Wikipedia talk:WikiProject Medicine: Difference between revisions

Not quite sure where to bring this up, but there are several articles on suicide methods that make me really uncomfortable and I think they're arguably illegal. Not sure if the best way to handle it was to view them as medical articles and keep an eye that they're not making biomedical claims without proper sourcing or if there's some other legal avenue to pursue. They're really good using a tone that sounds unbiased, like it's an objective discussion on the ethics of suicide, but they're really just pro-suicide sites and they're really dangerous. These people like to tag anything about suicide prevention as lacking NPOV or as demonstrating a "American" perspective. Reddit and other social media sites don't allow content or even links to websites that explicitly tell people how to comment suicide. Since they can't link to these articles, people will tell each other "Google suicide bag and read the wikipedia article." I would think if this content is illegal enough for reddit, it shouldn't be on wikipedia.

I think it could be argued that some of these are encouraging suicide. The suicide bag article is about exactly how to make your own suicide bag, including a diagram, with easily accessible items. The hardest thing to get would be helium or a propane-butane mixture and the rest are household items. Then look at what links there, literally any article about bags (purses, backpacks, etc.) links to suicide bag. Suicide methods is exactly what it sounds like and this is what links there: Teenage suicide in the United States, suicide prevention. Basically any article about suicide links to an article that tells you specifically how to kill yourself. Lots of them have a handy dandy suicide infoboxes that link to suicide methods. alt.suicide.holiday is an article on former usenet group that is clearly just a pro-suicide article.

This 2012 study showed that pro-suicide content on social media can increase the risk of completed suicide because it normalizes and glorifies the act and provides people with access to information about lethal methods. It specifically mentions methods using gas. This 2015 study discusses an increase in helium-related suicide deaths as a direct result of discussion about it in online forums. There have been stories in the news over the years about people who have been convicted for encouraging suicide on internet forums. Here's one from 2010 about a woman who was convicted for encouraging suicide online. What do other people think? PermStrump(talk) 14:35, 8 April 2016 (UTC)[reply]

insofar as the article suicide bag it seems well referenced--Ozzie10aaaa (talk) 17:42, 8 April 2016 (UTC)[reply]

This might be a good topic to take to the WP:VILLAGEPUMP. Obviously Wikipedia is not censored in so far as the content is not illegal in the United States (i.e. libel and child pornography). The dividing line is not always clear though I would think in this case the line is the difference between is and ought. Sizeofint (talk) 07:29, 9 April 2016 (UTC)[reply]

The article's subject itself is notable and therefore is worthy of an entry in Wikipedia. However I am concerned that Wikipedia and/or the editors of the article might be construed as assisting suicide, especially if a high-profile case is reported in the media (e.g. "Robin learnt suicide technique from Wikipedia"). This article requires a formal legal assessment. Axl ¤ [Talk] 10:27, 12 April 2016 (UTC)[reply]

I don't know about legal assessment. I reviewed it and I think it is stays on this side of WP:NOTHOWTO. I noticed that for a while it had a suicide hotline hatnote, like this. It was taken off pursuant to this RfC at the Suicide article. Jytdog (talk) 11:15, 12 April 2016 (UTC)[reply]

Sizeofint, Did you mean the idea lab or the main village pump? I'm trying to put together a more cohesive argument so it does sound like I'm just trying to censor wikipedia. Jytdog, that's a good point about NOTHOWTO. Something definitely didn't feel encyclopedic about it to me, but I couldn't put my finger on it and I think you hit the nail on the head. I don't know if it's a coincidence or someone who read this thread, but for the past 2 days an IP editor has repeatedly removed the diagram from the Suicide bag article on the grounds that it's OR. It's a bit of a slow motion edit war. I think they each have 2 reverts now, but there have been a few hours in between each one. I wonder how long it will go on. I never would have considered arguing that an image was OR, but I think the IP has a good point. I'm not getting involved yet though, because I'd rather focus my energy on trying make a policy that specifically addresses this topic. If that fails, my back up will be NOTHOWTO for the majority of the text and OR for the image. Axl, that's also my concern (that it could be construed as assisting suicide) plus that it likely is assisting suicide based on the 2015 study that I linked above. PermStrump(talk) 18:24, 12 April 2016 (UTC)[reply]

I was talking about gaining wider input from the community at the village pump. Sizeofint (talk) 20:37, 12 April 2016 (UTC)[reply]

we have disclaimers all over the place; i see the concern about bad press but the disclaimers are WMF and as I understand it they are solid. And Permastrump what i wrote was I think we are OK per WP:NOTHOWTO. There are a few places it could be tweaked but generally it is good. There aren't actually instructions there. Jytdog (talk) 18:36, 12 April 2016 (UTC)[reply]

Hi all. I've been talking to medical doctors, researchers, and major suicide awareness charities about this article, and some others, for the past two years, with full in-person meetings every few months. Their view is that not only is Wikipedia classed as a "pro-suicide" website in terms of the information it provides, but that the occasional spikes in attention that come to these articles are probably reflected in real-life suicide attempts. They are particularly concerned about the diagram: their research indicates that the existence of the diagram does cause suicides and attempts at suicides that would otherwise not happen. We've been a bit stuck on how to move forward with this on Wikipedia, though - a big discussion about it could work both ways. Chase me ladies, I'm the Cavalry (Message me) 14:28, 14 April 2016 (UTC)[reply]

Can you tell us what standards they use to decide whether an information source is "pro-suicide"? WhatamIdoing (talk) 04:14, 15 April 2016 (UTC)[reply]

I don't know how many people are researching this so I kind of wonder if I'm about to quote any of the people Chase me ladies, I'm the Cavalry has been talking to, but here's how Collings and Niederkrotenthaler (2012), and Kemp et al. (2011) define prosuicide websites... Sites that:

• have detailed suicide instructions or descriptions of suicide methods
• advocate suicide or describe suicide methods in detail
• are permissive or encouraging of suicidal behaviors
• promote or enable suicide by describing suicide methods.

Both papers put prosuicides sites in direct contrast with "suicide prevention, and suicide support" sites that offer resources, psychological, social, or practical support to reduce suicidal behaviors. Collings and Niederkrotenthaler said, "many websites [have] life-promoting characteristics (such as the opportunity to contact a support service) and potentially suicide-promoting characteristics (such as detailed descriptions of suicide methods) have been found to be closely intertwined" This is definitely true on reddit where they like to call themselves "pro-choice" and claim to be places for "discussion about the moral, ethical, and religious implications about the right to choose the time of your own death." But they all contain links that tell you ways to kill yourself. They are NOT "pro-choice" or "suicide neutral" as they claim. Same with the Wikipedia article that sounds "NPOV." It's really just a prosuicide site that normalizes, glamorizes and encourages suicide attempts in individuals who are already high-risk. This is all supported by the studies I've linked, especially Gunnell et al. (2015). PermStrump(talk) 06:27, 15 April 2016 (UTC)[reply]

Permstrump I hear and understand your passion on this, but it seems that you want WP to take a moral stance. Have a look at Abortion. Is that a "pro-abortion" article because it doesn't have hotline information for counseling? (real question for you). I could see someone arguing that.

I also want to note that we have a whole article on Suicide methods and a Template:Suicide_sidebar. There has been some of this kind of discussion at both talk pages over the years (!) as well as Talk:Suicide and they get shot down each time. Jytdog (talk) 06:54, 15 April 2016 (UTC)[reply]

Jytdog, this isn't a moral stance, if I'm honest. The article on abortion does not tell people how to perform an abortion (especially not with at-home methods) - instead it talks about the procedure from a medical/scientific standpoint. Secondly, I would argue that our general goal - "a world in which every single person on the planet is given free access to the sum of all human knowledge" - means that we shouldn't be promoting suicide methods in the way we currently are. Moral issues aside, (and this may seem quite cold, but) if vulnerable people use the information on our site to end their lives unnecessarily, then we're not adding the the world's knowledge - we're working to reduce it. Chase me ladies, I'm the Cavalry (Message me) 14:20, 15 April 2016 (UTC)[reply]

WhatamIdoing, to answer your question: I don't know the specifics, but two key points came through: first, that Wikipedia articles are often a "how-to" guide rather than a sensible, neutral analysis, and secondly that the vast majority of people who are looking for suicide methods online turn to Wikipedia as a source.

Jytdog: Re: the abortion article, is there notable documentation in peer reviewed sources that say Wikipedia.specifically. is contributing to a public health issue by facilitating people to follow through with abortions that are illegal in their jurisdiction by normalizing, glamorizing, promoting, and providing access to the means for performing self-abortions at home (normalizing them by discussing them at length without balance from opposing viewpoints and linking to list articles and websites about regular people who have had abortions with a focus on how quick and painless their abortions were; glamorizing them by listing all of the celebrities who had abortions and the exact methods they used; promoting them by inserting pro-abortion infoboxes in every article someone on the fence might visit, and links at the bottom of completely unrelated articles to articles detailing abortion methods; and providing the means by detailing all of the information someone would need (including illustrated diagrams) to perform a "quick and painless" self-abortion at home without a medical provider using easy to access household items)? Because if that were the case, then yeah, I'd say we should definitely rethink what we're doing with our abortion articles. Because that's exactly what the suicide articles do and that's exactly what scholars have directly connected to spikes in actual suicides that correspond with spikes in page views of wikipedia articles on that method following major news reports on noteworthy people committing suicide. Gunnell et al. (2015) use Robin Williams's suicide as a very disturbing example. He did not actually use asphyxiation, but for 1 hour the suicide bag article said he did and the visits to that page increased astronomically, as did suicides completed by asphyxiation with gas. Look at Suicide_bag - what links there, literally any article about bags (purses, backpacks, etc.) links to suicide bag. PermStrump(talk) 15:33, 15 April 2016 (UTC)[reply]

That was a navigation template at work, I've changed it pending discussion. Certainly wp:NOTHOWTO, but the topic is clearly notable. It is also very current event driven. The Canadian parliament is (unwillingly) grappling with medically assisted suicide issues at present, as no doubt are others. The hard part will be finding NPOV sources without legitimizing self help approaches. LeadSongDog come howl! 18:17, 15 April 2016 (UTC)[reply]

I haven't spent much time thinking about medically assisted suicide, but I do sometimes wonder why even a few people bother with it. In comparison to the unregulated "homemade" methods – which are often so simple that even a brief explanation is "detailing all the information someone would need" – it seems like a lot of work for no benefit, except maybe the emotional comfort of having your decision "approved" by some medical or government authority (think "certified proof for my loved ones that I'm not mentally ill").

I'm not sure that every single article about suicide should have a "right to respond" section. If an article is about a particular method, then it makes sense for the information to be restricted to that particular method. For example, in the suicide bag article, editors could reasonably include information about, say, the ethics of this choice vs others (e.g., it's probably more ethical than jumping off a bridge and thereby triggering a search and rescue mission that could endanger emergency response workers). But I don't see room in an article like that for something on the ethics of committing suicide at all; it's off-topic. WhatamIdoing (talk) 03:29, 16 April 2016 (UTC)[reply]

Some of the sources I've linked above talk specifically about the suicide bag and ethics of suicide, so it wouldn't be off topic. I have it on my to-do list. I'm not really concerned about medically assisted suicide for people with terminal illnesses. The problem is that that's not who these prosuicide sites are usually aimed at/who they hurt. PermStrump(talk) 10:42, 16 April 2016 (UTC)[reply]

Oh dear, this issue again. Suicide bags exist. They have for decades. As an encyclopedia, WP covers them. The article describes them, what they look like, their history, what people have said about them, etc. There are no step by step instructions (such instructions are readily available elsewhere [1] [2] [3] etc etc). As for the panic about increasing numbers of people using this method, it should also be noted that total numbers of suicides have not risen (indeed, suicide rates are stable or falling in most countries)

The fact that a slightly increasing percentage of suicides (the numbers are tiny) are choosing this method (for euthanasia as well as suicide) is to be expected, since it is painless, non-toxic, aesthetically acceptable and easily obtained (until recently), compared, for instance, to carbon monoxide poisoning, hanging and other brutal and distressing methods (some of which are also extremely dangerous to bystanders and medical response personnel, e.g. CO poisoning). Those who would bury the suicide bag article probably have good motives (nobody wants to see depressed youngsters making this error), and are not on a religiously-motivated campaign, but the outcome, if we suppress it, is unlikely to be good. People who are absolutely determined to kill themselves will find a way, and that way will generally be much more distressing and dangerous for all concerned. In addition, helium canisters these days are "cut" with 20% oxygen (due to a global shortage of helium) [4], so the method does not work for many who try it. To make it effective, you have to get argon or nitrogen, and these are simply NOT casually available. Buying these gasses is not something most people are equipped to do. Ratel (talk) 21:50, 17 April 2016 (UTC)[reply]

From [5]:

Without balloon helium tanks, potential suicides have to order very large canisters from gas suppliers. They are heavy, come delivered by a truck, and are expensive. This whole topic is becoming moot ... Ratel (talk) 22:22, 17 April 2016 (UTC)[reply]

Interesting. Diluting 99.x% helium with 20% air will give a hypoxic mixture (roughly 4% oxygen), which should be quite effective at asphyxiating a human at normal atmospheric pressure. However, I was under the impression that balloon helium has 20% oxygen added, specifically to avoid accidents with people breathing it from balloons to produce squeaky voice effects. Maybe this varies between countries. • • • Peter (Southwood) ^(talk): 09:44, 20 April 2016 (UTC)[reply]

resonant frequencies are many times higher in a human vocal tract that has helium in contrast to one that just has "air"--Ozzie10aaaa (talk) 10:41, 30 April 2016 (UTC)[reply]

Suicide bags result in quick and painless death — MEDRS or not?

Discussion currently ongoing at: Talk:Suicide_bag#Removed_swaths_of_original_research_and_primary_sourced

• Should we allow primary sources?
• Should we allow images without references on controversial issues?
• Are case reports WP:DUE?

Please comment. Carl Fredik 💌 📧 21:30, 9 May 2016 (UTC) [reply]

Who is this "We" you refer to, and where do they get the authority to make this decision? • • • Peter (Southwood) ^(talk): 13:45, 10 May 2016 (UTC)[reply]

• 'Please note, the suicide bag article is right now undergoing what appears to be a concerted tag team attack to destroy the content. Is this what wikipedia is coming to, a censored portal? All editors need to examine their consciences here, and decide if we are going to reflect what's going on in the world, or play a more paternalistic role. Ratel (talk) 22:19, 9 May 2016 (UTC)[reply]

Having multiple editors disagree with your position is not the same as a tag team. Carl Fredik 💌 📧 22:50, 9 May 2016 (UTC) [reply]

A sudden, concerted mass deletion of material, by several editors, on a longstanding article, is most definitely a tag team effort. Ratel (talk) 06:26, 10 May 2016 (UTC)[reply]

Actually you need to read WP:TAGTEAM and be careful about levelling false accusations of it because it's not WP:CIVIL and can lead to you being sanctioned. If you have grounds for your accusation you need to take them to WP:AN/I. Alexbrn (talk) 12:23, 10 May 2016 (UTC)[reply]

How else explain an article (that has been more or less ignored for years) getting 3 or 4 new editors, all with the same agenda (mass removal of text to the point of aggressive edit-warring), in the space of a week? If it looks like a duck, walks like a duck etc. But I may be wrong. Incredible coincidences can happen, perhaps this is just a chance occurrence. Ratel (talk) 12:38, 10 May 2016 (UTC)[reply]

Take it to WP:AN/I then, with your evidence. Here is not the place. It is very common for poor articles build with a spurious WP:LOCALCON to get heavily edited when they receive fresh eyes and a widened consensus, for example as a result of their being raised at a Noticeboard. Alexbrn (talk) 12:43, 10 May 2016 (UTC)[reply]

Real life precludes ANI action. But I'd welcome an admin freezing the article as it was so that all the reverting can stop and things can get sorted on Talk Ratel (talk) 12:56, 10 May 2016 (UTC)[reply]

As an uninvolved editor with a small amount of experience in editing medical articles related to diving, the editing interventions based on claimed biomedical information do seem rather over the top.• • • Peter (Southwood) ^(talk): 13:37, 10 May 2016 (UTC)[reply]

Diving and suicide methods have quite different implications do they not? Controversy dictates how important it is to adhere to quality sources, this is a principles of WP:RS. Carl Fredik 💌 📧 14:44, 10 May 2016 (UTC)[reply]

Not really. Divers accidentally die through the same biological mechanisms that kill the users of suicide bags. The fact that one death makes some people more queasy than the other doesn't really change the biomedical facts about what happens if you get your Nitrogen/Oxygen balance wrong (or Helium/Oxygen, for really deep dives). They both need good-enough sources, and neither absolutely requires gold-plated-only sources. "Controversial" only applies to BLPs. What you're probably thinking of is the "extraordinary claims" idea, and the biochemistry here isn't the least bit extraordinary. WhatamIdoing (talk) 02:51, 11 May 2016 (UTC)[reply]

As far as I can tell, no-one on Wikipedia is prescribing suicide bags as a medical intervention, or claiming that this would be an acceptable medical practice. Therefore why should the article on suicide bags be considered within the scope of MEDRS? A more appropriate standard for reliability should be applied to the sources used.• • • Peter (Southwood) ^(talk): 07:51, 11 May 2016 (UTC)[reply]

• we need more opinions at Talk:Suicide_bag--Ozzie10aaaa (talk) 18:08, 10 May 2016 (UTC)[reply]

It is well-known that breathing a severely oxygen-deficient atmosphere (4 to 6%) results in unconsciousness after a few breaths, and that the exposed person has no warning and cannot sense that the oxygen level is too low (http://www.csb.gov/assets/1/19/SB-Nitrogen-6-11-031.pdf). No warning would imply no pain, but I don't expect to find peer reviewed studies or Cochrane reviews confirming or disproving that assumption.

Maybe it's time to clearly define the limits of MEDRS, and ban "off-label use". Prevalence 21:32, 10 May 2016 (UTC)[reply]

Changing MEDRS won't stop POV pushing.

Speaking of which: I suspect that part of the public health concern about this uncommon method stems from the population that chooses it, and I wonder whether that's addressed. It's not the method of choice by sympathetic old cancer patients; instead, it's largely used by men with traditional risk factors for suicide (e.g., impulsive, young, white, recreational drug users). So I'm wondering whether there is real-world POV pushing at play here, too: parts of society have decided that this is a 'bad suicide' (a young person acting independently, if probably stupidly) rather than a 'good suicide' (a terminally ill elderly person ending up equally dead, but with the explicit blessing of a government bureaucracy and the medical establishment). Because, you know, if you truly wanted to stop suicides, you'd stop worrying about this method, and this article, and instead make it illegal for my local (American) pharmacy to sell an unlimited number of bottles containing 375 extra-strength pills of liver failure each to any kid who can use a credit card. WhatamIdoing (talk) 02:54, 11 May 2016 (UTC)[reply]

Changing (or more precisely, specifying the limits of) MEDRS will not stop POV pushing, but it would make using MEDRS as an excuse/ weapon by the POV pushers easier to refute/dismiss, hence a good thing. • • • Peter (Southwood) ^(talk): 07:37, 11 May 2016 (UTC)[reply]

I agree, of course, but I don't think that we'll get there until WP:MEDDUE exists. People cite MEDRS because it's a good hammer, even when the tool they really need is a screwdriver. WhatamIdoing (talk) 13:23, 12 May 2016 (UTC)[reply]

I surprised there seems little pushback at this article to what seems very dubious proposals. The latest is to source a description of how "peaceful" death-by-helium is, to eyewitness accounts. Alexbrn (talk) 12:54, 12 May 2016 (UTC)[reply]

Perceived peacefulness is not WP:Biomedical information. Therefore, plain WP:IRS guidelines apply, and that guideline probably requires nothing more than a newspaper article and WP:INTEXT attribution. WhatamIdoing (talk) 13:23, 12 May 2016 (UTC)[reply]

How the human body reacts physically to a substance / the nature of the death that subsequently occurs is biomedical information. The proposed source is the book Final Exit. Alexbrn (talk) 13:56, 12 May 2016 (UTC)[reply]

"Causes myoclonus" is biomedical information. "Seemed subjectively peaceful to bystanders" is not. WhatamIdoing (talk) 14:09, 12 May 2016 (UTC)[reply]

Possibly, but that's not the proposed wording and not the intended meaning of the edit, which is justified by the proposer thus: "We have ample evidence from numerous sources that this is a quick and easy way to die, and deleting that simple fact from the page by impugning the source is POV". The "evidence" being proposed for this "simple fact" is somebody saying "When I witnessed the helium death of a friend of mine it could not have been more peaceful". This seems to be way worse than using a well-published case report even: it falls off the bottom of WP:MEDASSESS. Alexbrn (talk) 15:52, 12 May 2016 (UTC)[reply]

Um no. That was not the evidence proposed, that was merely an example. There are different sources for the fact that the death is quick and peaceful. You can also go to the WP article Inert gas asphyxiation for data such as

According to the U.S. Chemical Safety and Hazard Investigation Board, in humans, "breathing an oxygen deficient atmosphere can have serious and immediate effects, including unconsciousness after only one or two breaths. The exposed person has no warning and cannot sense that the oxygen level is too low."

and

suddenly breathing pure inert gas causes oxygen levels in the blood to fall precipitously, and may lead to unconsciousness in only a few breaths, with no symptoms at all

And of course Ogden's studies draw on a large number of eyewitness accounts. And backing this up, autopsy does usually not show any notable findings, (lots of RS for this) suggesting an absence of unconscious death struggle. Ratel (talk) 22:29, 12 May 2016 (UTC)[reply]

The CSB.gov source that Ratel and Prevalence are referring to has nothing to do with suicide bags. It’s about accidental, gradual exposure to nitrogen in the workplace in a contained environment like a small room. I’m going to quote few sources that talk about death by nitrogen asphyxiation to illustrate how irrelevant the CSB source is. But I want to clarify something first... There are 2 different statements by 2 separate people about the physical reaction (or lack there of) to the inhalation of inert gas using a suicide bag. One is a primary source in a low-impact, peer-reviewed journal written by Ogden, a right-to-die advocate and criminologist, that talks about how quick, painless and peaceful death is with helium and a suicide bag. The other statement is from a self-published newsletter written by Nitschke in which Nitschke says that helium has a risk of adverse effects, but nitrogen is much better in comparison. I’m NOT suggesting that the sources quoted below that talk about nitrogen should be used in the article since they’re about nitrogen asphyxiation using masks or in a contained environment in the workplace, not suicide bags.

1) This CNN article from 2015 is about Oklahoma looking for humane alternatives if the Supreme Court ruled that lethal injections were inhumane: While the Supreme Court case was pending, Gov. Mary Fallin signed a bill that would allow the state to perform executions with nitrogen gas if lethal injection is ruled unconstitutional or becomes unavailable. While the medical community has voiced concerns about the method, at least one group thinks the Sooner State might be onto something. Philip Nitschke, director of the right-to-die group Exit International, said the increasing difficulty in obtaining pentobarbital has prompted him to consider gas as an alternative...”

Perfect illustration of how Nitschke doesn't represent the mainstream, medical view. By the way, Nitschke already sells suicide kits with pure nitrogen for $690, so I wonder if that has anything to do with why he claims there are zero adverse effects compared helium, the product gas of choice promoted by his right-to-die competitors, who have essentially rejected Nitschke and his methods. Not to mention the Medical Board of Australia suspended his medical registration, to which Nitschke replied, ‘Oh yeah? Well I was going to break up with you first. So there.’

