simplification desired does not routinely exist. -- Colin°Talk 09:08, 26 February 2020 (UTC)
  • I would still not want to include any actual numbers as "the price" based upon that. However, if a reliable source discusses affordability by region, so can the article. Seraphimblade Talk to me 18:32, 26 February 2020 (UTC)

Pyrimethamine is an example where pricing information is available and due (maybe not due as much as given though). --Hipal/Ronz (talk) 19:46, 27 February 2020 (UTC)

Africa[edit]

Just to give an idea of how a $ price might relate to affordability in Africa:

  • Egypt. The lowest paid unskilled government worker earns 40 Egyptians Pounds or USD $5.80 per day in 2013. This is also the official minimum wage and was raised to 66 Egyptians Pounds last year. Healthcare insurance with free prescription covers about 60% of population, but quality of public health service and low availability means the private sector is often used instead, and there is a strong tendency to buy overpriced branded prescriptions vs cheaper generics.
  • Kenya. The lowest paid unskilled Kenya Government worker earned Kenya shillings 166.167 (USD 2.045) a day. 58% of the Kenyan population lives on less than USD 2.00 per day. "Some essential medicines are unaffordable to the lowest-wage Kenya government workers and by extension more than half of the population"
  • Ghana. The lowest paid government worker earns only about one US dollar per day and 45% of the population live on less than one US dollar per day. "the study showed that there was no discernable relationship between the prices paid by patients and the procurement prices in the Public and Mission sectors" "low prices obtained by Public and Mission sector procurement were essentially not passed on to patients" "many of the short term treatments (eg for acute diseases) would be difficult to afford for many Ghanaians" "treatments for chronic conditions were also revealed to be simply unaffordable for the average Ghanaian" "the final price of many medicines are relatively much higher, and less affordable, in Ghana than in other countries" "many families will suffer financial catastrophes when disease strikes"
  • Ethiopia. The lowest paid government worker earns Birr 6.70 or US$ 0.80 per day. Around 44 % and 81 % of the Ethiopian population earn less than US$ 1 and US$ 2 per day, respectively. "Overall availability of medicines in the public health facilities and SP/ERCS retail outlets was very low. Consequently, patients are forced to purchase drugs at higher prices in private pharmacies or go to informal sector or forgo treatment." The "cost of treatment of diseases is unaffordable to the majority of the Ethiopian people." and this is due to very low income despite relatively low cost.

In developed nations, we might think someone on minimum Government wage represented the poorest in our society, whereas for many African countries, those workers are richer than the majority. Public health is sometimes free and and sometimes not but generally provides poor service and private sector is very expensive. Clearly the Egyptian earning $5.80 can afford more than the Ethiopian earning $0.80, though the prices are a bit cheaper in Ethiopia and the Egyptian might buy a branded medicine rather than cheap generic. As I noted elsewhere, affordability depends on where you live, and is more of a political/economic factor than something specific to one drug vs another drug. Many Africans cannot afford any of these "essential" medicines. -- Colin°Talk 11:03, 26 February 2020 (UTC)

Notices[edit]

As of RfC launch Wugapodes has agreed to act as a closer. Depending on the nature of the conversation it might or might not make sense to do a three editor panel. Best, Barkeep49 (talk) 23:02, 23 January 2020 (UTC)

It looks like Ymblanter should also be available as a closer, based on their most recent comment at AN. Advertising the discussion early at ANRFC might help with finding additional closers as well. Sunrise (talk) 00:49, 25 January 2020 (UTC)
I had missed that. Thanks. Best, Barkeep49 (talk) 01:15, 25 January 2020 (UTC)
So far, I only volunteered to close this RfC. This might or might not make me involved, but I am not yet prepared to make statements now on the RfC at which talk page we are now in.--Ymblanter (talk) 07:52, 25 January 2020 (UTC)
My mistake, I hadn't realized your comment was about the other RfC. Sunrise (talk) 12:34, 25 January 2020 (UTC)
No problem. Let us do it step by step. First I need to close that one.--Ymblanter (talk) 18:07, 25 January 2020 (UTC)
Now I closed that one, and I do not feel myself involved in the topic, so I can be a closer of this one. However, if there are objections (if users feel that I am involved) I will obviously recuse. I still have no interest in the topic, and I have not read this RfC.--Ymblanter (talk) 19:36, 28 January 2020 (UTC)
No problem here (other than feeling bad that you had to close that mess). SandyGeorgia (Talk) 19:37, 28 January 2020 (UTC)
IMO none of the admin who have helped here in an admin capacity (BK, Ros, Wug, Ymb, sorry if I'm forgetting anyone) are involved, and thanks to all of you for chipping in. Levivich 17:24, 29 January 2020 (UTC)
Agree and thanks. -- Colin°Talk 17:32, 29 January 2020 (UTC)

References[edit]