2) This Time article is about the same debate in OK: Changing the context could prove problematic. Administrating the gas within a prison is much different than the instances in which pilots and divers have slowly and accidentally experienced a lack of oxygen. Dr. Michael Weiden, a pulmonary expert at NYU School of Medicine, says that while nitrogen could be administered without medical professionals, using it for capital punishment could create an ironic consequence: the need for sedation… somebody who thinks that an individual who’s asphyxiating will not freak out without sedation is foolish.”

3) This peer-reviewed case study (PMID 23899346) from 2015 about a suicide by nitrogen asphyxiation with a scuba mask, says, “Deliberate nitrogen asphyxiation is also viewed by some as a more humane way to end human life. Nevertheless, execution by nitrogen asphyxiation is not used by any nation in the world.”

In 2010, Ogden had a case study (PMID 20211999) published in a low-impact, peer-reviewed journal^[1] where he talks about 4 assisted-suicides he observed that involved helium asphyxiation using face masks. This is the primary source cited to support the claims that suicide with helium and a suicide bag is quick and painless.^[2]

4) In contrast, this peer-reviewed study from 2013, which is unlisted by PMID (see WP:PARITY), says that one of the two cases they studied had "bilateral eyelid petechiae and large amounts of gastric content in the airways. These findings challenge the assumption that death by this method is painless and without air hunger, as asserted in Final Exit." They also found that the time to death varied from 5-10 minutes to up to 40 minutes.

This is exact situation is why WP:MEDRS exists! I shouldn’t need to create an argument for using MEDRS from scratch just for this specific article. PermStrump(talk) 03:58, 13 May 2016 (UTC)[reply]

• Permstrump, you're confused by the fact that there are several ways to die from inert gas exposure, some much more efficacious than others. If you'd read Final Exit and The Peaceful Pill Handbook you'd know that there are very specific instructions to follow for using a suicide bag. Those instructions are not on WP because of WP:NOTHOWTO. The chapter from the latter book on how to use the suicide bag correctly runs to ~50 pages of instructions and videos, about all manner of aspects that must be done correctly. But in summary of the basic process, one has to put a completely flattened bag at the top of the head above the ears with collar loosely on head, turn on nitrogen to fill the bag like a tent with pure nitrogen/inert gas (takes ~2 minutes) and wait till nitrogen is escaping from the bottom of the bag, take rapid deep breaths (hyperventilate), then exhale completely (expel all air from lungs), then lower bag over head and take a deep breath, with cord and toggle snug against neck. This is a very precise sequence of events; if it is not done right, if there is insufficient nitrogen flow, or if the bag is not fully compressed and empty of air when the process begins, then failure to die quickly and peacefully can ensue, and this would be why we see some (a few) autopsies that show petechiae and aspiration of vomitus. If there is still air in the bag, that can delay the onset of unconsciousness and death. As Ogden says, "done correctly" the method is just about foolproof. I'd hazard a guess that most people who get a bag and a canister of helium don't know what to do, and there is a real chance they'll fuck it up. Sorry to have to be brutally specific, but these are the facts. Now perhaps you can think of a way to incorporate this information into the article as a warning? Ratel (talk) 04:25, 13 May 2016 (UTC)[reply]

• Ratel, no, I cannot think of a way to incorporate that into the article without original research or synthesizing multiple sources. That's one of several reasons why the current version isn't WP:NPOV. There are virtually no actual experts in the field who share the same view and had their work on the topic published in a solidly reliable, independent source that we could cite in lieu of Nitschke and Ogden's weak sources. There aren't even enough other people giving it the consideration to publish statements contesting their claims, making it next to impossible to appropriately contextualize. WP:FRIND says, "Points that are not discussed in independent sources should not be given any space in articles. Independent sources are also necessary to determine the relationship of a fringe theory to mainstream scholarly discourse." The current wording, despite attribution, still sounds like there's general consensus in the medical field that these 2 methods are quick and painless and all you need is a plastic bag and inert gas. Even if we take for granted that their statements are true (which in my opinion is dubious given the sources in my previous comment), even then their statements would only be true if the method is used properly, which the article technically says, but doesn't adequately emphasize, and likely can't without SYNTH due to the dearth of coverage on the topic outside of a small, radical group. PermStrump(talk) 05:43, 13 May 2016 (UTC)[reply]

@Ratel: I also think you should strikeout/delete the extraneous details from your last comment unless you're deliberately trying to scare other editors away from contributing to this discussion/article. I didn't need to understand the any of the details you gave about how to use the method properly in order to comprehend that there are more likely to be adverse reactions when you do it wrong. PermStrump(talk) 05:52, 13 May 2016 (UTC)[reply]

Permstrump:

1. I maintain that Ogden and Nitschke are not "weak sources". I think you need to RfC that.
2. I don't see the current page as not NPOV. It has a nice balance when I read it. I don't get a sense of slant at all.
3. FRINGE does not apply. Nitschke is discussed in thousands of sources, and his views on suicide with nitrogen published widely. One of numerous examples [6]:

   Nitrogen can provide people quite a quick, peaceful, totally legal and totally undetectable death.

   If he were clearly wrong, we'd have seen heavy pushback to the numerous such statements he has made in press worldwide; we'd have most definitely heard about it by now. And Ogden? Well, he is in Scientific American! Fringe 😂 ?
4. I could insert something about proper procedure being imperative, and cite it to Nitschke's book. Unfortunately it is behind a paywall.
5. No, no dearth of coverage of this topic, thousands of news articles, but no mainstream coverage of the warnings.
6. Me trying to scare off other editors? Sorry, I don't understand your meaning. Ratel (talk) 07:36, 13 May 2016 (UTC)[reply]

At this moment, I'm only saying Ogden and Nitschke are weak sources for the statements about how quick and painless nitrogen/helium+suicide bag are and that there aren't adverse effects. They're weak because there isn't a single independent reliable source that can be used in addition or in place of Ogden and Nitschke. The sources you just liked are blog/newspaper articles by journalists who were quoting/paraphrasing Nitschke's beliefs. The fact that Nitschke said those things doesn't need more sources. I've explained multiple times in various threads on Talk:Suicide bag how their views qualify as fringe on wikiepdia. It's a slam dunk. There's really no doubt about it. The argument of editors who disagree with me has basically boiled down to, "Nuh huh. Their views aren't fringe," but no one has been able to provide a single independent reliable source to show that other SCHOLARS agree with them. It doesn't matter how many people "in-universe" hold the same view. That's how WP:FRINGE works. "Statements about the truth of a theory must be based upon independent reliable sources... Points that are not discussed in independent sources should not be given any space in articles. Independent sources are also necessary to determine the relationship of a fringe theory to mainstream scholarly discourse." The editors claiming something isn't fringe are the ones who have to prove that support from mainstream scholars in the field exists. Until proven otherwise the WP:ONUS is on the editors who want to include the disputed content to find the better sources. It really should be removed until then. PermStrump(talk) 08:44, 13 May 2016 (UTC)[reply]

Permstrump said: Ogden and Nitschke are weak sources for the statements about how quick and painless nitrogen/helium+suicide bag are and that there aren't adverse effects. They're weak because there isn't a single independent reliable source that can be used in addition or in place of Ogden and Nitschke.

So if we ignore two of the experts who have made this their life's work, we have no sources? Perm, that's only true if you ignore the great sources I gave above showing almost immediate unconsciousness ("one or two breaths"), and the existence of studies featuring inert gas asphyxia autopsies without petechiae or inhalations (therefore without what is called in veterinary science an "unconscious death struggle" example). Do you need links to the U.S. Chemical Safety and Hazard Investigation Board document and more studies showing unremarkable autopsies? For FRINGE to come into play, Nitschke and Ogden and Humphry and Dr Bruce Dunn and etc would all have to be claiming something that flies in the face of the wording of FRINGE, namely: an idea that departs significantly from the prevailing views or mainstream views in its particular field. For example, fringe theories in science depart significantly from mainstream science and have little or no scientific support. Ratel (talk) 09:48, 13 May 2016 (UTC)[reply]

Like I already said above, the CSB source has nothing to do with suicide bags. The Auwaerter et al. source doesn't support Nitschke and Ogden's statements; it repeats them, but doesn't support them. Auwaerter: "In the last years, right-to-die activists promoted suicide methods by asphyxiation with use of gases as being relatively quick and painless." WP:FRINGE says, "Statements about the truth of a theory must be based upon independent reliable sources." Auwaerter et al. did not attest to the truth of that theory. None of the names you mentioned are independent of the topic. They're part of the small, radical group, so no, the fact that they agree with each other doesn't make it mainstream. PermStrump(talk) 10:02, 13 May 2016 (UTC)[reply]

* Permstrump, we're going round in circles

CSB source has nothing to do with suicide bags — of course not, but CSB source is about breathing a pure inert gas in an enclosed space, which completely agrees with the statements of Nitschke, Ogden et al, so let's not play semantics, it just wastes everyone's time.

Statements about the truth of a theory — it's not a theory. Plenty of people have died like this, some filmed by Dignitas, some observed directly & reported to researchers like Ogden, some scuba divers by mistake, some workers around inert gases. Where's the theory? Where's the fringe claim? If you do it properly then just a couple of breaths and you're out, 10 mins later (or longer if there is a vestige of oxygen) you're dead. If you don't do it properly you can take ~10-50 seconds to lose consciousness and up to 50 mins to die, with some twitching and movements, and possibly some signs at autopsy (inhalations, heart congestion, a few other signs I forget now, but none of which would have been felt consciously by the unconscious suiciding person, so relevance is moot). This is not controversial, nobody has contested it except the one source you have who looked at only 2 deaths by inert gas asphyxia and based his doubts on the one case with petechiae and inhaled vomitus, but this case also took a known emetic before breathing nitrogen, and in any case there is no proof that case experienced any pain, so the author's questioning of the painlessness of the method is strange. You can complain all you like about lack of numerous independent verifiable sources that echo these details, but you're never going to get a lot of researchers doing this kind of research when you see what happened to Ogden, who got himself unavoidably into a legal minefield that hobbled his career, so bleating about lack of verification from other sources gets us nowhere. And then you have the latest review study in this field that calls bag+inert gas an "easily understood and generally effective suicide method". Want to quote that? Ratel (talk) 11:30, 13 May 2016 (UTC)[reply]

Quoted above too... Changing the context could prove problematic. Administrating the gas within a prison is much different than the instances in which pilots and divers have slowly and accidentally experienced a lack of oxygen. Dr. Michael Weiden, a pulmonary expert at NYU School of Medicine, says that while nitrogen could be administered without medical professionals, using it for capital punishment could create an ironic consequence: the need for sedation… somebody who thinks that an individual who’s asphyxiating will not freak out without sedation is foolish.” Time. PermStrump(talk) 13:35, 13 May 2016 (UTC)[reply]

The Howard source doesn't support "quick and painless" or "peaceful" or "without adverse reactions." It would be much better in place of those 2 citations. The "easy to understand and effective" comment was also specifically about a plastic bag alone, not with gas, BTW. If you include all 3, it severely lacks NPOV. PermStrump(talk) 13:40, 13 May 2016 (UTC)[reply]

Most people who do not want to die would freak out if they knew someone was actively killing them. I would guess that it has more to do with the fact that someone is killing them than the actual method in use. Would it be unreasonable to suggest that the reaction might not be the same if the subject actually wants to die? • • • Peter (Southwood) ^(talk): 09:36, 4 June 2016 (UTC)[reply]

Mainstream?

• Ogden is WP:INDY according to Wikipedia's standards. He gets nothing from his papers except what any other academic gets from their papers. If we start declaring that experts aren't independent, then we will never be able to cite any journal article – no surgeons on surgical methods, no drug manufacturers on drugs, no pesticide researchers on pesticides, etc. Ogden actually is that "single independent reliable source" that you're looking for.
• When you have one reliable source saying X, and no reliable sources saying anything about it, then saying X (perhaps with WP:INTEXT attribution) is DUE. For example, we don't reject LD50 numbers when there is only one source for that number.
• Here's how we know that "other SCHOLARS" accept Ogden: Multiple other scholars cited his paper.
• Permstrump, you're saying in your comments here that government sources about the proven effects of occupational exposure to Nitrogen is irrelevant, but that vague speculation in a newspaper about using it for lethal execution is just fine. This sounds like cherry-picking sources based upon their POV to me, and that won't produce an acceptable article. WhatamIdoing (talk) 13:53, 13 May 2016 (UTC)[reply]
• Permstrump:

1. Capital punishment: Using nitrogen for capital punishment would be difficult to impossible without sedation because to make it work properly you need complete co-operation (see instructions above). Some condemned prisoners will co-operate, most will not.
2. Without adverse reactions : The ultimate adverse reaction is death. And since the autopsy-discovered sequelae, which are rare, occur after loss if consciousnesses, they are moot. So why are you making an issue of them? To the user, the process is still painless, otherwise we'd have seen people interrupt it (note the eyewitness accounts and films by Dignitas showing some involuntary movements but no attempt to remove bag or mask).
3. BTW did you get access to the full text of the Kleespies paper? That paper seems to be more about a "debreather" than a suicide bag. Ratel (talk) 20:24, 13 May 2016 (UTC)[reply]

• Ratel, Yes, capital punishment is different from suicide, but so are the situations CSB was referring to that involved people who were unaware of accidentally and gradually being exposed to nitrogen while in a small room. Obviously that would be different than what if feels like when you have a plastic bag over your head. My point was essentially that the policies and guidelines exist for a reason. It's so easy to draw false conclusions with honest intentions, but WP:SYNTH and WP:COATRACK prohibit us from drawing conclusions from 2 separate works and from citing sources that aren't directly relevant to the topic at hand. It makes it really straight forward: CSB isn't talking about suicide bags, so it's irrelevant to this article. That should save us from wasting time arguing about sources that are unlikely to be useful for anything other than POV pushing. Yes, I have access to the full text of Kleespies (and pretty much any academic journal) through the library at work. I'll respond to your comment on Talk:Suicide bag after this and C&P some quotes from Kleespies.

WhatamIdoing: "Mr. Ogden is director of the Farewell Foundation, which advocates for assisted suicide." Source. PermStrump(talk) 00:30, 14 May 2016 (UTC)[reply]

So? Being employed in your field of expertise is not a conflict of interest for that scientific field. If it were, then we'd have to stop citing prominent world experts in nearly every subject. No more citing Peter Piot on infectious diseases, for example, because he's running a non-profit organization that relates to to his scientific expertise. WhatamIdoing (talk) 04:11, 14 May 2016 (UTC)[reply]

I don't know if Peter Piot is, but I assume you mentioned him because he's well accepted an expert in his field by other exerts in his field, which is not true of Ogden. He's one of few adherents to a view well outside of the mainstream in his field (aka WP:FRINGE) that he has some financial and much personal investment in. I didn't say he can't be cited in that article or any other article, but when it comes to this topic, it needs to be properly contextualized and his statements can't be given false weight. PermStrump(talk) 15:22, 14 May 2016 (UTC)[reply]

You keep saying that, but the reliable sources keep saying things like "internationally known assisted-suicide expert"[7], "a world-leading researcher"[8], "a respected social scientist doing research on illegal behavior"[9], "one of the world’s foremost experts on assisted suicide"[10] who "altered fundamentally the way the situation is looked at"[11]. So unless we're redefining this to mean "the mainstream of the field, counting only people who agree with the One True POV™", then I think we're going to have to give up on calling him FRINGEy or "outside the mainstream". He is definitely too accepting of suicide to please the pro-life people, and he is reportedly too restrictive to please the right-to-die people, but I checked about a dozens news sources, and I didn't find a single one that said he was anything other than a prominent researcher doing fairly good work in the legally fraught field of (sometimes) watching people commit crimes (i.e., watching people assist in a suicide attempt, when their assistance is illegal in that jurisdiction).

My mind is open on the point, but if you want me to change my mind, then you need to come up with some reliable sources (=not merely a repetition of this unverifiable assertion) that say he's not an expert. You might start with Canadian political sources; since he and his research has influenced every piece of Canadian legislation about assisted suicide for years, you might be able to find a political hatchet job in any magazine that opposed the legislation. If it's not there, it's probably not going to be in any standard news source. WhatamIdoing (talk) 04:19, 15 May 2016 (UTC)[reply]

I'm not sure what the question is anymore. He's "in-universe" as evidenced by the fact that he founded Farewell Foundation. No other scholars call him an expert. The only people who call him an expert are a few journalists, and even then they're calling him an expert in "assisted suicide", which isn't even a field of anything. (notability vs acceptance). There's also his legal conflict of interest:

Vancouver-based Ogden has been researching assisted death as a criminologist since 1991 and began pushing for legal reform with the birth of his Farewell Foundation last year. Behind the political advocacy, he’s also quietly performed the far more ethically thorny work of supporting those who can’t wait for the legal and political debate to play out.... Ogden’s work as a death facilitator has led to police questioning on seven occasions, he says. He was subpoenaed three times to court (in 1994, 2003 and 2004)." (source)

—PermStrump(talk) 09:39, 15 May 2016 (UTC)[reply]

This is a a silly, fatuous, vexatious charge. Russel Ogden IS an expert in the field of assisted suicide and voluntary euthanasia, as his long list of Pubmed indexed studies into this field show objectively. Not only is he called an expert in the field of assisted suicide by numerous major news sources, but his list of published studies into the topic, more than any other researcher AFAIK, speaks volumes. Let's stop this pointless discussion now please. Ratel (talk) 11:16, 15 May 2016 (UTC)[reply]

It doesn't matter if the "pro-life" people say that he's "in-universe" with the "pro-suicide" people. Ben Goldacre is "in-universe" with the evidence-based medicine people, and we don't say that he's FRINGEy or not an expert. Having a firm opinion on a socially controversial subject doesn't change anyone's status as an expert on assisted suicide.

Also, there are healthcare professionals right here on Wikipedia who have "been subpoenaed". That's what happens to the victims and witnesses of a crime, not to the alleged criminals. "Pushing for legal reform" (according to one source, his goals are to reduce the number of painfully botched suicides and suicide attempts that turn into murder, and to make it clear in Canadian law that merely sitting in the same room as a suicide attempt, especially in the capacity of a journalist or scholar, without physically trying to stop it, is not itself a crime) is not a "legal conflict of interest". Conflicts of interest are spelled out pretty clearly in law, and they involve tangible benefits (money, goods, or services).

All you've proven is that he's WP:BIASED. It would hardly be surprising if a scholar in the social sciences hadn't formed a strong opinion about his subject area. WhatamIdoing (talk) 16:33, 15 May 2016 (UTC)[reply]

"Assisted suicide" isn't a field of study so one can't be an expert in it. WP:INDEPENDENT says, "A third-party source is not affiliated with the event, not paid by the people who are involved, and not otherwise likely to have a conflict of interest or significant bias related to the material." See also WP:Third-party sources#Conflicts of interest. Clearly not independent on multiple fronts. —PermStrump(talk) 05:30, 17 May 2016 (UTC)[reply]

yes that's true--Ozzie10aaaa (talk) 10:23, 27 May 2016 (UTC)[reply]

I have been including pricing information in medication articles. We have a good source here that gives the price range found internationally and in a number of countries in the developing world. Often the variation between prices is less than 5 fold. I have also been providing the US price as presented in this book but there are other good options. The US is not only a large portion of the EN speaking population but a large percentage of our readership. Also most other countries are somewhere between the global price and the US price. Doc James (talk · contribs · email) 22:44, 15 May 2016 (UTC)[reply]

Previous discussions:

• [12]
• [13]
• [14]

A few late notes:

• Most of the sources provide average wholesale prices – the price paid by pharmacy buyers, not the price paid by individual consumers.
• Most of the sources provide a price range, not a single number.
• We have sources that provide both US wholesale prices and global wholesale prices. There is no need to provide prices only from the US.
• Most drugs are generic, and the typical price for most generic drugs is relatively stable for years.

WhatamIdoing (talk) 15:56, 30 May 2016 (UTC)[reply]

Support including pricing details

• Support as proposer per the following reasons:

The most important reasons to provide this information is that it is useful to our readers, it is notable, and it can be well referenced. More useful I would argue than which episode of which American sitcom a disease or medication occurred in. A whole sub-domain of medical research is based on prices, that of cost benefit analysis. I would like to address some of the opposes:

• We do not have prices for all countries so we should therefore provide none.
  • Organizations like the IDA Foundation sell at the prices we are quoting to all low and medium income countries (this is more than 100 countries).[15] This is better than we typically have regarding rates of diseases. Often rates of disease are only available for the United States and Europe and yet we still include them.
• We do not give prices in all currencies.
  • We provide lot of numerical information such as the worth of a company in one currency. People know how to convert. We could build more tools to make conversion easier but that is another topic.

• Prices change widely from year to year.
  • This is simply not true. If we look at the price data over time for salbutamol in the graph, prices generally remain stable for years. When they do change widely this is often commented on and should be included in WP. Prices do change when a med becomes generic but this is also notable and only occurs once.
• Prices vary widely between similar countries
  • Also not true. We are quoting the wholesale prices available in all low and middle income countries. Prices in high income countries are also relatively similar. Typically for expensive medications there is no availability in the developing world other than going to the developing world and buying it.
• Some people have some coverage in certain countries so they should not care
  • People are either paying directly as an out of pocket expense or indirectly via insurance or taxes. If you are lucky enough to have some entity paying on your behalf, how much they are paying is at least as interesting as what receptors something works on.
• Some of the arguments appear to be that because we cannot provide perfect information we should provide no information.
  • We do not have perfect information for anything else either. How well does medication X work in Armenia or the DRC? We typically do not know as it has never been studied their. Or how well does medication X work among those with comobidites Y and Z? We also likely have no idea as meds are usually studied in a healthier than normal patient population (most people are excluded from trails). This however does not mean we should not provide data were it has been studied and among who it has been studied. Some applies to cost information.

Doc James (talk · contribs · email) 09:47, 2 June 2016 (UTC)[reply]

• Support Shelley V. Adams ‹blame
  credit› 03:30, 16 May 2016 (UTC)[reply]
• Support It is encyclopedic information, with decent sources available. With that said, ideally we could handle this with WikiData or something and pull it in, which would allow for things like automatic charting II | (t - c) 04:03, 16 May 2016 (UTC)[reply]
• Support inclusion of the wholesale prices when decent sources are available. Drugs are manufactured products produced by large corporations; the price that a product sells for on the market is relevant commercially, even when/if it is unimportant medically. WhatamIdoing (talk) 04:09, 16 May 2016 (UTC)[reply]
• Support. It would be good to be able to easily compare the average wholesale price of a drug in one market with the average in another/others. In one of the discussions he linked to above, James suggested a drop-down list of price x country in the infobox or sidebar, updated at Wikidata.

Knowing how slow Wikipedia and Wikidata can sometimes be in updating information, it might be prudent to always associate a price with its date: "The average 2015 wholesale price in the U.S. was x per standard dose. The average 2015 wholesale price in Australia was y per standard dose." --Anthonyhcole (talk · contribs · email) 04:14, 16 May 2016 (UTC)[reply]

• support when reliable sources are available--Ozzie10aaaa (talk) 10:14, 16 May 2016 (UTC)[reply]
• support only per my comment in the middle previous discussion, and not in infoboxes: "If, as with some cancer drugs, the cost is exceptionally high, placing them out of reach of many patients even in the West, and that has been the subject of RS (it need not always be MEDRS-compliant) coverage, then certainly that should be added, in a section in the text. In England these matters are done in public in the National Institute for Health and Care Excellence approval process, generating lots of RS coverage in some cases. Equally that aspirin is dirt cheap can easily be referenced. But I think we should avoid saying much about the mass of mid-price drugs, for the reasons set out above, plus the need (which we may not be able to cope with) to update when they come off-patent etc. We should just cover the extremes. Johnbod (talk) 15:51, 15 June 2015 (UTC)" Johnbod (talk) 14:51, 16 May 2016 (UTC)[reply]
• Support. I wish to respond to Kashmiri's opposition arguments below, because they are all excellent reasons which must be directly addressed.
  • Kashmiri refers to this English Wikipedia policy which historically says, "no prices". Wikipedia:What_Wikipedia_is_not#Wikipedia_is_not_a_directory. There is more discussion on this topic at WP:PRICES. I do not think the prohibition in the policy is on prices specifically, but instead, the prohibition is on primary data and information which is not backed by reliable sources. Prices often are those things, but not always. Sometimes reliable sources make price information available for consumer reference, and in that case, Wikipedia might include the information.
  • I agree that if price data is included then there has to be continual mindfulness about global markets. It is not acceptable to present only United States prices. I do not think Wikipedia has to be global, but there should be diversity in presenting data. If prices were presented, they could either be "international" somehow, or they could present more than one marketplace.
  • I disagree that price data is irrelevant in OECD countries. I work for a consumer organization, Consumer Reports, which does activism and lobbying that more medical pricing data be made more public. Consumer REports advocates for greater public awareness of how drugs are purchased, and what happens to the many people who for whatever reason seek to buy drugs on the open market without the support of other funding programs.
  • I am able to provide an organizational opinion that providing drug pricing information is not medical advice. Consumer Reports has published drug price information for decades and has done so in a way is not medical advice, and that establishes a precedent. Example publications presenting price information include the yearly Best Drugs for Less report, educational materials directing consumers to consider price, and consumer guides for ~50 classes of drugs (statins, for example) which compare "effectiveness, safety, and price". It often happens that there can be multiple drugs available to treat a medical condition and price is a major guiding factor in choosing which one is appropriate for the patient. It is politically difficult to acknowledge that people get different medical care depending on the money they have, but it is the reality, and having access to information on drug prices makes it easier for consumers have discussions with their health care providers about what sort of treatment matches their health care needs and the money they have.
  • I might agree that there is not consensus to add prices, but at the same time, I disagree that there is consensus to exclude them. I think it would be best to say that lots of people have varying opinions on the matter, and it is difficult to come to agreement on what is best. I do think there is consensus that without good sources to cite, Wikipedia definitely should not attempt to include price information.

Here are things that I would want to see if prices remained in Wikipedia articles:

1. Excellent sourcing. Right now International Drug Price Indicator Guide and the Tarascon Pharmacopoeia 2015 Professional Desk Reference Edition are proposed as sources. It might be worthwhile to critique these or any sources to confirm or deny that they are respected, reliable, and presenting the sort of information which meets Wikipedia goals to be international and meet general reader needs.
2. Discussion about what kinds of prices are acceptable, and what are not acceptable. For example, there might be consensus that Wikipedia only present prices at the consumer level, and exclude prices at the industry or wholesale level. Whatever the case, perhaps it would be helpful to discuss restrictions and limits in advance. Johnbod makes a sensible suggestion that only the best established prices be mentioned. In the case of drugs, it is easier to describe the cheapest off-patent drugs and the latest, most expensive and highly controlled drugs. Discussing the mid-level markets where the variation is greatest is most difficult. I am not sure what is possible.
3. There should be discussion about international relevance. I have a lot of sympathy for India, which Kashmiri mentioned. In India practically everyone buys out of pocket from local pharmacies. India is a major drug market and would be a great contrast to pricing information from OECD countries. Even if there is no ready solution to providing drug information relevant to Wikipedia readers in India, I think it would be helpful to state that it is a problem if Wikipedia were presenting price information for some places but was not providing a solution for price information in India. China would be another good market to address, but I think it would be easier to eventually get data relevant to India since India's drug market responds to international drug import and export markets more than China's more state controlled market.

Blue Rasberry (talk) 15:23, 16 May 2016 (UTC)[reply]

• Support — as long as we use international price points and not only US. Also preferable to solve this using Wikidata and including the information in the infobox. Carl Fredik 💌 📧 18:13, 16 May 2016 (UTC)[reply]

Thanks CFCF have been looking at importing prices by bot into Wikidata. Doc James (talk · contribs · email) 18:19, 16 May 2016 (UTC)[reply]

• Support — If someone wants to go through the effort of putting prices in, and other editors update them from time to time and it's clear to the reader what the source of the data is, then I would see it as a valuable contribution. EvMsmile (talk) 06:09, 18 May 2016 (UTC)[reply]
• Cautious support. We're not a price comparison website (CHEAP VIAGRA HERE) but medication pricing is a public health issue and would be encyclopedic. JFW | T@lk 09:48i, 19 May 2016 (UTC)
• Strongest possible support wherever sources are available. This is a major factor in the profitability of drug companies, and what drives the profitability of a particular company is almost always important information about that company. Not knowing that the vast majority of Cephalon's $2.8g in profit comes from two types of fentanyl (fentora, actinq) that either have expired or soon to expire patents and wo types of modafinil (provigil, nuvigil - yes guys sorry but they are the same damn thing,) might lead one to false conclusions about the future profitably of Cephalon - a company that makes 3b now - but only made 400m a year before they bought the rights to modafinil through the orphan drug program only to jack them up to what they are now - unless Cephalon manages to find another similar drug to exploit, their profits are likely to decline significantly within seven years. Such price increases greatly increase the skepticism the orphan drug program, and explains why some support policies similar to India's. This is at the extreme end, but one of the drugs I am on costs approximately $20,000 a month while costing, if I'm reading the DoJ report correctly, under $20 to produce. This combined with wikipedia'a article made more clear the reason behind the behavior of the pharmacist's at the pharmaceutical company - they've been under continuous threat of losing exclusivity for not reporting safety events. When you have tens of thousands of patent that costs you $20 a patient a month and make you $20,000 each, you're going to be obsessive about reporting any perceived safety event, while aggressively gaslighting you regarding any actual significant safety event that occurs. Since it's a risk evaluation management drug w/ fda, I guess I'll be talking to the FDA and the state board of pharmacy tomorrow. I already had objections to things like the orphan drug program, but reading relaed articles on-wiki as well as this debate itself was certainly to me. Even if we reach a general 'no', I'd say still include price data for a drug patented by someone who works at the VA 9/10 of the time that treats a disease frequently acquired in war.. that he made too expensive for the VA, his regular employer, to pay for much of the time. Sorry for the random typos keyboard issues today. User:Kevin Gorman | ^{talk page}

  Would you clarify please whether you propose that the pricing, costs and company revenue are mentioned in individual drug articles or in manufacturer articles? Thanks. — kashmiri ^TALK 11:17, 29 May 2016 (UTC)[reply]

• Support - I am a registered Pharmacist in India and this is a useful information to have on Wikipedia. National Pharmaceutical Pricing Authority controls pricing for drug and prices are stable most of the time. Net worth of a company or organization is given only in one currency and people are smart to convert it in local currency. AbhiSuryawanshi (talk) 10:25, 2 June 2016 (UTC)[reply]

Just to respond briefly to this; I am sure we can all appreciate that there might be value in having access to wholesale prices determined by the NPPA in India, by the NHS in England and by others in other jurisdictions. The first issue is whether that is a proper role for wikipedia. I'd argue no, for reasons others have given elsewhere in this discussion. But second, this isn't even what is being proposed here, which is a range of wholesale prices made up from partial data taken in spot instances in specific places to give a range of values, which might be different by 100 or 1000 times. It'll be utterly useless for determining anything much about the likely wholesale prices in India or in any other jurisdiction that isn't known to be at one or other end of the range of prices. JMWt (talk) 14:01, 2 June 2016 (UTC)[reply]

Would be useful JMWt if you provided some evidence to support your claims. The IDA Foundation sells pharmaceuticals in India and they are typically within the ranges that are being provided. So yes the price range provided for low and middle income countries does help one determine the price in India as it is one of those countries. The price range in this group of countries for salbutamol is 1.12 to 2.64 USD.[16] I highly doubt you could find a med that has a difference of 10 times let alone 100 or 1000 times on this website Doc James (talk · contribs · email) 14:48, 2 June 2016 (UTC)[reply]

It'd be useful if you didn't just keep pointing to the same source and instead tried reading what others are saying. For example this WHO report which showed significant variations on the wholesale purchasing prices within India, with some states paying more than the lowest available retail price for salbutamol (page 83 of that paper). Even within India the WHO found significant variations in wholesale price for salbutamol - a sample medication you've introduced for discussion and not me. I don't know whether India is within the range you've described (I doubt it given the booming local pharma industry there) and cannot see how you could possibly know whether the wholesale price in other developing countries was within 10 times of the lowest stated. JMWt (talk) 15:20, 2 June 2016 (UTC)[reply]

This "'paying more than the lowest available retail price" is one reason why we should include this information:-) The lack of transparency / availability of prices is one of the reasons why this occurs. User:AbhiSuryawanshi is from India maybe he could answer your question regarding if India is in this the price range presented. Doc James (talk · contribs · email) 15:31, 2 June 2016 (UTC)[reply]

I was born with severe Asthma and Salbutamol literally saved my life in difficult times. I purchased it from various locations over a period of time. It is available in given price range.
As I was born in rural India - it was difficult to understand how it worked and I learned about pharmacodynamics using Wikipedia. Along with functionality, pricing is another angle which is equally important and awareness can save many lives. Most of the drugs are subsidized in India and 'on humanitarian grounds' - Price range can help/encourage people to buy drugs and it might be useful to keep a check on malpractices. AbhiSuryawanshi (talk) 20:07, 2 June 2016 (UTC)[reply]

• Support per User:Kevin Gorman and User:Bluerasberry — OwenBlacker (Talk) 13:11, 4 June 2016 (UTC)[reply]
• Support. The suggestion is just, people have the right to access information of prices in different parts of the world, and can be well referenced, so it is reasonable for inclusion. The price of medications are important at the international level. --BallenaBlanca (talk) 19:56, 10 June 2016 (UTC)[reply]
• Support including pricing information because potential users may want to know the price. Pricing can vary and it will help the reader to know the real prices. People should not overpay for medications. Another idea could be to have one article with pricing for each medication for the different countries. QuackGuru (talk) 20:06, 10 June 2016 (UTC)[reply]

The hope is to include more discussion of how prices of a medication have varied over time and vary between different areas of the world as high quality references support. Doc James (talk · contribs · email) 20:30, 10 June 2016 (UTC)[reply]

• Support - I'm not sure if the price of every medication is notable, but to me, for example, vaccines where UNICEF/GAVI is involved in pricing, the pricing is, itself, notable.Smmurphy^(Talk) 21:21, 10 June 2016 (UTC)[reply]
• Support - I think adding prices is a very good idea as it paints a picture that words cannot describe. I have edited various medical articles on Wikipedia, and I always feel that I cannot do enough on socioeconomic conditions regarding the article, without showing some sort of unintentional bias. An example of this may be "people in most parts of Africa have issues getting access to drugs due to the staggering price" hurts the readers perception of Africa. Instead of excluding the successful countries in South Africa explicitly in the sentence, creating awkward phrasing, and feeding into the perception of Africa as a monolithic structure. By providing the raw data, it can help relieve this bias and provide the reader with a better picture of why a health issue effects a region more than another. As long as the information comes from a reliable, third party source, I see no issue with this. I also wonder if WikiData integration would also be possible. Peter.C • talk • contribs 16:09, 11 June 2016 (UTC)[reply]

Oppose including pricing details

• Strongly oppose on various grounds, including WP policies:
  • WP:PRICE states clearly that Wikipedia is not a sales catalogue and item's current pricing is NOT encyclopaedic information.
  • Wikipedia articles are (mostly) about specific compounds used in pharmacology; WP even requires use of INN names. Whereas pricing can only be given for commercial products.
  • Per WP:GLOBAL, Wikipedia is a GLOBAL ENCYCLOPAEDIA and the majority of English Wikipedia readers are based outside of the US.[17]
  • US drug prices are among the highest in the world [18] [19]. Consequently, quoting US prices will be very misleading.
  • The majority of OECD countries offer public health insurance coverage to their populations, with many (or sometimes all) drugs paid for by the state. Prices found in US pharmacies are utterly irrelevant for those populations.
  • We run a real risk that if we advertise lower prices, patients might be discouraged from buying the medicines they need, instead hoping to find them somewhere cheaper; and thus harming their health. That's the reason Wikipedia is very clear that IT SHOULD NOT OFFER ADVICE.
  • From the links listed by OP, there seems to be a consensus on not adding retail pricing on Wikipedia at all.

— kashmiri ^TALK 09:25, 16 May 2016 (UTC)[reply]

You missed the qualifiers at WP:NOTDIRECTORY which is "unless there is an independent source and a justified reason for the mention"

It is not a medical product unless you can actually buy it.

43% of our readers are in the USA [20]

As mentioned we are providing a range of prices which applies to dozens if not more than a hundred countries. There is also a global market in medications.

US prices are among the highest in the world and therefore giving US prices typically provides an upper limit.

That the majority of OECD countries pays for medications for outpts will need a reference. It is not the case in Canada.

Doc James (talk · contribs · email) 15:30, 16 May 2016 (UTC)[reply]

• I don't really know what section to comment in. Is the question whether prices can sometimes be included, or that we should include prices routinely? I don't think anyone will argue that pricing information is never appropriate – but if the proposal is to include prices routinely, then the proposal appears to violate WP:NOT. From NOTDIRECTORY, the use of pricing information requires a "justified reason," and specifically excludes "passing mention." The prices here appear to be passing mentions; the source is a database page with no commentary or context. I don’t have access to the Tarascon Pharmacopoeia, but I infer from the description that it's similar.

The standard here is that inclusion should require a source that includes the price as part of a discussion; simply listing it should not be sufficient. This is also in accordance with the comments of several other editors, including a couple in the discussion section that I think are otherwise most easily categorized as Opposes. If e.g. a drug's price has been criticized in the media, that's important information and it should be sourced appropriately. But finding the price in a database, or in any other context where it is presented without commentary, does nothing to establish its relevance to the article.

I also agree with the editors who oppose listing of prices in infoboxes; I see not listing prices in such a manner as one of the key qualitative differences that distinguish us from catalogues and other commercial websites. But inclusion in Wikidata is a different matter, and could be worth considering assuming that their policies allow it. Sunrise (talk) 19:53, 16 May 2016 (UTC)[reply]

The proposal is for whether prices can sometimes be included. Yes some are arguing that they should never be included it appears. Doc James (talk · contribs · email) 20:15, 16 May 2016 (UTC)[reply]

To clarify that part of my comment, I don't think editors will argue that sources like this should be excluded - in this case, we have an article in the New York Times where the drug's price is the main subject, and I'll support the use of that source in articles. But the sources being proposed above don't seem to be sufficient to meet the requirements at WP:NOT. (Also, allowing databases or other price reference guides would be essentially the same thing as allowing routine inclusion, assuming the guides are comprehensive). Sunrise (talk) 06:09, 18 May 2016 (UTC)[reply]

The main source I have been using just deals with WHO essential medicines. Doc James (talk · contribs · email) 18:26, 19 May 2016 (UTC)[reply]

• Oppose. Nothing good can come out of this - what seriously is it supposed to achieve? We know for a fact that the British NHS pays within a five-fold (what does that mean? 5 orders of magnitude? Five times?) difference of the wholesale price in India? I think, knowing how international products are traded, that's highly unlikely. And a conversion from USD to the local currency is going to mean almost nothing, as the wholesale price in any given market is going to vary enormously based on many different factors, so suggesting that it is "available" for this price means almost nothing outside of the USA. And the fact that 43% of readers are in the USA (which I doubt anyway) means that 57% are not. Why should the rest of us be fed information which is only relevant to a minority of readers in the USA? If you want USA-centric information, why don't you start your own digital encyclopedia. JMWt (talk) 17:03, 17 May 2016 (UTC)[reply]

5 fold means five times. What is being provided is both the US price and the global wholesale price. Doc James (talk · contribs · email) 21:02, 17 May 2016 (UTC)[reply]

And what do you think that's telling someone who isn't in the USA? You are presumably aware that a "global wholesale price" doesn't exist, right? JMWt (talk) 21:14, 17 May 2016 (UTC)[reply]

Did you look at http://erc.msh.org/dmpguide/ Doc James (talk · contribs · email) 22:31, 17 May 2016 (UTC)[reply]

Brilliant, although on quick search, "buyer prices" are only available for South Africa, Sudan and one or two developing countries. Still, hope you don't intend to duplicate this database on Wikipedia? — kashmiri ^TALK 22:39, 17 May 2016 (UTC)[reply]

@Doc James: I don't think I can access that page, but there is pretty good evidence that global prices vary much more than the quotes you've given, which appear to compare spot prices in a small number of locations. It is fairly easy to find wide disparities in price for specific medications in the literature, for example this recent article from the Lancet [21] "The price per bottle of all originator DAAs varied substantially: for sofosbuvir it ranged from $300 (India, Pakistan) to $20 590 (Switzerland); for daclatasvir from $175 (Egypt) to $14 899 (Germany); for simeprevir from $241 (Egypt) to $14 865 (Australia); for ledipasvir-sofosbuvir from $400 (Egypt and Mongolia) to $24 890 (Germany); and for ombitasvir-paritaprevir-ritonavir (or 2D regimen) from $400 (Egypt) to $20 215 (Switzerland)." I accept that's not talking about wholesale prices, but I'm not sure why we should have confidence that the reference you're using is fully comparing the full range of prices worldwide. JMWt (talk) 09:14, 18 May 2016 (UTC)[reply]

It is the range of prices in the developing world rather than the developed world. Doc James (talk · contribs · email) 17:16, 18 May 2016 (UTC)[reply]

@Doc James: In this section, editors are invited to present their arguments. Room for discussion is below, in the following section. It will be helpful if you, the proposer of this RFC, patiently wait for the outcome, refraining from picking an argument instantly with those who dare to oppose. Try not to discourage people from commenting please with such a behaviour! Thanks, — kashmiri ^TALK 18:19, 18 May 2016 (UTC)[reply]

User:kashmiri you have made your position clear. User:JMWt asked a specific question and I responded. Doc James (talk · contribs · email) 18:57, 18 May 2016 (UTC)[reply]

The prices quoted by the IDA Foundation is avaliable in more than 100 countries per [22]. Doc James (talk · contribs · email) 09:50, 2 June 2016 (UTC)[reply]

Strong, strong oppose per Kashmiri who makes a number of very good points including about our global nature, national insurance schemes, not listing prices, and misleading readers. A global wholesale price doesn't reflect at all the large amount of other English-speaking countries who may subsidize or nationally or regionally negotiate or mandate prices. Some of these other large countries include the UK and India and as per JMWt 57% of our readers. As a non-US reader I am completely opposed to a misleading and potentially harmful effort that doesn't reflect the reality of sale prices for 57% of our readers, nor take into account insurance rebates etc. I don't think this issue can be dealt with in the same nuance that we'd expect of a WP article, and such a nuance certainly not in an infobox.--Tom (LT) (talk) 02:27, 18 May 2016 (UTC)[reply]

User:LT910001 the BNF discusses prices in the UK. Doc James (talk · contribs · email) 21:42, 3 June 2016 (UTC)[reply]

Strong oppose - see my comment in the discussion below for my rationale, and Kashmiri's excellent comment. This does not belong in Wikipedia. Garzfoth (talk) 03:29, 18 May 2016 (UTC)[reply]

• Strongly Oppose. Per NOT. While there are many cases where prices can and should be included as part of encyclopedic content, it has to be on a case-by-case basis. Unless I'm overlooking something, I'm not seeing arguments that clearly show NOT should be overruled for all medications. --Ronz (talk) 17:52, 20 May 2016 (UTC)[reply]
• Weak Oppose with basically the same caveats as Johnbods support above. Per WP:NOT we shouldn't attempt to become a pricing list but where price has been a factor in the coverage then prices should be included. I don't think it should be in the infobox as it will always need more clarification than an infobox can provide as to where and when the price is from. SPACKlick (talk) 16:03, 24 May 2016 (UTC)[reply]
• Oppose I am not terribly excited about this, but I generally agree with the foregoing opposes, and in any case I am generally reluctant to support any form of tabular data that requires regular updating. It is an invitation to error, confusion and embarrassment, as well as being doubtfully encyclopaedic. I an unconvinced anyway, that any such table could give comprehensive and intelligible information on the subject, but am not inclined to study how deeply I am in error on this point. If instead there were to be a link to an off-WP site that could supply the service, I reckon I could hold still for that. JonRichfield (talk) 14:56, 25 May 2016 (UTC)[reply]
• (Summoned by bot) Oppose, basically per User:Sunrise above, with no opposition to inclusion on a case to case basis (when price of a single drug or a group of few drugs has been discussed by an RS); strong oppose to listing retail prices in a particular country.

The most deciding argument in my mind is "which price"? Just as for pretty much any product, "the" price does not exist as there are various retail/wholesale prices (this has been said multiple times already), but unlike any products, few if any drugs have a large international market with listed prices for similar products. On a particular day, bananas or oil have an "international" value on the market (despite minor differences among the products); drugs except maybe aspirin or other big-quantity-sellers do not have that.

I think however that the updating issues is not a problem, if we decide we want to include prices we can just use prose with WP:ASOF. Tigraan^{Click here to contact me} 11:45, 27 May 2016 (UTC)[reply]

• Oppose. Preditable, price info depends on: country, insurance policy, personal situation, drug process. There is no single reasonable 'single' cost estimation. -DePiep (talk) 20:56, 29 May 2016 (UTC)[reply]
  • Do you realize that we're talking about the wholesale prices, not what a particular person pays at the pharmacy counter? Also, do you realize that while there's no "single" cost, there are very good sources that provide price ranges, which would let us make well-sourced statements along the lines of "two to five cents per dose in most countries, as of 2016"? WhatamIdoing (talk) 15:48, 30 May 2016 (UTC)[reply]

Even 'wholesale prices' are fragmented by region, insurance policy, legal policy, paybacks, prescription incentives, dose-per-cure, other marketing tools, etc., in general. Legal drugs do not have a free market (unlike e.g. oil and copper). Worse, wholesale prices are not public and so rather meaningless to our Reader. Even if we simplify the problem to regions only (price in a country), we enter a 200-point data row. (the similar legal status of infobox drug has 8+1 separate regions/jurisdictions; rightly there are questions about this infobox data expansion into vapourspace). -DePiep (talk) 11:36, 31 May 2016 (UTC)[reply]

Did you look at http://www.pmprb-cepmb.gc.ca/view.asp?ccid=579 Doc James (talk · contribs · email) 12:39, 31 May 2016 (UTC)[reply]

One country sourced, 199 to go. What is your argument? How does it reply to my the other dimensions mentioned? -DePiep (talk) 10:41, 1 June 2016 (UTC)[reply]

I am seeing 8 countries listed and an international median price. This is how Canada determines the max price that a med can be sold at. Doc James (talk · contribs · email) 12:08, 1 June 2016 (UTC)[reply]

re "I am seeing 8 countries listed " Are you playing who's dumb? That's 192 countries to go (I'm generous). And again you did not answer my primary point. -DePiep (talk) 18:24, 1 June 2016 (UTC)[reply]

@Doc James: I must be missing something, because that link seems to be comparing prices in, or before, 2004. What relevance does that have to 2016? JMWt (talk) 19:34, 1 June 2016 (UTC)[reply]

One could find newer references. This 2013 review[23] the price is $2145 in 2013 while the max we see in 2005 was $2116. The price was fairly stable.Doc James (talk · contribs · email) 21:14, 3 June 2016 (UTC)[reply]

• Oppose, Wikipedia's purpose is not to provide specific pricing information, especially in something as specialized, complex, and variable as drug prices. However, when multiple reliable sources actually discuss (as opposed to just list or note) an item's price, it may be suitable for inclusion in that particular case. (The Martin Shkreli incident would make a good example.) But as a general practice, no, we do not and should not routinely include pricing. Seraphimblade ^{Talk to me} 13:28, 31 May 2016 (UTC)[reply]

What are you thoughts on this as a source http://www.pmprb-cepmb.gc.ca/view.asp?ccid=579 ? Doc James (talk · contribs · email) 12:09, 1 June 2016 (UTC)[reply]

• Oppose in some cases, support in others - Like many of the other folks in this discussion, I support including price details when they are the subject of discussion in reliable sources, but I oppose routinely including price information from databases per WP:NOTDIRECTORY. Yes, the information is useful, but Wikipedia is not a repository of all useful information. It's an encyclopedia. Kaldari (talk) 17:55, 3 June 2016 (UTC)[reply]

User:Kaldari no one is saying this should not be based on reliable sources. We use the British National Formulary to discuss use of medications in pregnancy and there effectiveness. They also discuss pricing details for meds in the UK. The World Health Organization discusses pricing of the medications on the World Health Organizations list of essential medicines. Both Canada and India have maximum prices set for new patented medications. No one is suggesting a reference to an online pharmacy is to be used. Doc James (talk · contribs · email) 20:58, 3 June 2016 (UTC)[reply]

@Doc James: If the prices are discussed (not just mentioned) in reliable sources, I'm fine with that. I've changed the title of my vote so it is more clear that I am only opposing conditionally. I honestly wasn't sure where to even put my vote since neither of the headers are clear what is being supported or opposed exactly. In the future, I would suggest asking a specific question in your RfC, as this one is very vague. Kaldari (talk) 21:06, 3 June 2016 (UTC)[reply]

User:Kaldari here for example is a CADTH review which does cost benefit analysis which of course depends heavily on the cost and therefore discusses the cost.[24] When the Canada agency that determines med prices last did the max allowed price calculation in 2005 [25] the price was more or less the same as in 2013. Doc James (talk · contribs · email) 21:19, 3 June 2016 (UTC)[reply]

• Strongly oppose. There are four basic reasons: 1) if you start including sales information on one product, there is no reason to exclude another; 2) price information on most commodities changes too often to renew it all the time, and outdated information lowers the quality of the articles; 3) price information on any kind of products tends to be unclear and dubitable, which in turn opens the way to NPOV; 4) Wikipedia is too Amerocentric as it is, there is absolutely no need to tilt it even more. --Oop (talk) 21:55, 3 June 2016 (UTC)[reply]

How does adding pricing info for the developing world make Wikipedia more Amerocentric User:Oop? Doc James (talk · Oppose in some cases, support in otherscontribs · email) 22:21, 3 June 2016 (UTC)[reply]

"I have also been providing the US price as presented in this book but there are other good options. The US is not only a large portion of the EN speaking population but a large percentage of our readership" I think taking that as a principle for building a global encyclopedia is very much wrong. (A fun fact: right now, I'm in a philosophy conference, listening to a Texas philosopher talking about ethical calculations using a geometric method. I'm tempted to bring up the case.) --Oop (talk) 07:40, 4 June 2016 (UTC)[reply]

The English Wikipedia isn't a global encyclopedia, per se, even though it aims to have as broad coverage as possible - its in English, which automatically cuts out the billions of people that don't speak English. What makes the Wikimedia projects global is that there are Wikipedia encyclopedias in 250+ languages. Nathan ^T 13:32, 4 June 2016 (UTC)[reply]

Rubbish. It is a global encyclopaedia edited in English by people around the globe and reflecting topics important in a range of different geographical locations. What it clearly is not is an "American Wikipedia". That's an incredibly offensive position. JMWt (talk) 14:00, 4 June 2016 (UTC)[reply]

• Very Strongly oppose. I won't recite the policies and guidelines listed by the other editors who also oppose this idea, but I completely agree them. Do we really want the encyclopedia to become the place where consumers come shopping for the best prices on medications? What about medical equipment? Therapies? Surgical supplies? Also I have concerns with the assumption that a medication manufactured here in the US, under the watch of the FDA is the same medication sold in Namibia or Haiti. Just because a drug has a certain 'title' does not mean that the other ingredients such as fillers are identical. Also, in less regulated countries, there is no guarantee that the drug even contains its active ingredients. Some global entrepreneurs may see this new information on a drug as a marketing tool and begin to influence the pricing structure to attract mail-order sales. In the poorest countries, I envision the nightmare of a whole industry springing up based upon the lowest pricing 'proven' by citing Wikipedia. I love Canada and have gone there to pick up some medications that were much less expensive that were subsequently confiscated by US Customs as I reentered the US. (I didn't know that this was illegal, oh well, now I do.) If some wants prices on medications, let them go to Google. This new proposal is humorous and ironic, since I recently had information about the availability and prescription requirement on a biological 'drug' deleted from an article with no explanation. So at best, this practice of providing pricing information is currently inconsistently practiced. Another concern is that the prescribing requirements differ between countries. If I am a consumer and I see that a prescription drug is slightly more inexpensive in Mexico AND I don't want to or can't afford to pay a physician in the US to prescribe it, I most certainly would drive across the border to purchase my self-prescribed medication. Are we also going to include the information that a drug is NOT available at any price in the US, Canada, UK, Australia? But hey, according to Wikipedia there is another country where you CAN get it? Please no. Best Regards,

  Bfpage |leave a message  10:50, 4 June 2016 (UTC)[reply]

User:Bfpage we do not include medication dosing information but yes we do include where a medication is and is not available already. The discuss is to include wholesale price as described by reliable sources. This is different than just googling the price.Doc James (talk · contribs · email) 16:29, 4 June 2016 (UTC)[reply]

• Oppose. What I pay my pharmacist, what the pharmacist pays the wholesaler, and what the manufacturer receives from the wholesaler, are likely to be very different amounts. And there's likely to be a subsidy paid by, or a tax received by, my country's government. Pharmaceuticals are nothing like oil, aluminium, bitcoins, or even cars, which are all, more or less, fungible.
• Oppose any exact numbers, per WP:PRICE. On the other hand, qualitative analysis of prices may be included in case-by-case basis depending on the notability of the corresponding research, per WP:DUE . Staszek Lem (talk) 22:09, 9 June 2016 (UTC)[reply]
• Oppose except in specific cases like Oseltamivir or Pyrimethamine where the price is a genuinely significant part of the story. Including pricing as a matter of course has far too many potential downsides—confusion when prices vary between countries, patients who don't understand wholesale pricing and think their pharmacist is ripping them off when they get charged more than "what Wikipedia says the price should be", patients who are discouraged from seeking treatment when a high price spooks them, patients outside North America who don't understand that US/Canadian prices are generally much higher than elsewhere and thus assume the medication they're being sold at 1⁄10 of what Wikipedis says is the going rate must be a placebo rather than the real thing so don't bother taking it… Remember, Wikipedia's main readership is primarily comprised of people with a medical knowledge no higher than "aspirin for headaches, antihistamines for hay fever". For us to include information with such a high potential to cause confusion (and which would create a permanent maintenance backlog, since the prices would need to keep being re-checked) there would need to be a clear and obvious benefit; I can't see a benefit in this case, since to most readers prices would at best be meaningless clutter and at worst be actively misleading, and those who do want to know the wholesale prices can easily find them elsewhere, likely with more up-to-date data than that being used by Wikipedia. ‑ Iridescent 22:32, 9 June 2016 (UTC)[reply]
• Oppose – the information is highly variable both spatially (due to different prices in different countries) and geographically (due to changes in prices over time). It will be difficult to provide this information in a globally comprehensive way and it will have a strong tendency of becoming outdated over time. Due to these factors, Wikipedia in general avoids including pricing information on anything (not just drugs), but there is no reason to treat drugs differently here from anything else. The existence of reliable sources for pricing information doesn't overcome the concerns about the information's high spatiotemporal variability, since however reliable they may be, they are generally speaking non-comprehensive sources giving prices only in certain markets at certain times. If a drug is exceptionally notable for being of high price (see e.g. media stories about whether private insurance companies or public health systems should pay for some extremely expensive drugs), there can be a justification for including information on its price in those specific cases, but not generally. SJK (talk) 08:06, 11 June 2016 (UTC)[reply]
• Oppose - I agree with the guidance at WP:NOT that was should not be including prices. I find the other examples of exceptions to that guidance unconvincing, as they all seem to be instances when the price was an important part of that particular subject, like a first at a a particular pricepoint or extensive coverage of the price in particular. There are also a few articles which, despite being FAs, have prices which wouldn't survive an RfC on the subject (if anyone cared that much). What's proposed here is a blanket exception not for a particular article but for an entire category. There are some good arguments in favor, don't get me wrong, but I think for an exception to WP:NOT to be made on that scale, there needs to be (a) truly compelling reasons, or else (b) a discussion at WT:NOT about the application of that guideline, absent something more specific. For the record, though, it seems reasonable, if there's agreement on a source/database, to include an external link to price information (for example, in an infobox). — Rhododendrites ^talk \\ 19:37, 11 June 2016 (UTC)[reply]

WP:NOT says "An article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention". The proposal is simply to follow WP:NOT. The proposal is to use independent sources and there is a justified reason as this represents an entire sub field of medicine. Doc James (talk · contribs · email) 00:08, 12 June 2016 (UTC)[reply]

So, this may be an area of ignorance for me. Are you saying that in the body of reliable sources about a particular drug, there would be sufficient coverage of the price such that you could make a claim of WP:WEIGHT? I would be very reluctant to say that any whole category of product is going to have price be one of the things the sources cover to a sufficient extent. That's because the bigger issue with WP:NOT is the part you left out: "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." Together I understand this to mean that price does not have inherent informational value relevant to Wikipedia. While we have the effect of influencing purchase decisions, that's not the point. So we need more than just the informative value of the price to merit including it in an article, and wouldn't include the price by default even where a affordability is a relevant subject to the broader subject. We should include prices when there's a weight claim to include in a particular article, with sources that discuss the price as an aspect of the subject, not at a point of data. — Rhododendrites ^talk \\ 14:49, 12 June 2016 (UTC)[reply]

There are agencies in many countries that set maximum allowed prices for prescription pharmaceuticals. They do this by reviewing the prices in different jurisdictions. For essential medicines the World Health Organization does a cost benefit analysis for each of them. So for essential medicines at least there is plenty of sources to justify WP:WEIGHT.

I would argue that this information deserves more weight than say what song lyrics it occurs in Doc James (talk · contribs · email) 15:34, 12 June 2016 (UTC)[reply]

That's more or less in line with what I would presume: that there are some articles for which price should be included given WP:WEIGHT. But that's already allowed under current policies/guidelines, as you've said, and an RfC wouldn't be necessary for that. I interpret this RfC as seeking consensus for a blanket exception such that any article in a particular category could/would include price regardless of weight.

As an aside, you won't typically get an argument from me if you want to remove "in popular culture" sections/sentences. :) — Rhododendrites ^talk \\ 15:54, 12 June 2016 (UTC)[reply]

It's a hard call, but I think Doc James is probably right. It's probably more efficient to have an RFC about whether to do this generally (not "always", but under appropriate circumstances) than to fight a hundred individual battles with editors who have never read anything more of NOTPRICE than its shortcut, or who have difficulty understanding that the line in NOTPRICE that says "unless there is an independent source and a justified reason for the mention" means "if you have an independent source and a justified reason, then you actually should include the price". Or who just misunderstood the goal, as evidenced by the themes in multiple comments here. We could mash several together to get an objection that amounts to, "Don't include wholesale prices in developing countries in Africa, South America, and Asia, because no two Americans pay the same retail price for a drug." Unless they go to Walmart, in which case hundreds of them cost $4. WhatamIdoing (talk) 16:58, 12 June 2016 (UTC)[reply]

Right about what? Or, more specifically, what is the point of disagreement which I have wrong? I can't really blame anyone for being confused, as this is an RfC with no question to answer. The question has to be inferred by a general statement that someone has been adding price information and the section headings ("Support including pricing details" and "Oppose including pricing details"). Hence I don't see how one could interpret this RfC as anything other than seeking consensus to add prices to articles about medications broadly. Of course I wouldn't interpret an RfC to mean "should we follow the rules as they current exist", because consensus is already established for that and opposition here wouldn't actually overturn those rules. — Rhododendrites ^talk \\ 17:29, 12 June 2016 (UTC)[reply]

I think that Doc James is right to start an RFC. Even though what he wants to do already is permitted under the "rules as they currently exist", many editors are unaware of what the rules actually say. Having this discussion helps people get on the same page. Besides, we seem to be learning useful things, e.g., from Nathan's comments about the incompleteness of the data behind the U.S. numbers. WhatamIdoing (talk) 00:24, 13 June 2016 (UTC)[reply]

User:Rhododendrites Yes this RfC was for a confirmation of WP:NOT's "An article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention". It was not for an exception to WP:NOT Doc James (talk · contribs · email) 01:32, 13 June 2016 (UTC)[reply]

Discussion

• Cost benefit analyses are done in many areas of the world and these rely on the cost of medications.
• Cost is also taken into account by the World Health Organization when they put together their essential medicines list.
• In many areas of the world medications are purchased in the international market. Medicine San Frontier for example puts together a price list to help with their work. Thus the international price applies to around 100 countries. Doc James (talk · contribs · email) 22:48, 15 May 2016 (UTC)[reply]

I personally don't feel like we should include price information in an encyclopedia. Here's why:

• The price varies depending on country
  • In Canada, the end-user price varies depending on province/insurance. Wholesale prices are controlled to some extent by the government.
  • In the UK, the end-user price is a flat fee set by the NHS. Prices are controlled to some extent by the government.
  • In the US, the end-user price varies depending on insurance status (have insurance vs. paying cash) and insurance benefits (lots of different ways to handle drug coverage - percentage-based, flat copays, deductables, etc). Additionally:
    • It varies based on what pharmacy you go to (store X (e.g. CVS) vs. store Y (e.g. Walgreens), retail vs. discounted retail (e.g. Walmart) vs. mail-order)
    • It varies if you use discounts, which can be third party ("drug savings card"?), manufacturer coupons (usually time-limited), manufacturer-paid (low income programs), etc
    • It varies based on the pharmacy benefits manager used and the drug formulary.
    • It varies based on insurance plan

Another major point is that when a generic for a brand-name drug comes out, prices can change drastically overnight. Medication prices are always changing, and there's no way that we can keep up with prices, which will be completely inaccurate for anyone seeking pricing information anyways as we're generally listing wholesale prices, which do not factor in several additional layers of profit margins, and are utterly useless to the average person. Here's a personal example for a hypothetical drug (although this is actually based on a real medication I'm on). I pay a fixed copay for this drug of $A. The pharmacy claims the drug cost $B on the info accompanying the drug (and that my insurer saved me $(B - A)). My insurer's report says they paid the pharmacy $C for the drug. $B is much greater than $(A + C). The cash price that pharmacy would charge for the same drug is $D according to GoodRX, which is close to the pharmacy's official cash price of $B. If you use GoodRX's discount program, you would pay $E. Confusing, right? Garzfoth (talk) 23:55, 15 May 2016 (UTC)[reply]

• I don't much like the idea of simply including the price indiscriminately or as a matter of routine. And considering what Garzfoth said just above, it may be better to use wholesale than retail pricing, or to indicate a range of prices. But I think the decision about whether to include pricing at all depends upon context. As Doc James said, it becomes relevant in the context of cost-benefit analysis, etc. So if, for a particular drug, there is content about something significant concerning cost-benefit or other analyses or classifications, then specific pricing information can and probably should be stated explicitly in that content. On the other hand, simply saying routinely for each drug that its typical price is such-and-such strikes me as unencyclopedic, and I would not want to see prices in infoboxes. --Tryptofish (talk) 00:22, 16 May 2016 (UTC)[reply]
  • User:Tryptofish We are using the whole sale price and we are providing a range of prices. We are not writing for "patients". Someone pays. Many people care about the price and price often determined what meds are covered.
  • This is not typically true "Medication prices are always changing" Medication prices are typically more or less stable for years. For example:
    • Price for salbutamol in a bunch of countries in 2014 between 0.0056 and 0.0132 per dose[26]
    • 2006 0.0043 to 0.0145 per dose[27]
    • 1996 0.0055 to 0.0095 per dose[28]
  • 20 years and the lowest price per dose changed by only one hundredth of a cent
  • Yes when meds become generic the price decreases. It is notable not only when the med becomes generic but the new lower cost if any.
  • By the way we are talking about meds on the WHO essential medication list. All these meds have had cost benefit analysis done.
  • Doc James (talk · contribs · email) 02:36, 16 May 2016 (UTC)[reply]

Is that adjusted for inflation? Seppi333 (Insert 2¢) 05:26, 16 May 2016 (UTC)[reply]

Do not think so. So a slight decrease in price over the years than. Doc James (talk · contribs · email) 05:29, 16 May 2016 (UTC)[reply]

US cell-phone pricing—which depends on carrier, contract-length, special promotions, etc.—is almost as confusing as US drug pricing, but the iPhone article is full of prices. Complicated pricing schemes (and the resulting obfuscation) are all the more reason to include an approximate "market price" that might be difficult for the average reader to locate independently. —Shelley V. Adams ‹blame
credit› 03:30, 16 May 2016 (UTC)[reply]

Yep, they seem to be violating WP:PRICE in the iPhone article. But that article has been cared for by Apple fans, and here we are dealing with serious stuff, not tech gadgets :) — kashmiri ^TALK 09:29, 16 May 2016 (UTC)[reply]

And than we have a whole family of articles on Price of oil. And Toyota Prius C have the initial price in the lead and other prices in other places. Doc James (talk · contribs · email) 22:56, 3 June 2016 (UTC)[reply]

The lone opponent has some interesting ideas, but I don't think that they hold up under scrutiny:

• "WP:PRICE states clearly that...current pricing is NOT encyclopaedic information."
  1. PRICE says that encyclopedic relevance can be established if the prices are discussed in good sources, and discussion of price is typical for generic drugs and universal for drugs still under (or recently released from) patent protection.
  2. Who said that it would only include "current pricing"? It'd be far more interesting to include information about how the price changed over time (e.g., once a decade for as far back as our sources go).
• "pricing can only be given for commercial products."
  • If it gets sold, then it's a commercial product, so this seems like a tautology. Perhaps you mean that prices can only be given for particular combinations of brand name/manufacturer/location/time? That wouldn't be factually true; we have good sources that give wholesale prices from around the world, based upon the compound itself.
• "quoting US prices will be very misleading....Prices found in US pharmacies are utterly irrelevant for those populations."
  • Who said that we'd be quoting only US prices? Who said that we'd be giving prices for any pharmacy? The goal is the wholesale price, not retail.
• "We run a real risk that if we advertise lower prices, patients might be discouraged from buying the medicines they need"
  • Wikipedia is WP:NOTCENSORED, even to protect people from their own ignorance about the difference between global wholesale prices and local retail prices. WhatamIdoing (talk) 13:34, 16 May 2016 (UTC)[reply]
• It strikes me that WP is the wrong place for such data to reside, though (depending on discussion results) it might be a good place for readers to find it. Price data is still data, and there's no real reason to bind it to an English language text format. It would be much more at home on Wikidata in a language-neutral form. Then insertions, revisions, national prices, currencies, and references inserted there once will be reflected on all using wikis simultaneously. We should avoid creating a local crapheap on w:en that just has to be cleaned up after the fact. LeadSongDog come howl! 16:12, 16 May 2016 (UTC)[reply]

Yes Wikidata has now been set up from what I understand to handle this data. I am not much of a Wikidata editor though.

I have just shown that the price of salbutamol internationally has not changed in 20 years User:LeadSongDog so not sure what "cleanup" you are referring to? Yes medications become generic once in their existence. We have a number of currencies that are used internationally with the USD and Euro being two of them. Many countries in the developing world either us USD or prefer it to their national currency.

Doc James (talk · contribs · email) 16:56, 16 May 2016 (UTC)[reply]

@Doc James:Every wp article that gets price info added into it would then need it removed once there's a way to use d: instead. It would seem simpler and better to just get the location right the first time. LeadSongDog come howl! 19:27, 16 May 2016 (UTC)[reply]

Hum okay thanks. Are we using d: for anything outside of the infobox at this point? I could look into doing that. Doc James (talk · contribs · email) 20:18, 16 May 2016 (UTC)[reply]

Doc James: For sure you mean Zimbabwe? [29] Neither China, nor India, nor Brazil, nor Russia (which combined account for more than 50% of world's population) do not "prefer USD" in drug pricing to the best of my knowledge. But ok, let's agree on USD or EUR, that still does not address the key questions raised above. And BTW even if price of salbutamol, a patent-free small molecule, has not changed in 20 years (I can't locate your proof, though), the most problematic and expensive drugs are those still covered by patents and/or in the marketing exclusivity period, and their prices can vary several orders of magnitude between countries. — kashmiri ^TALK 17:58, 16 May 2016 (UTC)[reply]

If you look at were I provide prices for salbutamol by year you will notice a link to the reference beside each.

With respect to countries that like USD I am thinking of Cuba, much of Central America, and much of Africa. In Tanzania they request payment of not only bribes but entry fees and hotel rooms in USD. Iran also requires payment of hotel fees and tour fees in either USD or Euro.

You mention "vary several orders of magnitude between countries". Several orders of magnitude fold is very small. If they varied by 10 or 100 fold that would be a stronger argument.

We already give a price range of salbutamol of 1.12 to 50 USD. Doc James (talk · contribs · email) 18:15, 16 May 2016 (UTC)[reply]

It's probably worth pointing out here that one order of magnitude is 10 fold; two orders of magnitude equals 100 fold. In any event, I'm not entirely convinced that it is a good idea to quote an "international price" in USD due to currency inflation and changes in forex valuations. Seppi333 (Insert 2¢) 18:24, 16 May 2016 (UTC)[reply]

Yes thanks. I have not seen prices vary by several orders of magnitude (100 fold) among OECD countries (except for brief periods of time). Would be interested in seeing a reference for this if one can be found.

Our sources often quote the price in USD. I know the MSF uses Euros. Doc James (talk · contribs · email) 18:43, 16 May 2016 (UTC)[reply]

I'm not saying an international price shouldn't be quoted in USD; if one quoted at all, it should be in USD because that's easily the most actively traded/liquid currency in the world. I'm just not convinced that a USD quote would be particularly useful to someone who doesn't live in the US because they'd literally need to look up their exchange rate and convert it to their currency for context (i.e., to compare the price of the drug relative to the price of other things they buy in their currency). Seppi333 (Insert 2¢) 18:54, 16 May 2016 (UTC)[reply]

Many outside the US know the conversion between their own currency and USD. Otherwise it is fairly easy to look up. Would be interesting to build a tool that uses a readers IP add the local currency in brackets. Doc James (talk · contribs · email) 16:31, 17 May 2016 (UTC)[reply]

Many outside the US know the conversion between their own currency and USD. - you know that how? Seppi333 (Insert 2¢) 16:36, 17 May 2016 (UTC)[reply]

That's a bit of a red herring. Whether or not individuals know this, the USD is the reference currency for interbank transactions on the foreign exchange market.(see http://www.bis.org/press/p130905_fr.pdf) We already have guidance at wp:CURRENCY saying that country-non-specific articles should use United States dollars, euros, or pounds sterling. We also have templates that can do the conversion {{EUR}}, {{GBP}} and apply historic inflation {{inflation}} where needed, and even a navbox: {{Exchange Rate}}, which renders as, e.g.

.LeadSongDog come howl! 18:49, 17 May 2016 (UTC)[reply]

ok, but that's quite misleading, because there are lots of reasons why products have different wholesale prices in different markets. An item might well be available for $x in the USA but be a completely different price elsewhere. Given that some medications are particularly sold in some jurisdictions at or below cost and some are vastly expensive in others, some spot wholesale price in one place is totally useless when one desires to know how much it would be to get a wholesale purchase where I am, Unless I happen to be in the USA. There is no "global wholesale" price of anything. How are you imagining this information would be informing the global WP reader? JMWt (talk) 21:25, 17 May 2016 (UTC)[reply]

@LeadSongDog: It's not a red herring at all. It's a real problem that is resolved by listing the US price with the price quoted in other major English speaking countries' currencies; the converted price needs to be updated with the closing exchange rate from the preceding day in order to circumvent the issue. Seppi333 (Insert 2¢) 22:28, 17 May 2016 (UTC)[reply]

@Seppi333 not just a matter of exchange rates at all. You can look at how national pricing of the new Hepatitis drugs such as Sofosbuvir to gain some insight into the determinants of pricing in non-US countries. As you may have encountered there are legislative approaches to essential and nonessential drugs, pricing of generies, and national or regional negotiation strategies that countries employ -- not to mention that many of these costs are not passed on in many non-US countries to the end users, who may have national or private insurance policies that reduce or rebate the costs of the drugs. Not an issue that can be simply dealt with by exchange rates.--Tom (LT) (talk) 02:32, 18 May 2016 (UTC)[reply]

I realize this. There's 4 price issues that have been discussed in this section: wholesale price variability in USD over time, USD inflation, pricing USD in other currencies, and the additional cost of a drug above the wholesale price which is unique to each nation and varies by government subsidization and/or private insurance. I'm just talking about the forex issue here. Seppi333 (Insert 2¢) 02:42, 18 May 2016 (UTC)[reply]

It seems rather obvious that we cannot provide "it costs X at the retail pharmacy at the corner of Main and Bank in city Y" for every retailer. Sensible retail pricing is likely not going to be at all feasible. It might be attainable to say that globally the wholesale prices for a standard quantity range from a low seen at about INR M to a high seen at about SFR N, with dated USD equivalents and citations of the form "On that date, one SFR was worth USD d. The reader can do the arithmetic if sufficiently interested, it's good practice for them.LeadSongDog come howl! 16:19, 18 May 2016 (UTC)[reply]

So many editors keep focusing on individual consumers. There's more to the economy than the guy who got prescribed antibiotics this morning and is trying to figure out whether he can save a little bit of money by going to a different pharmacy. Average global wholesale prices are far more important (to the world, to public health, to the global economy, to governments) than whether a given individual pays X or Y.

Also, we should just use whatever currency is used by our sources. It happens that it will be mostly US dollars. WhatamIdoing (talk) 14:49, 19 May 2016 (UTC)[reply]

break

The problem is, "global average prices" simply do not exist. Of course, if a drug is sold in US for $100 and in Bhutan for $1, one could say its "global average price" would be $50.50. But of course nobody sane will agree - the two economies or populations simply don't compare. An improvement would be, of course, to weight the "country wholesale price" for country population, getting closer to median price per global inhabitant. But this would not account for actual drug price, because drug consumption per inhabitant varies greatly from country to country. So, a still better way would be to try to calculate the mean price per unit sold globally – this would perhaps be the most informative of anything we can ever have. Not the "US wholesale price" as proposed by OP. However, the problem is that quite a number of payers (for example, nearly all payers across EU) procure drugs (or at least all reimbursed drugs) under confidential contracts and never disclose the quantities purchased or the prices paid; nor is patient aware of the price if the drug is received through government-funded healthcare.

These are all considerations one has to keep in mind when proposing to come up with any statistics that involve a large number of countries as well as data that is only estimated, not actual. And that's the reason we don't have sources that give "global average price" for drugs. — kashmiri ^TALK 16:04, 19 May 2016 (UTC)[reply]

Or one could provide a price range. Doc James (talk · contribs · email) 18:24, 19 May 2016 (UTC)[reply]

• Tellingly, Price of medications is a redlink. And can someone provide a fleshed-out example or two for this addition? So far, I only met general wordings like "1000 US$ per 500mg vial" (I'm generous here). -DePiep (talk) 10:48, 1 June 2016 (UTC)[reply]
  • At salbutamol "The wholesale cost of an inhaler which contains 200 doses is between $1.12 and $2.64 (USD) in the developing world as of 2014.^[1]" Doc James (talk · contribs · email) 12:31, 1 June 2016 (UTC)[reply]
    • salbutamol also says: "In the United States it is between $25 and $50 for a typical month supply". Why is it that I must pull this out myself? Why can not you provide an argument, even when it is supposed to help your point? Quite a non-constructive talk approach, Doc James.

-DePiep (talk) 18:16, 1 June 2016 (UTC)[reply]

Sorry not sure what the issue is User:DePiep? Doc James (talk · contribs · email) 09:59, 2 June 2016 (UTC)[reply]

The issue is, Doc James: you don't argue, you just throw in a link or a word. -DePiep (talk) 21:25, 4 June 2016 (UTC)[reply]

Doc James it would be interesting to hear you describe what you think an average wholesale price is, and what specific usefulness it might provide to any reader. I'm not opposed at all to having cost information in some or many drug articles where relevant, but it may be more useful to phrase it in terms of "average cost of therapy" (i.e. Avastin is $300k for a course of therapy treating X, $150k treating Y, etc.) But drug AWPs probably don't mean what most people would naturally assume them to mean, and even for an economic analysis would probably be of limited value. Nathan ^T 18:00, 3 June 2016 (UTC)[reply]

Agree with you about "average cost of therapy/course of treatment". I tend to use what the sources say.

The primary meds I have been working on are those on the WHO list of essential medicines. They are typically the only ones within this reference.[30] For the price in the developing world they list it per dose aswell as provide the defined daily dose. Am not providing the average but the range of available prices in the developing world. These ranges are typically fairly small. If one is buying for an NGO, pharmacy, or government in the developing world these details are useful. The price the consumer pays than is this plus markup. We say how much a Toyota_Prius_C costs as well as many other goods which I also think is useful. Doc James (talk · contribs · email) 20:49, 3 June 2016 (UTC)[reply]

That's why I asked the question of what you think a wholesale price for a drug represents, because generally speaking the reported wholesale prices (which are tracked as an average in the United States, and published by data aggregators like Medispan) are often higher than what a consumer would pay. The AWP of a drug might be $100, but the price to the pharmacy could be $3 and to the consumer $45. This is why I'm not convinced that including wholesale prices (which often don't reflect an actual price paid by anyone in any part of the supply chain) is very useful. If you had references for average manufacturer price or average sale price (AMP and ASP), or used the federal upper limit (FUL), this would be at least somewhat more useful data for the US. Nathan ^T 13:30, 4 June 2016 (UTC)[reply]

User:Nathan The proposal is to at least include the wholesale price in low and middle income countries (of which there are more than 100) and as provided by this source for essential medicines.[31] Doc James (talk · contribs · email) 16:50, 4 June 2016 (UTC)[reply]

So my question is this: do you think these wholesale prices actually mean anything to anyone? See below for a somewhat more detailed explanation of why I think they may not. This isn't medicine so much as it is the business of medicine, which is what I do; expertise in one doesn't necessarily overlap with the other, which I hope the medical professionals participating here realize. Nathan ^T 02:47, 6 June 2016 (UTC)[reply]

User:Nathan, I don't think that the goal is to provide "specific usefulness...to any reader". I think the goal is to educate readers about general economic issues, e.g., by teaching them how much prices vary between developed vs developing countries, how stable the prices for generic meds normally are, and how the cost of drug #1 generally compares to the cost of drug #2 (e.g., a drug that's off patent or from a different class). WhatamIdoing (talk) 03:16, 5 June 2016 (UTC)[reply]

Again - if the prices you are reporting don't reflect any particular reality, and don't even fit in the same frame of reference as you comparatively report them, then the usefulness of the information and the comparison is really questionable. A wholesale price in the US, reported as an average of wholesale prices reported by a sample of wholesalers, doesn't reflect anything close to what anyone pays and isn't meant to. Its similar to the sale vs list price phenomenon in that it is a marketing tool; Amazon will list something at $500 and then discount the price to $425 and say you are saving $75, even when all other sellers of the same item also charge $425. Similarly, a drug with a wholesale price of $500 or $1000 or $15,000 might have actual sale prices anywhere between 1% and 80-90% of that amount - with no pattern in the variation. This is all true for US wholesale prices; if wholesale prices in other countries follow a more rational pattern, then any comparison is intrinsically apples and oranges. Not to put too fine a point on it, but if a pharmacy in the U.S. typically sells medications for 60-75% below the average wholesale price then reporting the wholesale price without that critical context is misleading at best. Nathan ^T 02:47, 6 June 2016 (UTC)[reply]

What does "typically sells" mean to you? Is that "the pharmacy bought the drug for $20 and I paid $5 (and my health insurance company paid $15, but let's ignore that, so we can say it's a 75% loss)"? Or "the pharmacy bought the drug for $20, I paid $5, and my health insurance company's marginal cost was $0, but they paid a flat fee of millions of dollars to the pharmacy chain, so their actual cost, after properly allocating everything, was rather higher than $0"? Or something else? WhatamIdoing (talk) 03:28, 6 June 2016 (UTC)[reply]

The sale price in this context is the combination of the patient payment and any third party payment, i.e. the whole amount paid to the pharmacy for the drug dispensed. Total reimbursement is typically a lesser of calculation with an average wholesale price discount (between 15 and 30%) as a baseline, and then various other discounts which combine to make AWP - 75% a common overall rate of reimbursement. Nathan ^T 12:58, 6 June 2016 (UTC)[reply]

On further reflection, it seems to me that there are varying reasons for someone to want such information: to compare costs of different products within one jurisdiction; to compare cost of one product across jurisdictions; or to compare costs over time as one product moves through development to patent licensing and then to generic or orphan status. Each of these would, if suitably sourced, be information of value to some readers. None depends on retail/wholesale price ratios, except to the extent that such markup varies between jurisdictions. So it should just boil down to the question "Can we reliably source this?" LeadSongDog come howl! 19:00, 3 June 2016 (UTC)[reply]

Would the British National Formulary be sufficient User:LeadSongDog for UK pricing? We deem it to be suitable for other content. Doc James (talk · contribs · email) 20:49, 3 June 2016 (UTC)[reply]

While it is no doubt reliable, their website strongly suggests that they are restrictive about licensing use of the data. I am inclined to doubt the applicability of such restrictions, to databases of facts, but before we get too far down that path, we should have an informed discussion of whether we need to be concerned about them. Alternatively, we could pursue getting an explicit WP compatible license.LeadSongDog come howl! 21:32, 3 June 2016 (UTC)[reply]

One would paraphrase and attribute the BNF. With facts not being copyright-able I do not think we have a concern. This will be no different than saying drug X has side effect Y with a ref to them. Doc James (talk · contribs · email) 21:36, 3 June 2016 (UTC)[reply]

FAs have plenty of prices

For example: PowerBook 100, Macintosh Classic, Sunbeam Tiger, Talbot Tagora, Sunderland Echo, Wonderbra, Maraba coffee, Holden Commodore (VE), Odwalla, Maserati MC12.

In other words more than half of all FA in WP:Brands contains pricing information, many of them fairly extensive. Doc James (talk · contribs · email) 16:48, 6 June 2016 (UTC)[reply]

Amphetamine#History, society, and culture includes price information (street price of illicit amphetamine in Europe during 2012) as well, although IIRC the only reason it's there is because it was requested at the FA nomination. Seppi333 (Insert 2¢) 21:08, 6 June 2016 (UTC)[reply]

Doc James I can't believe you really think medicines are traded like Maraba coffee or newspapers. Why don't you try to find out the global wholesale price of Windows OS instead? — kashmiri ^TALK 20:05, 9 June 2016 (UTC)[reply]

Yes there is this field called economics which is the "study of the use of scarce resources which have alternative use". It applies to all sorts of stuff even medications. Doc James (talk · contribs · email) 04:28, 10 June 2016 (UTC)[reply]

Doc James, those aren't valid comparisons (as I suspect deep down you know). The articles on computers, cars, videogames etc list the price at the time of release; Sunbeam Tiger and PowerBook 100 mention what they sold for in 1964 and 1991, not annually-updated cites to Auto Trader and Computer Shopper to list what one can currently buy one for, and when we talk about including pricing info we're certainly not proposing "Methadone cost nine pfennigs per gramme when it was introduced in Germany in 1937". Yes, Sunderland Echo lists the current price, but that's because the concept of a paid-for local newspaper is so unusual in Britain (even behemoths like Metro and Manchester Evening News are given away free and funded by advertising) that it has to be pointed out, since otherwise readers will assume that it's a freesheet. ‑ Iridescent 23:09, 9 June 2016 (UTC)[reply]

All these articles have prices and they are perfectly valid comparisons. Price_of_oil lists prices over time. The arguments you have put forwards would be like trying to delete the article on the price of oil because it does not tell you the price of gasoline at the pump. Doc James (talk · contribs · email) 04:22, 10 June 2016 (UTC)[reply]

Public health issue

The price of medications are a critically important aspect of global health. Yes many people in the developed world are partly shielded from the issue of price by their governments. But governments still address these issues and Wikipedia is write for all including those in government.

Our article on the rabies vaccine for example contains "The wholesale cost in the developing world is between 44 and 78 USD for a course of treatment as of 2014.^[1] In the United States a course of rabies vaccine is more than 750 USD.^[2]"

That information makes it perfectly clear why when a child gets bitten by a dog in the developing world, they often do not get immunized against rabies. The family and the NGOs can often not afford the ~50 USD and therefore the vaccine is often not available / given. This explains the current situation where we have a perfectly preventable disease continuing to kill about 50k people a year. To put that into context Ebola killed 11k people over 2 years.

Removal of pricing details will mean that Wikipedia will continue to tell you what video game, television shows, songs, and books feature rabies. Our readers will continue to be able to figure out which Beavis and Butt Head and House MD episode featured the disease but will struggle to figure out why it continues to kill so many people. Doc James (talk · contribs · email) 13:44, 10 June 2016 (UTC)[reply]

One argument is that those who sit on government committees know where to find pricing details better than we can provide them. As someone who is on one of these government committees the answer is that that statement is wrong.

Evidence provided by one of those opposing pricing info was "in India... some states paying more than the lowest available retail price for salbutamol (page 83 of that paper)"[32] which means those in governement do not know how to accurately find these details and thus supports there inclusion

Doctors Without Borders has done a fair bit of work to increase price transparency [33] and this is something they are interested in collaborating on. Doc James (talk · contribs · email) 13:45, 10 June 2016 (UTC)[reply]

Sources

Let's make a list of sources that could be used for finding wholesale (=not end-user costs) for medications. Here's a few that I know about; feel free to add others. WhatamIdoing (talk) 21:25, 19 May 2016 (UTC)[reply]

• WHO price list for Africa; prices given are for governments and non-profits only
• Red Book Online, complete with links to their policy and methodology for calculating the average wholesale price for each drug
• International Drug Price Indicator Guide covers multiple countries
• Medicaid's National Average Drug Acquisition Cost for US-specific information
• MSF's price list[34]
• Tarascon Pocket Pharmacopeia
• Canadian Goverenment[35] Gives "international median" This link also useful [36]
• CADTH reviews discuss price as part of cost benefit analysis
• British National Formulary discusses costs of meds

Other projects addressing same issue

The discussion here is about Wikipedia presenting prices. Other projects right now are also starting to consider this issue, and also considering where to get sources. This week Robert Wood Johnson Foundation announced the start of their Prescription Cost and Coverage Challenge, which is a developer conference asking who can make the best app to deliver drug prices to American consumers. I think that anyone who could put prices in Wikidata and pull prices out according to any established formula would have a better product than anything else likely to be submitted. Whatever the case - there is a community of developers there also might be looking at data. At this point the contest just wants a design mockup. Blue Rasberry (talk) 13:49, 24 May 2016 (UTC)[reply]

Interesting. Would be cool to see this happen at a global level. Doc James (talk · contribs · email) 01:24, 25 May 2016 (UTC)[reply]

The other day, a medical journal editor asked me if Wikipedia is being manipulated by pharmaceutical or device manufacturers, and I told her there's no way of knowing for sure, short of a confession, and to the best of my knowledge no one's confessed. It did make me wonder, though, what the general feeling was here. Do you suspect there are shills at work on Wikipedia? (Let's not argue the point here, I'm just wondering about your level of suspicion/conviction, if any.) --Anthonyhcole (talk · contribs · email) 12:31, 22 May 2016 (UTC)[reply]

in terms of pharmaceutical or device manufacturers they probably (unfortunately) see opportunity, since their goal is to "make a profit", they most likely come at us w/ multiple accounts,there simply aren't enough people to handle COI, we need to be more proactive to stop them(when they sign up-directly ask if they have COI and if so... deny them access...IMO)--Ozzie10aaaa (talk) 13:09, 22 May 2016 (UTC)[reply]

• We have strong evidence of editors targeting specific companies/drugs/treatment plans, even with a proven COI. It is possible that these simply act out of poor judgement, not realizing that Wikipedia abhors COI, but I think it's very naive to think that is always the case. We will likely not see any true confession, as it is not illegal and the editor only needs to create a new account. While not pharmaceutical in nature, there is at least on user who has confessed to paid-editing who worked on medical topics: User:FergusM1970. Carl Fredik 💌 📧 13:55, 22 May 2016 (UTC)[reply]
• Sometimes an editor has a more obvious COI due to their username, e.g. this exchange. Scray (talk) 15:09, 22 May 2016 (UTC)[reply]
• It's likely happening. My impression is that editors are likely choosing to hide their coi as best they can rather than disclose, but it's just an impression from the lack of disclosures I encounter in these type of articles vs other topics. My solution is to mention WP:COI to every new editor that I contact. --Ronz (talk) 16:41, 22 May 2016 (UTC)[reply]
• Within central topics the issue with company editors is small. At the smaller / less central topics company editors are fairly common. We got a write up about it here http://www.theatlantic.com/business/archive/2015/08/wikipedia-editors-for-pay/393926/ Doc James (talk · contribs · email) 17:31, 22 May 2016 (UTC)[reply]
• I've seen occurrences on dietary supplements and phytochemical articles where developing consumer trends and marketing opportunities evolve readily from misinformation spread by celebrities and quacks. It requires an editor to keep skepticism sharp, apply WP:5P1 and WP:5P2 and adhere to WP:MEDRS sourcing if clinical efficacy is claimed. --Zefr (talk) 17:45, 22 May 2016 (UTC)[reply]
• The FDA wrote rules a few years ago on what the manufacturers/marketers of regulated drugs can and can't say on social media sites (Wikipedia counts as social media), and that encourages a certain amount of caution. We have occasionally had a few good pharma contributors, including some from GlaxoSmithKline who identified their employer in their usernames, years before that option was even explicitly permitted in the username policy. In my experience, pharma contributors are rare, scrupulous about following the rules, and very happy to supply sources. I don't remember encountering any device manufacturers (which is too bad, because there's much to say about those products, and overall less risk of problems with clinical efficacy claims).
  But AFAICT there are no such regulatory rules for sellers of dietary supplements or alt med products, and that's an endless problem area. WhatamIdoing (talk) 21:13, 22 May 2016 (UTC)[reply]
• We had a device manufacturer quite recently, and nutriceuticals and alt-med is rife with them, and they are allowed to continue despite that. I hold extremist mainstream views mind you. -Roxy the dog™ woof 21:17, 22 May 2016 (UTC)[reply]

Interesting. Thank you all. I'll point her to this thread. --Anthonyhcole (talk · contribs · email) 01:56, 23 May 2016 (UTC)[reply]

• I find that I come across very little COI editing from bigger pharma/biotech companies about the companies themselves. I have seen promotional editing around new drugs, especially mAbs for cancer, some of them from bigger companies. But mostly it is startups (see for example Alacris which is undergoing AfD now) or smaller companies (see Talk:Peregrine Pharmaceuticals) - and often this takes the form of hyping clinical trial results. Reagent companies do it too. We had an article created (pretty clearly for pay) about Exon Bio's mAb-making platform and then another editor spammed wikilinks to that article into several others. Medical device companies are the most aggressive. I actually emailed the founding scientist of a MED-EL as their employees were pretty relentless adding content about their devices and how they work into Wikipedia and to their credit, the spamming stopped. And the Atlantic article tells about James' experience with Medtronic. Yes the dietary supplement space is pretty rife with conflicted editing.

Two other things I want to mention about WP that no one else has yet. The first is that advocacy editors are a huge problem - no one can quantify if people with a financial COI or who are advocates harm WP more, but both are a big problem. In the medical space, we see that especially with people upset about side effects. All our articles about Quinolones had been extensively worked on by someone who disclosed on-wiki that he was head of a patient advocacy group and had made those articles into horror stories; an editor who is no longer here cleaned most of that up. Likewise we get folks wanting to dramatically emphasize side effects of SSRIs (especially sexual side effects). Likewise articles about circumcision have been beset by people opposed to the practice. Lots of the alt-med issues arise from advocates, perhaps more than from people with a financial COI. We have had super fierce battles about chronic Lyme for example and our article about acupuncture is a militarized zone. And very recently we have had .. what shall i call them, bio-hackers maybe? -- writing all kinds of promotional how-to content about nootropic drugs.

The other thing I want to say is that I think most everybody in WP:MED is very watchful and I think we do a pretty good job keeping promotion and advocacy out of our articles. Article maintenance is a ton of work. WAID will not like it that I say this, but one of the beneficial "side effects" of our strong sourcing guideline is that generally it is hard to get lousy (i.e. driven by promotion or advocacy) content about health into WP because generally MEDRS sources won't support it. The strong sourcing guideline along with our active maintenance is powerful.

Finally, Anthony one thing I would love for your journal editor friend to be aware of, is that when they publish reviews that make claims that are really not supported by the work that has been done in the field this harms Wikipedia. Everything in WP starts with sources, and when those articles enter the literature, they are MEDRS sources, and we are stuck with them and advocates use them like hammers. I for one am very grateful for high quality medical editing. I don't know if your friend is aware of how dependent we are on the work he/she and their colleagues do. Jytdog (talk) 03:42, 23 May 2016 (UTC)[reply]

Talking about people (very probably) involved in litigation coming here - a fresh example: Special:Contributions/Enmeshed. Jytdog (talk) 05:00, 31 May 2016 (UTC)[reply]

• There is no instance in the popular Wikipedia community consciousness of any medical organization corrupting Wikipedia content, or even attempting to do so. There are hardly any examples of any medical organization engaging Wikipedia in any way that has an impact the Wikipedia community would recognize. I am aware of numerous claims outside the Wikipedia community among advocates of alternative medicine that Wikipedia is controlled by agents of big pharma that wickedly add evidence-based medical content to Wikipedia as a way to suppress the public availability of alternative medicine. I really wish the big pharma shills would come here and do that, but have seen no evidence that this happens. The rumors that circulate complain about regular Wikipedians in this forum, and not unknown actors, and I think no one in this forum is suspected by other forum members to be a secret big pharma spy. The rumors are based on a misunderstanding that regular Wikipedians are commercial actors. Blue Rasberry (talk) 19:34, 23 May 2016 (UTC)[reply]

Of course Big Pharma don't go out of their way to discredit alt med. Alt med products earn Big Pharma billions of dollars each year, often through specialist alt med companies that are owned by major pharmaceutical companies. Giant pharmaceutical firms actually own the bulk of the industry. Pfizer owns Centrum, Bayer owns One a Day, and Procter & Gamble owns supplement maker New Chapter; See also. Adrian J. Hunter^{(talk•contribs)} 10:22, 6 June 2016 (UTC)[reply]

I think you are confusing alternative medicine with the dietary supplement business. The two are ENTIRELY different. — kashmiri ^TALK 18:55, 6 June 2016 (UTC)[reply]

Well, there's certainly some overlap. Shark cartilage pills are sold as dietary supplements, but that's alt med. It probably makes sense to think of it on a continuum that runs from mainstream medicine through dietary supplements and out to the fringiest ends of alt med.

But I don't think I'd describe mainstream brands of basic multivitamins as "alt med". "Anti-evidence med", maybe, but still mainstream. WhatamIdoing (talk) 03:45, 7 June 2016 (UTC)[reply]

All I'm trying to say is that Big Pharma has no financial incentive to support our mission, because they profit tremendously from an ignorant and gullible public. That's true whether they're selling plausible but discredited "mainstream" products (antioxidants?) or patent nonsense (chlorophyll tablets). Adrian J. Hunter^{(talk•contribs)} 02:53, 11 June 2016 (UTC)[reply]

While I do not support "big pharma shills" coming here due to some less than positive interactions. Agree that the rumors of a significant impact are untrue. Alt med folks are unhappy with WP:MEDRS. Doc James (talk · contribs · email) 21:38, 23 May 2016 (UTC)[reply]

Yes, although not always. There is a bunch of editors with a truly messianic approach, who seem to go over the top in bashing alt medicine. Look at Burzynski Clinic, it not just states that the guy is a fraud (which he likely is): the bunch of editors seem to take weird pleasure in debating every single court case, even ongoing one, in the lengthy article; at detailing every single negative mention of the clinic. Any attempts to restore balance get you attacked and reverted. I gave up long ago. That's the approach I guess which makes some question the motives of some WP editors. — kashmiri ^TALK 06:39, 24 May 2016 (UTC)[reply]

It seems increasingly hard to get people to remember what an encyclopedia article looks like. On both sides of the alt med subject (and other controversial subjects), we have people who want to provide very lengthy expositions of every detail that supports their POV. WhatamIdoing (talk) 01:46, 25 May 2016 (UTC)[reply]

I think that all of these articles are discussing the same concept by different names.

• Shared decision-making
• Patient participation
• Patient-centered care
• Participatory medicine
• Health consumerism

I would appreciate comments on merging any or all of them at Talk:Patient_participation#Proposal_to_merge_articles_on_similar_concepts. Thanks. Blue Rasberry (talk) 19:25, 23 May 2016 (UTC)[reply]

Agree. SDM is the most often used term IMO. I suggest merging it all to that. Doc James (talk · contribs · email) 21:32, 23 May 2016 (UTC)[reply]

I support the idea of merging these articles.

There's probably another set of articles, with various names that amount to "patients using the internet" that could also be merged into one sensible one. WhatamIdoing (talk) 16:32, 26 May 2016 (UTC)[reply]

• more opinions please(gave mine)--Ozzie10aaaa (talk) 10:54, 5 June 2016 (UTC)[reply]

At Talk:Intelligence_quotient#2012_study a couple of people are saying that IQ should be subject to WP:MEDRS. The article is not in the medicine project, Ibut I would appreciate your input to the discussion. Dmcq (talk) 20:19, 28 May 2016 (UTC)[reply]

Thanks for the post Dmcq. I am the one who proposed this at the article talk page, when I moved content that was being contested, that was based on a primary source, to the Talk page here. So I am saying "yes" to this with regard to the WP:Biomedical information about the science (biology, neuroscience, psychology). History, society and culture, etc are of course not subject to MEDRS. But the core scientific discussion of this should be, yes. Jytdog (talk) 20:39, 28 May 2016 (UTC)[reply]

I think the MEDRS discussion is really a distraction here, because it looks like there's already a consensus to focus on high-quality sources along the same lines as MEDRS. That said, if the question is on what MEDRS requires, you can't declare an entire topic to be either MEDRS or not - that has to be determined on a case-by-case basis for each statement being cited. Things that require MEDRS sourcing would include anything that associates it with conditions (either directly or by implication), as well as information that might be relevant to interventions (given the existence of those associations). Statements about the underlying biology may or may not require MEDRS depending on whether they have any medical or health-related implications. On the other hand, information about things like the societal views surrounding the topic are excluded, as Jytdog pointed out.

Of course, none of that changes the fact that higher-quality sources trump lower-quality sources anyways, or that choosing to exclude the latter is a valid editorial decision. (But framing that exclusion as being an application of MEDRS probably isn't the best idea, because of the legitimate objection that not all the information is within MEDRS' scope.) Sunrise (talk) 22:30, 28 May 2016 (UTC)[reply]

I don't dispute that MEDRS supports high quality sources. The problem I feel is that it is aimed at butt covering in case some idiot injures themselves rather than at covering the main points of view with due weight. Thus at that IQ article Jytdog removed a bit about a study of multiple types of intelligence because the source was a newspaper article based on a primary source. In any other place that would be a secondary source based on a reliable source. There was also a sentence following about a comment in another journal disagreeing with it. That is perfectly fine for most scientific articles but they'd just do the MEDRS thing which is designed to stop health problems due to wrong information. It is just inappropriate for the article. Dmcq (talk) 20:14, 29 May 2016 (UTC)[reply]

Newspaper articles are almost always WP:INDY, but not usually secondary. See WP:Secondary does not mean independent and WP:PRIMARYNEWS.

The more important point isn't whether the already-cited source is good enough. The more important question is whether, if you had read all of the reliable sources in the world about this subject, you would have included this (and maybe cited a fancier source in the process). "Not already cited to a stellar source" is not the same thing as "Cannot be cited to a stellar source". WhatamIdoing (talk) 16:00, 30 May 2016 (UTC)[reply]

As I said in this case it was reporting on a primary source which was a peer reviewed paper. It wasn't a shill piece for a pharmaceutical company and it was a highly reputable paper. I take your point about weight and in fact the article already has 51 citations in other papers but seemingly what they want is some meta study or review paper, the other paper talking about it wasn't enough for them. The problem I have with MEDRS is I feel that Wikipedia should in most cases be like a good librarian, yes in the case of Mogadol you don't want to say anything dangerous, but if a person comes in asking for something about different components of intelligence in an IQ test because they read about it in the newspaper is it really very sensible to stretch for a pharmacopoeia and say no that information is not definite enough to be safe to say anything about? Dmcq (talk) 16:15, 31 May 2016 (UTC)[reply]

One of the things you are not taking into account here is that if you search pubmed you get over 2000 papers. You cannot do them all - so on what basis are you going to select ones to "profile" in Wikipedia? One of the things that MEDRS does, is provide filters for which sources to use - it says take the most recent reviews from the most appropriate/best journals you can find. So now we can focus on say just the three of four most recent reviews from the best journals in those search results (with additional filters last 5 years and reviews), and summarize what they say, counting on the experts in the field who wrote the reviews to highlight which studies have been important. Jytdog (talk) 20:04, 31 May 2016 (UTC)[reply]

We can do it exactly like any other topic in Wikipedia. Do you think there aren't enormous numbers of papers about calculus? Do you think the article only lists articles which reflect the latest thought like exterior differentiation, well actually that's 100 years old but not many readers will know about it. Instead it tries to be high level and deal with the sorts of things that people who know just a little might be interested in. And they have links to more detailed articles. And those have links to more detailed articles again and that is four levels down from the top. The sort of stuff that is at the top is what is popular, what people who write articles for the general interested public though I must admit popular mathematics may not be all that popular. And even then people complain about the articles being too technical. How is a person supposed to get in to a subject where popular articles and newspapers are ignored and only the latest research as described in peer reviewed reviews is allowed? Dmcq (talk) 20:44, 31 May 2016 (UTC)[reply]

Wikipedia isn't about the cutting-edge of science — but about established knowledge. This is extra important when it comes to medicine — but I believe it is nearly as important when it comes to psychological topics such as IQ. Carl Fredik 💌 📧 20:49, 31 May 2016 (UTC)[reply]

(edit conflict) I agree fully with Jytdog and MEDRS can also be seen as a tool that helps us limit what is otherwise an overwhelming task. By limiting what sources we allow we remove from the equation the need to review and balance different primary sources — and seeing as this field has a wealth of high-quality secondary sources there really ins't a need to cite a newspaper summary of a primary source. WP:SCIRS is an essay that might be applicable here — it closely mirrors much of MEDRS, with some minor differences. MEDRS and similar guidelines help us determine WP:DUE weight — if it is rare or fringe enough to not merit inclusion in secondary source it is likely not due. Carl Fredik 💌 📧 20:45, 31 May 2016 (UTC)[reply]

I just pointed to a subject that has an enormous amount written on it and is very technical as an example of how people are quite happy in other subjects without MEDRS. I am happy for WP:SCIRS to be applied. It is quite different from WP:MEDRS. It allowed for instance articles like Faster-than-light neutrino anomaly before other studies of the result because it was reported to the public. This is what I'm talking about there. This was reported to the public but MEDRS would have us say nothing in Wikipedia and even later leave out popular understanding about it. What MEDRS instead says is that only people with access to medical journals behind paywalls can write anything and anything in popular publications is banned, it is not the encyclopaedia that can be edited by anyone. And I respect that for all the dangerous drugs and quack treatments in medicine. I'd like to know why you think IQ should be treated with kid gloves though more than say the articles about Arab-Israeli conflict and suchlike things when there are so many rubbish test your own IQ books around and it is mainly a social construct rather like a triathlon score? In fact isn't the triathlon far more dangerous? Dmcq (talk) 08:14, 1 June 2016 (UTC)[reply]

What MEDRS instead says is that only people with access to medical journals behind paywalls can write anything and anything in popular publications is banned ← that is a perverse & mistaken reading. The overall goal is better summarized in the opening para: " ... all biomedical information must be based on reliable, third-party published secondary sources, and must accurately reflect current knowledge". Can't see why anybody would want to disagree with that. Alexbrn (talk) 10:52, 1 June 2016 (UTC)[reply]

Well, one consequence of that approach – especially when "reliable, third-party published secondary sources" is interpreted to require academic secondary sources and to exclude lay-oriented secondary sources – is that it amounts to a requirement that certain articles must be incomplete, exactly at the time when we can reasonably expect readers to look for it here.

Naturally, editors with different values will have different opinions about how much of a problem this is. The approach taken at SCIRS is to try to find a way to include some mention of the material in a relevant article. Perhaps that would be more appropriate in this case. WhatamIdoing (talk) 16:13, 1 June 2016 (UTC)[reply]

Yes but such an approach would also be mistaken, since MEDRS does not exclude lay-oriented secondary sources (quite the opposite) - which are sometimes the best. Alexbrn (talk) 16:20, 1 June 2016 (UTC)[reply]

That is not how I read them, for instance see WP:MEDRS#Popular press compared to WP:SCIRS#Popular press. Yes they both warn about problems - but MEDRS in addition says says 'Findings are often touted in the popular press as soon as original, primary research is reported, before the scientific community has analyzed and commented on the results. Therefore, such sources should generally be entirely omitted' and 'For Wikipedia's purposes, articles in the popular press are generally considered independent, primary sources.' Direct reports by a reporter of an accident might be considered a primary source but that is simply not so in general. WP:SCIRS right at the stat says 'Although news reports are inappropriate as reliable sources for the technical aspects of scientific results or theories, they may be useful when discussing non-technical context or impact of science topics, particularly controversial ones' whereas WP:MEDRS says ' Primary sources should generally not be used for medical content – as such sources often include unreliable or preliminary information, for example early in vitro results which don't hold in later clinical trials.' SCIRS has a section WP:SCIRS#Respect primary sources. Compare that to WP:MEDRS 'Primary sources should generally not be used for medical content – as such sources often include unreliable or preliminary information, for example early in vitro results which don't hold in later clinical trials.' They are very different guidelines. Dmcq (talk) 15:14, 2 June 2016 (UTC)[reply]

Then you need to re-read them and not nit-pick. They are very similar guidelines. Both warn about the problems of using popular press as sources, for the same reasons. SCIRS doesn't explicitly recommend omission, but implies it in its warning. SCIRS advises that news reports are inappropriate for technical aspects of scientific theories; and MEDRS tells us not to use news reports for biomedical claims. SCIRS has a section advising editors to respect primary sources such as reports of historic experiments, but advises that sources are to be cited appropriately; that's no different from MEDRS which does not prohibit primary sources for historical content. Compare MEDRS's 'Primary sources should generally not be used for medical content – as such sources often include unreliable or preliminary information' with SCIRS's 'Such evidence should include reviews of the literature including the work of several different research groups. Individual papers often disagree with each other'. Of course the guidelines are very similar to each other because both require us to use the best quality reliable sources whenever they are available - and that means not using primary sources when reliable secondary sources can be found. --RexxS (talk) 16:02, 2 June 2016 (UTC)[reply]

Actually, it appears that SCIRS encourages the use of primary sources: "A primary source, such as a report of a pivotal experiment cited as evidence for a hypothesis, may be a valuable component of an article. A good article may appropriately cite primary, secondary, and tertiary sources."

Also, is this really a "biomedical" claim? Where's the "medical" information in saying that century-old concept of a g factor in intelligence – an idea that has been criticized as being unfalsifiable and therefore unscientific – is really just a fancy name for memory, reasoning and verbal skills (things that, unlike g, have a known biological basis)? This appears to be the disputed diff. I'm not seeing medical information in there. WhatamIdoing (talk) 19:17, 2 June 2016 (UTC)[reply]

I disagree. SCIRS encourages using primary sources appropriately, as do all the sourcing guidelines, including MEDRS. The disputed claim was removed to the talk page for discussion because it was a poor source (Undid revision 722327526 by Code16 (talk) moving this to talk for discussion; sourcing is poor and unclear to me if this should be in the article at all - see talk), not because it failed MEDRS - although falling short of the standards set by MEDRS is usually a pretty clear sign of a poor source. This idea that any content which isn't incontrovertibly a biomedical claim is somehow released from any obligation to use the best available sources needs to be knocked on the head with extreme prejudice. --RexxS (talk) 22:04, 2 June 2016 (UTC)[reply]

There is no requirement in any policy or sourcing guideline that obliges editors to use "the best available sources". The policies set a minimum standard, and that minimum standard is rather lower than "best".

I'm perfectly willing to consider whether this source meets the minimum standard. But my point in asking whether there's anything "medical" in this "bio-psychometrics" statement is to figure out which of the specific minimum standards is most relevant. If there's no "medical", then MEDRS isn't the most relevant standard. Perhaps SCIRS is; perhaps plain old RS is. (Several, including BLP and HISTRS, obviously aren't relevant.) WhatamIdoing (talk) 06:48, 3 June 2016 (UTC)[reply]

Of course one can use primary sources but every policy and guidelines says we should use independent secondary sources generally; sure there are situations were primary sources are actually best and you know as well as anyone that what those few situations are. We are not talking about them here. There are lots of things people can do in WP. When you have a situation where one editor is pushing to use low quality sources and a bunch of others are aiming high, what in God's name is the point of wikilawyering in favor of poor quality sources? Jytdog (talk) 09:18, 3 June 2016 (UTC)[reply]

@WhatamIdoing: You seem to misunderstand that policies and guidelines are descriptive, not prescriptive on Wikipedia. Just because nobody has bothered to write down our requirement to use the best available sources is not a "get-out-of-jail card", giving anyone licence to source our content to the minimum standard. When you are challenged to use the best sources available, it is not a defence to say "The policies don't require it". You need to address the question: "What possible reason could I have for not using the best sources that can be found?" And the answer is usually "because they don't suit the POV I'm trying to push". Making do with second-best sources is merely enabling those who want Wikipedia articles to fit their own world-view, regardless of what the real science is. --RexxS (talk) 14:02, 3 June 2016 (UTC)[reply]

Just now seeing this section on the same day I am discussing a matter with an IP about sex differences in intelligence, I agree that WP:MEDRS-compliant sources should usually be used for IQ topics. Flyer22 Reborn (talk) 01:34, 3 June 2016 (UTC)[reply]

And I consider brain anatomy information (how the brain works, is affected, etc.,) a biomedical topic. Flyer22 Reborn (talk) 01:36, 3 June 2016 (UTC)[reply]

Human intelligence is a brain anatomy topic. Flyer22 Reborn (talk) 01:39, 3 June 2016 (UTC)[reply]

I believe that many experts would disagree with your belief. WhatamIdoing (talk) 06:48, 3 June 2016 (UTC)[reply]

And considering that the study of brain anatomy involves the topic of intelligence, as anyone who actually read sources on brain anatomy, especially ones about the human brain, would know, your belief on that is wrong. I usually cite sources for matters like these, but you can find them yourself easily enough. Flyer22 Reborn (talk) 06:19, 5 June 2016 (UTC)[reply]

I do wish those pushing for MEDRS would stop this business of saying anyone rejecting MEDRS is rejecting high quality sources. It is particularly illogical to say that MEDRS is the same as SCIRS but that a person saying SCIRS should be used is a POV pusher trying to put in less good sources. Is it about the same so there is no real argument or is it so different that it is okay to launch a personal attack when a person supports SCIRS? Dmcq (talk) 21:48, 3 June 2016 (UTC)[reply]

Yes, I'm sure you're not keen to hear that the community would prefer to see you using high quality sources. Nobody posting here has told you that MEDRS is the same as SCIRS. 'Same' and 'similar' are not synonyms. Nor has anyone on this page associated high sourcing standards with POV-pushing. Are you trying to tell us that you think SCIRS encourages you to use less good sources? It doesn't. You like playing strawman much? --RexxS (talk) 00:37, 4 June 2016 (UTC)[reply]

From what you when I said the guidelines are different: "Then you need to re-read them and not nit-pick. They are very similar guidelines." and various other bits trying to say they were practically equivalent. And just above " You need to address the question: "What possible reason could I have for not using the best sources that can be found?" And the answer is usually "because they don't suit the POV I'm trying to push". Making do with second-best sources is merely enabling those who want Wikipedia articles to fit their own world-view, regardless of what the real science is." So are you actually saying here that SCIRS is an appreciably different standard and exactly what are you implying by talking about PO)V pushing here? Your "Yes, I'm sure you're not keen to hear that the community would prefer to see you using high quality sources." because I support SCIRS on an article rather than MEDRS is a direct personal attack. I think you need to go away and reconsider your attitude before continuing and then address the issues rather then attacking the person Dmcq (talk) 10:35, 4 June 2016 (UTC)[reply]

I'm not convinced that "the community" will agree that a heavily cited peer-reviewed paper is actually "a low quality source" for the statement in question. Reliability depends upon the statement being supported, and quality isn't some simple binary concept. WhatamIdoing (talk) 03:20, 5 June 2016 (UTC)[reply]

@Dmcq: When I told you that the guidelines are similar, I meant similar, not identical - nor vastly different. That's normal English usage for most of us. When you were trying to discredit the guideline you don't like by making a mountain out of the molehill of differences from a similar guideline, I pulled you up on it by affirming how similar they are. You then switched to the usual CPUSH defence of pretending that I said something that I didn't: that the guidelines were the same. That allows you to make a strawman argument, but it really is obvious. And don't bother trying to fit me up with the "personal attack" malarkey, I've seen all too many times before from CPUSHers. So I'll ask you again, what possible reason could you have for not using the best sources that can be found? --RexxS (talk) 22:56, 9 June 2016 (UTC)[reply]

Well since you seem to think a personal attack is okay can I say I consider your arguments extremely stupid and beside the point and believe you indulge in personal attacks because you are incapable of anything better. Dmcq (talk) 23:39, 9 June 2016 (UTC)[reply]

Best possible

This is a bit of a tangent, but I think that the regular folks here need to be thinking about this.

So in terms of credentials, we begin with what most of your old folks know: I've spent about the last eight years working on the sourcing guidelines. For those of you who don't know, here's a quick metric to consider: All of these pages predate my first edit, and yet I'm still one of the most frequent participants ever in discussions and changes to these pages. The current numbers appear to put me at #6 at WT:V (#14 on the policy), #2 at WT:RS (#7 on the guideline), #2 at WT:CITE (#5 on the guideline), #1 – the most prolific contributor ever – at WT:MEDRS (#3 on the guideline). As a consequence of spending more a thousand of hours on this subject, is highly probable that I am familiar with these guidelines and policies, including both what they say, what they have said in the past, and how well they do, or don't, reflect what a variety of community members think about them.

And with that set of "credentials", aka "you should pay attention to her, because she does actually know what she's talking about on this subject" out of the way, I want to tell you something important about this "best possible source" idea: The community does not support requiring the best possible source.

The community adores the best possible source. The community is pleased whenever you replace a mid-quality source with a top-quality source. But that same community refuses to require the best possible source. This can be seen if you follow enough discussions for enough years, but it can also be seen in the policies and guidelines themselves. For example, WP:BURDEN requires an editor to provide only a single source that that editor sincerely believes to be reliable (NB not "the best possible source", but merely reliable) for the statement. You should all recognize that picture. That picture, with that statement, which explicitly accepts "lightweight" sources for some purposes, has been in both RS and MEDRS for years.

There are many reasons for the community's rejection of "best possible" as a requirement instead of an aspirational hope, but the basic categories are easy enough to grasp:

• It's hard to agree what "best" means. For example, an editor once claimed that his five-year-old source was better than the existing five-year-old source because it was one month newer. (Apparent actual reason: his source had a different POV.)
• Requiring "the best" often results in NPOV violations. See, e.g., most disputes about overmedicalization of gender ("you can't include that POV; it's not from a medical journal!"), many geopolitical disputes ("That source is from Russia! Everyone agreed that Russian sources aren't 'the best'"), etc..
• Requiring "the best" destroys editors. Nobody wants to join an organization when their efforts to contribute are met with reversions instead of collaboration. If the source is barely "good enough", then your next move is to offer better ones, not to revert the other guy until he jumps through enough sources.

The bottom line is that while it's good to have "the best" sources, what's actually required is to have "good enough" sources. "Good enough" depends upon the exact words of the specific statement. And it's that last bit that I think some people have been overlooking in this dispute. The source isn't stellar, but it's probably "good enough" for the exact statement being made.

And, one of these days, I need to (probably quit my job and) finally write WP:MEDDUE. We need to stop claiming that MEDRS prohibits sources that do fully and reliably verify the sentences they're supporting. WhatamIdoing (talk) 03:49, 5 June 2016 (UTC)[reply]

I think you're making a fundamental mistake by viewing sources as being "good enough" to support a particular statement (as opposed to e.g. the "best" to support that statement). That's putting the cart before the horse, as we need to be writing the statements to reflect the sources, not searching for sources to substantiate the words we're writing. That's where some experts and most POV-pushers run into difficulties: they start from what they think the article should say and then struggle to find sources that support what they want to write against the efforts of established editors who want to write the text from the best sources. I'm sorry for the experts who come unstuck like that, but Essjay poisoned that route a long time ago. I, for one, am not prepared to compromise the fundamental principles of editing Wikipedia to make life easier for groups of editors who don't want to be bound by the same principles as I am.

Contrary to what you're suggesting the community actually does support requiring the best possible sources. That's how Wikipedia has worked from day one. Somebody finds a decent source or two and uses them to write a article; later on somebody else finds a source that they think is better and re-writes the article to reflect the better source; that either sticks (and is accepted by the community) or someone reverts it - and if that becomes a dispute, the community (in the shape of other editors) eventually adjudicate. But whichever way it works out, the 'winning' version has been judged by the community to be using the best source(s) found so far for that context. When Wikipedia is working properly - for example with well-watched articles in fields where there are lots of good quality sources - then sources that are not as good as the best that can be found will be steadily replaced by better ones. And although you can claim that nobody has written down that the best sources are required, I can counter that by affirming that Wikipedia is not governed by written policies, but by the firm imperative to improve articles no matter what (WP:IAR). If you can find me a policy that says we should stick with "good enough" sources in preference to better ones that are clearly available, I'll concede the argument. But I'm willing to make a small wager that no such policy has ever been written, nor ever will be. --RexxS (talk) 23:26, 9 June 2016 (UTC)[reply]

Perhaps we need to get a shared understanding of what the word requires means before we talk about this any further. When I say the community does not "require" the best possible source, I mean that the community "does not require" as in "does not 'demand as necessary or essential; have a compelling need for'[37] the best possible source rather than a merely "reliable" source.

"Required" is not, so far as I understand the word, something that describes an optional choice: for example, all editors are required to comply with copyright law at all times, with zero permissible exceptions. "Requiring the best possible source" would mean that every single source that is "reliable" but is not "the best" must be rejected. For example, reputable mid-tier academic journals are "only reliable" sources rather than "the best possible" sources, so editors would be required to not use them (assuming that a source from a top-tier journal exists).

Now, how do you define the word require, as in "the community either does (or doesn't) require the best possible sources"? Or, perhaps more efficiently, if you use my definition of this word, do you still believe that the community truly requires "the best possible source", or will you agree with me that the community only prefers excellent sources, but requires "reliable" ones, even if those "reliable" sources aren't actually the best possible sources? WhatamIdoing (talk) 04:30, 11 June 2016 (UTC)[reply]

I thought perhaps you were treating "the community requires the best sources available" as if it were a conscious decision by an individual. But it's not. You know this is a wiki and articles are often improved without a "guiding hand" behind the improvements. The very nature of crowd-sourced editing leads to trends occurring, and I'm referring to the way that works on Wikipedia. When I say the community requires the best sources, I mean that, by and large, any reasonably well-trafficked article will see its sources improve toward those that consensus deems the best. It's not because an editor comes along and is compelled by rigid policy to replace "good enough" sources by "better ones"; it's because sooner or later somebody finds a better source and uses it in the article to replace the poorer ones. It doesn't work perfectly, and it's not guaranteed to be a monotonic progression towards perfection, but given enough time and enough edits, the sourcing in the average article will tend to improve towards using the best sources that can be found. And I maintain that that process is not optional. Let me ask you, given a reasonably well-trafficked article sourced to these "mid-tier" sources, and given that editors are aware of "better" sources, do you actually believe that there is no pressure to replace the former with the latter? That's how I understand the community requiring something - by what happens, not by what is written down <hyperbole>on some policy page by a tiny cabal of editors who have never actually edited an article in their entire Wiki-careers.</hyperbole> Are we any nearer a mutual understanding now? Cheers --RexxS (talk) 18:51, 11 June 2016 (UTC)[reply]

I have been attempting to use plain English throughout, which is probably what threw you off.  ;-)

I hope and believe in, as if an article of faith, the inevitability of improvements to articles. But "someday, someone will probably improve the source" is not at all what I'm talking about. I mean instead that, if the best is required, then the less-than-best is prohibited – and not just when someone else already has a better source in hand and is willing to improve the article with it right now.

And here's why this matters in practice: If "the best is truly required", then any editor can simply go blank anything that is supported by a merely "good enough" source (e.g., most of Barack Obama). Not "replace with something better", which is what you're talking about, but just "blank". Hey, "the best" is required, and newspapers aren't "the best", so goodbye to all that. But if instead the rule is that "'the best' is preferred, but 'good enough' is acceptable", then any editor is welcome to improve the less-than-best sources (and content), and to encourage other people to upgrade the sources (and content), but not to blank sources that aren't "the best" (unless, of course, those sources are so far removed from "the best" that they aren't even "good enough", which happens all the time). And it seems to me that this latter approach is how it works in practice, all over the project: "the best" is preferred, but "at least good enough" is what's required.

(Your hyperbolic statement about the tiny cabal of editors is unfortunately accurate. Policies and guidelines are written by an incredibly tiny fraction of the community. [Wait, I meant to say, "WP:There is no cabal".]) WhatamIdoing (talk) 03:38, 12 June 2016 (UTC)[reply]

Sure - I don't think we're too far apart in what we actually believe, but maybe we tend to look at thinks from a different perspective. I accept that you can make the argument in theory that "requiring the best sources" could lead to a CPUSHer arguing that they could blank content that doesn't cite the best sources, but I think we might agree that in practice they would get short shrift, and persisting in that would probably lead to them being sanctioned. That's how I see the community working to 'require' particular behaviour when editing. I think your perspective is that there's a "rule" that says "sources are required to be good enough", while I'm saying that the invisible hand of community consensus eventually enforces a stricter "non-rule" (should that be "!rule", I wonder?) which insists on the best sources. The only advantage of my position is that I don't have to put up with the shit of some wikilawyer trying to play off one guideline against another, like some naughty kid trying to do the same with two parents, in order to get his own way. Cheers --RexxS (talk) 09:51, 12 June 2016 (UTC)[reply]

•  Comment: The concept of "intelligence quotient" originated within, and still belongs to, the field of psychology. Psychology not being a medical science, there is no justification to apply criteria developed by WP Medicine to articles belonging to other projects or branches of human knowledge. Even if some doctors pondered over human intelligence. — kashmiri ^TALK 06:43, 5 June 2016 (UTC)[reply]

Kashmiri, psychology is a branch of the medicine field. User:Flyer22 Rebornc (talk) 07:29, 5 June 2016 (UTC)[reply]

@Flyer22 Reborn: It is not. You are likely confusing psychology with psychiatry. — kashmiri ^TALK 08:09, 5 June 2016 (UTC)[reply]

As Kashmiri says psychiatry is a branch of medicine but psychology is not. It has applications in medicine, that is different. Anyway my problem is with applying standards that look to be set up to protect people from quacks and their own selves to all sorts of things where is is no such worry. My feeling about it is that there should be two separate guidelines, one for finding medical sources and one on care in articles which have the potential for causing harm and we need to get things right to avoid being blamed for it and trust that having accurate information more than balances the harm of not censoring. Dmcq (talk) 08:36, 5 June 2016 (UTC)[reply]

That sounds reasonable, although the standard would have to be developed from scratch - while WP:SECONDARY applies also to psychology-related articles, guidelines on admissible sources, similar to MEDRS, need to be drafted anew, taking into consideration that several branches of psychology have more affinity with humanities than with science, and as such are less standards-oriented than medicine, giving more acceptance to individually-held theories. — kashmiri ^TALK 10:10, 5 June 2016 (UTC)[reply]

Kashmiri, I considered that you might point me to psychiatry. Kashmir and Dmcq, I understand the difference between psychology and psychiatry; I've studied those fields enough. And I know that psychology and psychiatry are often confused. The confusion, or rather equation, is common, even among health professionals. And that's for valid reasons, which I will get to in a moment. But I'll concede that branch perhaps wasn't the right word. My point about "psychology [being] a branch of the medicine field" was that the literature commonly considers psychology an aspect of the mental health field. Our own Mental health article currently states, "Mental health is a level of psychological well-being, or an absence of psychiatric illness." And the mental health field does fall under "medicine." Furthermore, I've come across many sources over the years that include psychological issues as part of the definition of psychiatry. For example, this 2012 Psychology: Themes and Variations source, from Cengage Learning, page 70, states, "To summarize, psychiatry is a branch of medicine concerned with the diagnosis and treatment of psychological problems and disorders." It also states, "Some people are confused about the difference between clinical psychology and psychiatry. The confusion is understandable, as both clinical psychologists and psychiatrists are involved in analyzing and treating psychological disorders. Although some overlap exists between the two professions, the training and educational requirements for the two are quite different." It then goes on to explain. Because of the overlap, I've met enough doctors who consider the matter "tomato tomato." If we look at more sources, we see that psychologists are commonly designated as part of the medical field. For example, this 2012 Learn Psychology source, from Jones & Bartlett Publishers, page 581, states, "A counseling psychologist is a mental health professional who helps people experience difficulty adjusting to life stressors to achieve greater well-being." It also states, "Clinical psychologists are mental health practitioners who research, evaluate, and treat psychological conditions." And when it comes to mental health topics, we do adhere to WP:MEDRS. If someone has a psychological disorder, WP:MEDRS sourcing is the way to go." That was my point. Our own Psychological disorder article is currently titled "Mental disorder," and it lists "mental illness", "psychiatric disorder" and "psychological disorder" as WP:Alternative names.

As for human intelligence being a topic that should comply with WP:MEDRS sourcing, I don't see the issue. A lot of human intelligence aspects concern things that fall in the area of medicine, and using quality book sources on human intelligence is enough to adhere to WP:MEDRS. Flyer22 Reborn (talk) 06:17, 6 June 2016 (UTC)[reply]

@Flyer22 Reborn: Thanks. (1) I am perfectly aware of the fact that some people and some publications confuse the two. (2) That does not give us green light to follow the suit. (3) "Mental health" does not always fall under medicine - the subject of mental health is studied in various disciplines, including medicine (psychiatry), psychology, sociology, anthropology (see Medical anthropology), economy, etc. (4) "If we look at more sources, we see that psychologists are commonly designated as part of the medical field." Disagree with "commonly", even if sometimes for some authors, psychologist = clinical psychologist; which of course is not true. Your quote says only that a counseling psychologist treats psychological conditions - note that "psychological conditions" does not mean "medical conditions".

In short, I still see no reason to equate psychology with just clinical psychology - cf. the subject box to the right of the lede. We can't force using MEDRS criteria on all those disciplines of psychology, and I doubt editors in the field will see any reason to accept it. Should be asked at WP:PSYCH, though. — kashmiri ^TALK 09:28, 6 June 2016 (UTC)[reply]

A useful rule of thumb is to consider where people are educated, how long that education takes, and how the profession is regulated. On all these issues, psychology and psychiatry are different. Regarding the broader issue, the idea that medicine is a science is contested. For example, I note that there is no article on Christopher Boorse or his Biostatistical Theory (there should be), but there is one on Thomas Szasz. Trankuility (talk) 10:22, 6 June 2016 (UTC)[reply]

Trying to equate psychology and psychiatry is a bit like like trying to equate sports and medicine. Yes there is sports medicine but that doesn't mean we have to use MEDRS on data about how to train for the shot putt 'biomedical information' though that may be. Or are people here really wanting to do things like that in some rule following way instead of examining what MEDRS is in aid of and what the principles of Wikipedia are? Dmcq (talk) 13:51, 6 June 2016 (UTC)[reply]

I agree with Kashmiri that "Mental health does not always fall under medicine". The field of health is generally considered to be bigger than the field of medicine. WhatamIdoing (talk) 15:12, 6 June 2016 (UTC)[reply]

Kashmiri, when reliable scholarly sources, on some level, equate psychiatry with clinical psychology, should we really call it "confusion," though, given the overlap...especially when the sources are aware that the terms are distinguished by many? By that, I mean that there are enough sources noting that psychiatry and clinical psychology serve the same purpose for a number of topics, and there are doctors who see very little difference between psychiatry and clinical psychology. This is why I stated above, "Because of the overlap, I've met enough doctors who consider the matter 'tomato tomato'." This is especially true for therapy issues. For example, this 2015 You and Your Child's Psychotherapy: The Essential Guide for Parents and Caregivers source, from Oxford University Press, page 36, notes the differences between clinical and counseling psychologists, clinical social workers, mental health counselors, psychiatrists, and notes family therapists, marriage therapists, addiction counselors, and then goes on to state, "Therapists with any of these degrees will be able to provide therapy for your child -- in this there is very little difference between psychologists, social workers, psychiatrists, or mental health counselors." Some sources also argue that there is no real difference between a counseling psychologist and a clinical psychologist. This 2014 Psychology Applied to Modern Life: Adjustment in the 21st Century source, from Cengage Learning, page 493, states, "Two types of psychologists provide therapy, although the distinction between them is more theoretical than real." It then goes on to explain. When I've studied psychological topics, many of them being tied to psychiatry, I've repeatedly found that it's common for the authors of those sources to not clearly define psychology, or that that they have a definition of psychology that sounds very much like psychiatry. To that point, this 2013 Perspectives On Psychology source, from Psychology Press, page 1, states, "Most people have some idea what psychology is about, but they are often confused by the distinction between psychology and psychiatry. In fact, it is easier to define 'psychiatry' than 'psychology': psychiatry is concerned with the study and treatment of mental disorders. The definition of psychology has changed over the centuries, so it will be useful to adopt a historical approach."

I didn't state that "mental health" always falls under medicine. Nor did I state that we should "equate psychology with just clinical psychology." But I was making the case that many aspects of psychology do fall under "medicine" and should typically require WP:MEDRS-compliant sourcing. This is why I gave the following example: "If someone has a psychological disorder, WP:MEDRS sourcing is the way to go." But what I actually meant was that if a topic is about a psychological disorder, WP:MEDRS sourcing is the way to go. If it's a WP:BLP matter -- where the article notes that the person has a psychological disorder -- regular reliable sourcing is fine. Flyer22 Reborn (talk) 07:09, 7 June 2016 (UTC)[reply]

I've never heard anyone call even extreme stupidity a psychological disorder or something to be treated with psychiatry, so what has that all got to do with IQ? Dmcq (talk) 08:41, 7 June 2016 (UTC)[reply]

The topic of psychology came up. Flyer22 Reborn (talk) 09:21, 7 June 2016 (UTC)[reply]

Someone who has access to paywalled medical refs please check recent edits to the article by User:Cmp8868. There have been significant changes which appear to rely on existing references which I cannot access. • • • Peter (Southwood) ^(talk): 07:50, 2 June 2016 (UTC)[reply]

A bunch of primary sources when reviews are avaliable. Doc James (talk · contribs · email) 16:15, 2 June 2016 (UTC)[reply]

Are Immersion pulmonary edema and Swimming induced pulmonary edema different? This is implied by the Pulmonary edema#Other article, but what is the difference? • • • Peter (Southwood) ^(talk): 12:52, 6 June 2016 (UTC)[reply]

DAN says they are the same thing.[38] So one should redirect to the other. Done Doc James (talk · contribs · email) 12:56, 6 June 2016 (UTC)[reply]

Trimmed a bunch of primary sources. More to go. Doc James (talk · contribs · email) 13:12, 6 June 2016 (UTC)[reply]

Thanks, I will sort that out. • • • Peter (Southwood) ^(talk): 06:45, 7 June 2016 (UTC)[reply]

I see it has already been done. Thanks, • • • Peter (Southwood) ^(talk): 06:47, 7 June 2016 (UTC)[reply]

I just noticed this a new user's page and had never seen it. They use content about vaccines starting at about 1:15 as an example about NPOV.

How do you all feel about this? Jytdog (talk) 15:47, 2 June 2016 (UTC)[reply]

It is from 2010. The comments about vaccines are horrible. We are not a newspaper that goes out of its way to find two "sides" to give weight to. Will see about fixing this. Doc James (talk · contribs · email) 16:06, 2 June 2016 (UTC)[reply]

Recommendation is we remove it as outdated. Doc James (talk · contribs · email) 16:28, 2 June 2016 (UTC)[reply]

probably best to do so--Ozzie10aaaa (talk) 16:38, 2 June 2016 (UTC)[reply]

• I have nominated that video for deletion here. Jytdog (talk) 11:01, 5 June 2016 (UTC)[reply]
  • A claim that the material is wrong and shouldn't be used for education is not usually accepted as a justification for deletion on Commons. WhatamIdoing (talk) 19:00, 5 June 2016 (UTC)[reply]

    User:WhatamIdoing What can you do to help get this video taken out of use? It is a bunch of places on meta for Outreach and the Education program; help, training, bookselves, etc. Jytdog (talk) 03:38, 6 June 2016 (UTC)[reply]

    Getting it overwritten (by something good) is likely to be the most efficient option. If anyone has a good idea for a replacement example, that might increase the chance of success. WhatamIdoing (talk) 05:40, 6 June 2016 (UTC)[reply]

    The reason I asked you is because your first response wasn't helpful and you work at least part time for the WMF and I thought you might know who would be useful to talk to about getting it taken down every where it has been posted and have a good one made. It appears to have been made and propagated by WMF and I assume that they paid the person who made it (who no longer works there) and paid for it to be made, and will pay someone to take it down and make a new one. Jytdog (talk) 07:53, 6 June 2016 (UTC)[reply]

    The file was created by a video company and uploaded by the head of the Wiki Education Foundation. I could be wrong, but the WMF is unlikely to touch it. They try to stay out of content disputes. WhatamIdoing (talk) 14:44, 6 June 2016 (UTC)[reply]

• please give opinion(gave mine)for deletionthank you--Ozzie10aaaa (talk) 10:34, 6 June 2016 (UTC)[reply]

Copying Pine, who is working on a video project. Producing a replacement video for this would be helpful. Thanks, James Hare (NIOSH) (talk) 13:12, 6 June 2016 (UTC)[reply]

I've reached out to the uploader via email who said they would take care of taking down the video. Yay. Jytdog (talk) 18:03, 6 June 2016 (UTC)[reply]

Well done! I'm glad that has finally been removed from training materials. I've been complaining about that very video for almost two years now: Wikipedia talk:Training/For students/Verifiability. Thanks Jytdog. --RexxS (talk) 16:34, 10 June 2016 (UTC)[reply]

This user had removed a paragraph that was supported by a secondary source (Swann 2013) and replaced it with a paragraph that was only partially supported by a primary source (removing the secondary source), without giving the reason:

https://en.wikipedia.org/w/index.php?title=Mixed_affective_state&type=revision&diff=723351811&oldid=722383241

I partially reverted the edit, removing the poorly supported paragraph added and restored the original paragraph:

https://en.wikipedia.org/w/index.php?title=Mixed_affective_state&type=revision&diff=723434214&oldid=723388982

I made a comment on the IP address's talk page informing the user that their paragraph had been reverted and explaining why (sourcing):

https://en.wikipedia.org/wiki/User_talk:194.74.238.137#June_2016

Without responding to the talk page comment, the user changed the paragraph again, without giving the reason, messing up the formatting, and adding statements that aren't supported by the secondary source in question (while keeping the secondary source as the only source cited):

https://en.wikipedia.org/w/index.php?title=Mixed_affective_state&type=revision&diff=723529352&oldid=723478315

The user's edits are at least partially correct, but the user has not added any sources to support their statements. I'm not sure what to do, however. Please assist.--Beneficii (talk) 18:41, 3 June 2016 (UTC)[reply]

left note w/ IP/talk--Ozzie10aaaa (talk) 10:50, 5 June 2016 (UTC)[reply]

I am not sure that article should exist; i agree that the IP editor is trashing this article and the article on bipolar. have been meaning to fix it but haven' gotten there. Jytdog (talk) 10:53, 5 June 2016 (UTC)[reply]

Cas (or anyone else who knows about this kind of stuff), is "Mixed affective state" the current terminology for this subject? I'm not seeing many recent sources that use this exact phrase. WhatamIdoing (talk) 19:11, 5 June 2016 (UTC)[reply]

I'm no expert, but a Gscholar search shows uses of the term, mostly in older sources. Again from searches, mixed episode or (bipolar) mixed state seem more common. Here is a relatively recent review that prefers mixed state. ICD-10 and DSM-IV-TR use both mixed state and mixed episode. Cyclothymia seems some part of nomenclature, too. --Mark viking (talk) 19:33, 5 June 2016 (UTC)[reply]

Yes we still use the term, though I tend to see it more as a hypomania/mania with dysphoric mood. I have not looked at literature or current thinking on this...and need a coffee and some uninterrupted time, hopefully later today. Cas Liber (talk · contribs) 21:01, 5 June 2016 (UTC)[reply]

Agree. I am not a mental health professional, but my impression from searches like this one is that the terms "mixed mania" and "mixed depression" are commonly used in the literature, and "mixed affective state" seems to fit with the pattern (e.g. PMID 25687279). — soupvector (talk) 22:48, 5 June 2016 (UTC)[reply]

about your correction I quite liked "patter". ") Jytdog (talk) 10:51, 6 June 2016 (UTC)[reply]

We discourage the use of conference "papers" to support biomedical information, but they do get mentioned and cited occasionally anyway. Under some circumstances, that might even be okay(ish). But there seems to be a world of basically fraudulent conferences out there, using impressive names or names that are trivially confused with reputable conferences, including these 160 academic conferences, which are all allegedly happening in the same hotel on the same two days next month. (The hotel has 235 guest rooms, if you're curious.) These 160 alleged conferences cover many areas, mostly tech- or business-related.

I don't know how easily we'll be able to spot this stuff. The example given is the perfectly legitimate 6th International Conference on Cyber Security vs the apparently illegitimate 18th International Conference on Cyber Security, which "just happens" to have the same name. Blanking anything with a name that matches the list won't do. However, for this particular example, all of them come from waset.org, which means that we can find them when we have links to their website.

User:Beetstra, what do you think about putting World Academy of Science, Engineering and Technology's website on the spam blacklist, with a whitelist entry for the article about the business? These aren't likely to be accepted as reliable sources. WhatamIdoing (talk) 05:59, 6 June 2016 (UTC)[reply]

@WhatamIdoing: Hmm, I generally discourage a direct blacklisting just because it is unreliable and should not be used as a source. It does however happen that there is a good consensus among a reasonable group of editors that this is a better solution (so it becomes a community consensus blacklisting). I would however then encourage to get such a consensus on the reliable sources noticeboard to attract people outside only one (or a few) wikiprojects. (personally, I would not be against the idea: if a source is notoriously unreliable and its use would make those parts of Wikipedia where it is used worse, that that source could then be blacklisted. It is however not what the spam-blacklist was made for, and that is what editors would argue against. If only WMF XOR developers would perform the long awaited overhaul of the spam-blacklist to make a more flexible system and detach it from the 'spam' pejorative ... then this would become much easier to do/consider). --Dirk Beetstra ^{T C} 06:09, 6 June 2016 (UTC)[reply]

I would support blacklisting that. Thanks WAID. Jytdog (talk) 07:56, 6 June 2016 (UTC)[reply]

• Support Yes as soon as you publish something you get an endless stream of emails to speak at this "fake" conferences and to publish in "fake" open access journals. They basically make money from those who speak at them or publish in them. Doc James (talk · contribs · email) 11:55, 6 June 2016 (UTC)[reply]
  • I'll start a discussion at RSN. Dirk's right that it would be good to get other people's opinions. WhatamIdoing (talk) 14:45, 6 June 2016 (UTC)[reply]

The article about the medicine taurolidine has been rewritten by an editor whose username matches the name of a company that produces the drug, Geistlich Pharma (talk · contribs · deleted contribs · logs · filter log · block user · block log). I've left a COI message on the user talk page and reported at WP:UAA. In addition, older versions of the article are essentially the sole work of another SPA, CETP2014 (talk · contribs · deleted contribs · logs · filter log · block user · block log), so that version may have COI issues as well. It would be helpful if someone from this WikiProject with expertise in this area had a look. Deli nk (talk) 12:10, 6 June 2016 (UTC)[reply]

Will look. Doc James (talk · contribs · email) 12:12, 6 June 2016 (UTC)[reply]

Okay blocked the account in question and trimmed a bunch of the primary sources and replaced them with reviews. Doc James (talk · contribs · email) 12:49, 6 June 2016 (UTC)[reply]

Further comments here Talk:Onychomycosis#More references for some limited benefit of tea tree oil appreciated. Doc James (talk · contribs · email) 12:12, 6 June 2016 (UTC)[reply]

need opinions(gave mine)--Ozzie10aaaa (talk) 10:23, 7 June 2016 (UTC)[reply]

gave my opinions too :) EllenvanderVeen (talk) 00:17, 14 June 2016 (UTC)[reply]

Some fierce battles going on there and the article protected and a request for MED folks made via a tag on the article. Jytdog (talk) 09:39, 7 June 2016 (UTC)[reply]

Currently protected. Doc James (talk · contribs · email) 15:26, 7 June 2016 (UTC)[reply]

I'd really appreciate some help from some otorhinolaryngology folks in getting the article into something that resembles scientific consensus. It risks becoming an advocacy page for a particular view of the syndrome. Is there a way to call for help specifically from people with expertise in the field? Dubbin^{u | t | c} 08:07, 8 June 2016 (UTC)[reply]

After a sudden onflux of new users who identify as ENS sufferers, I found a forum posting directing people to the page. I am now the subject of considerably vitriol there and a Facebook has apparently also been mobilised. I am doing what I can to keep the discussion productive and civil. Any help would be appreciated. Dubbin^{u | t | c} 12:43, 8 June 2016 (UTC)[reply]

There were three recent reviews so I used them to rewrite the whole thing. Please review if you like, folks. But we may be in for an onslought from internet forums which are apparently an important source of support for people with ENS, so eyes at least will be useful. Doc James has added some protections. Jytdog (talk) 15:19, 8 June 2016 (UTC)[reply]

I was doing a trawl through PubMed and Trip database at the same time. There seems to be something to the syndrome, and opinion seems to have shifted on the issues over the last few years, but there aren't many secondary sources that I could find. I suspect that a group of advocates have coined a catchy phrase for "iatrogenic atrophic rhinitis" and it's caught on. There's nothing wrong with that, but it results in a lack of breadth of sources that would lead to good secondary reviews. I've watchlisted the article anyway. --RexxS (talk) 17:50, 8 June 2016 (UTC)[reply]

• Kuan EC, Suh JD, Wang MB. Empty nose syndrome. Curr Allergy Asthma Rep. 2015 Jan;15(1):493. Review. PMID 25430954 (excellently done)
• Leong SC. The clinical efficacy of surgical interventions for empty nose syndrome: A systematic review. Laryngoscope. 2015 Jul;125(7):1557-62. Review. PMID 25647010 (really excellent, Cochrane style)
• Sozansky J, Houser SM. Pathophysiology of empty nose syndrome. Laryngoscope. 2015 Jan;125(1):70-4. Review. PMID 24978195 - By one of the advocates for the condition. Still remarkably not woo.
• Coste A, Dessi P, Serrano E. Empty nose syndrome. Eur Ann Otorhinolaryngol Head Neck Dis. 2012 Apr;129(2):93-7. Review. PMID 22513047
• Hildenbrand T, Weber RK, Brehmer D. Rhinitis sicca, dry nose and atrophic rhinitis: a review of the literature. Eur Arch Otorhinolaryngol. 2011 Jan;268(1):17-26. Review. PMID 20878413
• Payne SC. Empty nose syndrome: what are we really talking about? Otolaryngol Clin North Am. 2009 Apr;42(2):331-7, ix-x. Review. PMID 19328896

Jytdog (talk) 17:56, 8 June 2016 (UTC)[reply]

Template:Lt icon Jeigu ne netaip atsiranda kraujuotakos sutrikimai širdije. Galvuoje atsiranda insuitas,tai pagal paskalo desnis ir mano mechanika ir biomechanika.{mano 111-S DESNIS tai Marcelio Atsiranda [ŠN]širdies nepankamumas, kuria rekalaujia ko grešžčio likvyduoti simptomai.TAI medicinos ir mechanikos teisioginiai ryšiai,tame tarpe prežiastiniai ryšia. Ryšai laike tampa prežaistiniai; — Preceding unsigned comment added by 193.219.55.113 (talk) 13:09, 7 June 2016 (UTC)[reply]

Unable to understand. G translate gives "If not, not right there kraujuotakos širdije disorders . Galvuoje occurs insuitas This is according to Pascal's Law and my mechanics and biomechanics . { My 111 -S is Marcel 's Law Appears [ HF] heart deficiency, which rekalaujia what grešžčio likvyduoti simptomai.TAI medicine and mechanics teisioginiai communications, including prežiastiniai connection. Rys time becomes prežaistiniai"

Doc James (talk · contribs · email) 14:39, 7 June 2016 (UTC)[reply]

Bing translate isn't much better "If a person who is not širdije kraujuotakos appears in the disorders. Galvuoje appears in the insuitas, the desnis and my paskalo mechanics and biomechanics. {My 111-S DESNIS it Appears [ŠN] Marcel heart nepankamumas, which rekalaujia what grešžčio likvyduoti symptoms. THIS is the medical and mechanical connections, including prežiastiniai teisioginiai ryšia. Time Ryšai becomes prežaistiniai" Sizeofint (talk) 18:32, 7 June 2016 (UTC)[reply]

I believe that there are a couple of typos in it, which cause serious problems for machine translation. But the overall idea seems to be about Pascal's law and the mechanical (fluid dynamics) cause and effect of blood flow on heart disease. WhatamIdoing (talk) 18:54, 7 June 2016 (UTC)[reply]

And in philosophy, Marcel's Law seems to be: Anxiety and jealousy make the heart grow fonder.[39]. --Mark viking (talk) 19:32, 7 June 2016 (UTC)[reply]

I guess this "Lithuanian" text is already autotranslation. It makes no sense at all. Hugo.arg (talk) 15:25, 8 June 2016 (UTC)[reply]

A rapidly emerging technology sector affecting some $131 B in nanomedicine product sales this year, there are several overlapping but disjointed articles here (health impacts), here (environmental concerns), here (toxicology) and here (main nanomedicine article). A merger discussion is underway. Thoughts on consolidation? --Zefr (talk) 15:02, 7 June 2016 (UTC)[reply]

have commented(BTW [40] this is a projection from 2012)--Ozzie10aaaa (talk) 01:36, 8 June 2016 (UTC)[reply]

Thanks for the feedback here and on the merge Talk page, Ozzie10aaaa. The difficulty in obtaining accurate market numbers for nanomedicine sales is that they only appear in expensive reports, this 2015 version priced at US$6000, so only promotional summaries are generally available. The 2012 projection I used above was quoted more widely in expert reviews, whereas the 2015 report projects 2016 sales at a considerably higher value of $328 B (calculated). --Zefr (talk) 02:22, 8 June 2016 (UTC)[reply]

Just a reminder when reviewing edits, no one few people make a more than 5k byte edit in one go. Therefore when you see edits such as this https://en.wikipedia.org/wiki/Special:Contributions/Pandeysandeep check them for copy and pasting issues. Best Doc James (talk · contribs · email) 22:26, 7 June 2016 (UTC)[reply]

Not to go against the general point here, but I make edits that are >5k bytes on occasion. Ten or twelve references will do it. Sunrise (talk) 00:53, 8 June 2016 (UTC)[reply]

Looking there your last couple of thousand edits all edits over 5k were moves. But yah could happen. Doc James (talk · contribs · email) 02:01, 8 June 2016 (UTC)[reply]

I've been known to do this too. ([41], [42], [43], [44]) Usually when creating a new article, though, because a whole load of refs and templates will go in at once. Opabinia regalis (talk) 02:20, 8 June 2016 (UTC)[reply]

Where on earth have you got no one makes a more than 5k byte edit in one go from? When I'm composing a section (or rewriting an entire article) in a sandbox prior to sending it live, I do this all the time—here's a 123kb addition if you want a particularly extreme example. ‑ Iridescent 10:24, 8 June 2016 (UTC)[reply]

I stand corrected :-) I have been doing a lot of follow up of copyright issues [45] Doc James (talk · contribs · email) 14:06, 8 June 2016 (UTC)[reply]

Perhaps the MEDRS guidelines are not sufficient to deal with controversies within the peer reviewed realm. As pointed out in this article the "low salt intake is bad" camp is arguing for a position that is untenable when considering the totality of the evidence. All they have are results of cohort studies where the statistical analysis cannot correct for confounding factors to a sufficient degree to allow such conclusions to be drawn. Such results do get published because things are done "by the book", but that should not distract from the obvious issues when drawing such conclusions. E.g. among the people who have low sodium intake there will be more frail people who don't eat much. Such effects are not going to be corrected for to the degree necessary to be able to see any effect due to low salt intake as explained in detail in the article. This has to be contrasted with the evidence that does exist about the health effects of very low salt intake from intervention studies and indigenous populations who have extremely low salt intakes. Count Iblis (talk) 01:18, 8 June 2016 (UTC)[reply]

User:Count Iblis would you please point to the specific articles so we can see? thx Jytdog (talk) 01:21, 8 June 2016 (UTC)[reply]

The main salt article is already problematic, the section on "Diet and health" obviously does have to summarize the evidence, but the way this is done makes it look like both sides have equally good arguments, while one side's arguments are far more plausible. Far more problematic are the articles Health effects of salt and Salt and cardiovascular disease as they report on the results of large cohort studies without putting these results in the context of the discussion in the scientific community where the problems that I referred to above are raised. Count Iblis (talk) 01:33, 8 June 2016 (UTC)[reply]

Thx, will look. Jytdog (talk) 01:36, 8 June 2016 (UTC)[reply]

Here we have a good review of RCTs [46] and [47] And this good review. [48] Doc James (talk · contribs · email) 02:17, 8 June 2016 (UTC)[reply]

..Wow, the sourcing at Salt and cardiovascular disease is pretty pathetic. Results from 1971 treated as current? It certainly needs some attention. LeadSongDog come howl! 04:53, 8 June 2016 (UTC)[reply]

[49]review--Ozzie10aaaa (talk) 09:59, 8 June 2016 (UTC)[reply]

I've seen a lot of headlines about this recently, so it's hardly surprising. It might be more efficient to wait a couple of weeks, when the media's attention has moved on to something else. WhatamIdoing (talk) 23:30, 8 June 2016 (UTC)[reply]

Often true, but the article views seem pretty steady before yesterday (8 June) - sometimes the readership moves on too. There only seem 1-2 editors adding such stuff. Johnbod (talk) 03:29, 9 June 2016 (UTC)[reply]

New account, CiproKills. -- Jytdog (talk) 04:55, 9 June 2016 (UTC)[reply]

actually that antibiotic is very effective--Ozzie10aaaa (talk) 10:41, 9 June 2016 (UTC)[reply]

Account now blocked. Doc James (talk · contribs · email) 13:20, 9 June 2016 (UTC)[reply]

I mean, Cipro kills billions of E. coli..... Keilana (talk) 13:43, 9 June 2016 (UTC)[reply]

haha keilana!EllenvanderVeen (talk) 23:40, 13 June 2016 (UTC)[reply]

I have the authority of the International Society of Blood Transfusion (ISBT) to start discussions about a formal collaboration between ISBT and Wikipedia to improve the Transfusion Medicine information on Wikipedia.

There is an international conference in September in which I would like to promote a collaboration to all working groups so that ISBT members can contribute to Wikipedia

Can you please let me know how I can develop this relationship — Preceding unsigned comment added by TransfusionDoctor (talk • contribs) 08:55, 9 June 2016 (UTC)[reply]

you need to speak w/ Doc James ... --Ozzie10aaaa (talk) 12:50, 9 June 2016 (UTC)[reply]

Thanks User:Ozzie10aaaa. I have emailed User:TransfusionDoctor Doc James (talk · contribs · email) 13:19, 9 June 2016 (UTC)[reply]

At WikiCon USA 2015 Doc James (talk · contribs · email) 14:31, 9 June 2016 (UTC)[reply]

I like the idea of a "safe area" for experts to come and engage. If what was said about suggestions left on article talk pages being ignored is a real problem, then we ought to see if we can do something about it. How about using a sub-page of WikiProject Medicine as a trial area? The 'project page' could contain information and a FAQ, and the 'talk page' could be the safe venue. We could see if suggestions made by experts there resulted in improved collaboration and engagement on medical articles. Maybe we could advertise it by a link from the WPMED talk page banner? What do others think? --RexxS (talk) 16:27, 9 June 2016 (UTC)[reply]

People often need to post here to get talk page comments noticed. We have 32K articles. I know many are very poorly watched.

Experts can of course post here for advice / suggestions / feedback. Doc James (talk · contribs · email) 16:42, 9 June 2016 (UTC)[reply]

Thanks for the note Doc James, and I agree this is a good place for drawing attention - it's about all I can do to watch here. I keep encouraging my colleagues to come and participate, but they aren't ready to dive in (or even venture a toe, it seems). — soupvector (talk) 03:35, 10 June 2016 (UTC)[reply]

WikiProject X has a feature for listing new discussion sections on talk pages tagged by a WikiProject. WikiProject Medicine has a lot of tagged talk pages so I think this feature would be especially useful for WikiProject Medicine. Unfortunately... it's been broken for the past several months! But once it is working again, I would be happy to have WikiProject Medicine use it. Harej (talk) 20:20, 12 June 2016 (UTC)[reply]

Visualization of data is useful. We have some great new tools here [50]

Am currently trying to figure out how to get some of them to work. Doc James (talk · contribs · email) 17:04, 9 June 2016 (UTC)[reply]

Ooh, very nice. Hadn't seen this before. Carl Fredrik 💌 📧 22:17, 9 June 2016 (UTC)[reply]

Not working that well yet unfortunately. Doc James (talk · contribs · email) 14:22, 10 June 2016 (UTC)[reply]

Cool! The syntax is somewhat complicated, but they seem to work as advertised. Boghog (talk) 15:45, 10 June 2016 (UTC)[reply]

Nice, I am saving this one for later. Was actually thinking about making epidemiological maps somehow of the data that is available, this could come in handy. EllenvanderVeen (talk) 23:37, 13 June 2016 (UTC)[reply]

Any hikers or desert-dwellers around here? There's a brand-new safety-related article at wikivoyage:Arid region safety, and the editor who started it would deeply appreciate some help expanding it. Wikivoyage is much simpler than writing a Wikipedia article on the same subject: They want sensible advice, aimed at travellers and based upon experience, with no need to cite sources (although you're welcome to list sources that you recommend on the talk page). If you know a bit about safety issues in deserts and other arid regions, please "Plunge forward" and help them out. WhatamIdoing (talk) 21:45, 9 June 2016 (UTC)[reply]

User:Doc James has run marathons in the Sahara desert. Count Iblis (talk) 00:37, 10 June 2016 (UTC)[reply]

See Category:Survival skills.—Wavelength (talk) 00:50, 10 June 2016 (UTC)[reply]

See b:Category:Survival.—Wavelength (talk) 00:53, 10 June 2016 (UTC)[reply]

There is an outbreak of cutaneous leishmaniasis in the Middle East.

• PLOS Neglected Tropical Diseases: Old World Cutaneous Leishmaniasis and Refugee Crises in the Middle East and North Africa (May 26, 2016)

—Wavelength (talk) 03:09, 10 June 2016 (UTC)[reply]

will look--Ozzie10aaaa (talk) 10:51, 11 June 2016 (UTC)[reply]

• article needs more editor help/edits,thank you--Ozzie10aaaa (talk) 10:30, 10 June 2016 (UTC)[reply]

The tool is now officially no longer maintained Wikipedia:WikiProject_Medicine/Popular_pages Doc James (talk · contribs · email) 21:56, 10 June 2016 (UTC)[reply]

I liked that. :( Jytdog (talk) 22:08, 10 June 2016 (UTC)[reply]

We have a new one here thankfully[51]. It includes mobile viewership but only contains the top 5K articles and is weekly rather than monthly. Doc James (talk · contribs · email) 22:11, 10 June 2016 (UTC)[reply]

This seems like it was written by a non-primary English speaker paraphrasing a medical textbook. It's a pretty short article. I tried to simplify the language, but I'm having to look up every other word, so I'm giving up now. Maybe someone with a better anatomy vocabulary will want to take a stab at it? :)

Eagle syndrome led me to Temporal styloid process, which doesn't have any in-line citations and this is the entire reference section: This article incorporates text in the public domain from the 20th edition of Gray's Anatomy (1918), and also to Temporomandibular joint, which has been tagged as {{technical}} since 2014 (and the tag still applies). I figured I'd point those out while I'm on the topic. —PermStrump(talk) 23:31, 10 June 2016 (UTC)[reply]

this [52] could be used for Temporal styloid process, --Ozzie10aaaa (talk) 20:11, 11 June 2016 (UTC)[reply]

http://www.ncbi.nlm.nih.gov/pubmed/25288710

Anybody? --Anthonyhcole (talk · contribs · email) 06:39, 12 June 2016 (UTC)[reply]

[53]--Ozzie10aaaa (talk) 22:55, 12 June 2016 (UTC)[reply]

Ok, the first comment below is good, plus one from Lane R with other links. There was This on the Cochrane blog, by Doc James and others, with several comments also. Johnbod (talk) 15:39, 13 June 2016 (UTC)[reply]

Thank you both. That's what I was after. --Anthonyhcole (talk · contribs · email) 15:03, 14 June 2016 (UTC)[reply]

Hi guys edit: lovely fellow Wikipedians :)

I am working on the Erythromelalgia page. I generally am a bit of a reference freak, and don't like anything that doesn't have a reference. But I have come across something that I need some input from.

In short, Erythromelalgia is a vascular disease that comes with episodes, triggered by heat and position of the body, which causes burning pain described as second degree burning pain, mainly in the feet and hands.

So I have read a lot of articles on pubmed. And also asked some question to some patients. And I have found they have a lot of good advice, that their doctors didn't give.

For example, taking a shower is a nightmare for these people (heat of water), and position standing up, causing all the blood to go to the feet and causing instant erythromelalgia attacks. I read something really smart when taking a shower, filling up the bathtub with cold water, and put their feet in there, while sitting taking a shower with 'normal' water. I thought it was pretty brilliant, considering these people otherwise couldn't take a shower ever, because of the heat from the water triggers an attack in the feet. And thought maybe doctors and patients could benefit from information like this.

But I don't want to wonder off too much on these patient advice things on medical pages like this, and wonder if I even should put it on there.

What do you guys think? and is there a page with guidelines I can have a look at? I remember there was something like that, but I can't find it anymore.

I already wrote patient advice somewhere on the page to not put ice directly onto the skin, since these cause ulcers and burning wounds, but that actually had a good pubmed reference with it.

EllenvanderVeen (talk) 21:34, 12 June 2016 (UTC)[reply]

re "Hi guys," - next time, please invite the girls too. There are great women active on WP too (writing f*ing great things about women btw). ;-) -DePiep (talk) 22:06, 12 June 2016 (UTC)[reply]

Oh my bad, you are right. As a girl myself I just use the term meaning both genders in general. Wasn't really thinking about it my bad <3 EllenvanderVeen (talk) 22:25, 12 June 2016 (UTC)[reply]

... is why used small print. to say ;-). Still, I recommend that link, written by Emily Temple-Wood. About a "super-awesome" or "freaking FANTASTIC surgeon" women. Inspiring. -DePiep (talk) 22:36, 12 June 2016 (UTC)[reply]

Yeah I will look into it, I read a little, looks amazing :) EllenvanderVeen (talk) 13:09, 13 June 2016 (UTC)[reply]

Hi Ellen, I think this could be an excellent example of self-care and how patients adapt to the condition, if you've got an acceptable source for it. However, there's good ways to go about and not-so-good ways to go about it. You don't want to phrase it as "If you have this, then try this trick"; instead, you want to present this idea in a more impersonal, educational fashion: "People who have this condition make many adaptations to their normal daily activities. For example, taking a shower can trigger pain in the feet from the hot water, so some people first fill the bottom of the tub with cold water and immerse their feet in it, to prevent the hot water from touching the skin on their feet".

I'm sure you'll come up with a clearer or shorter way to explain it, but if you've got a good source and you write it as an explanation of "how this affects activities of daily life for these people" instead of "cool trick you can try", then it's possible to include this. Concrete examples like this are very educational; they help our readers figure out how pervasive the effects of a chronic illness can be, and they even remind our doctors that there's more to disease management than just writing the next order.  ;-) WhatamIdoing (talk) 00:33, 13 June 2016 (UTC)[reply]

Yeah I know what you mean, I would try to make it as neutral as possible, I dislike websites that have these 'amazing' tips and tricks, that is not my goal. I thought it would benefit the patient for obvious reasons, but also for the doctor to be a better doctor for their patients. I didn't even realise about how readers can also think more about how a disease like this affect their lives, good one too. I do want to put it in a smaller subheadline. What would be a good neutral name for it? 'Patient self-care' any other ideas? ... EllenvanderVeen (talk) 13:09, 13 June 2016 (UTC)[reply]

It depends upon where you place it. ===Self-care=== is a good sub-section heading under ==Treatment== or ==Management==, but you'd want a different heading if you put it under ==Prognosis== (i.e., that part of the prognosis is that you'll spend the rest of your life adapting everyday activities to accommodate this, such as this example). WhatamIdoing (talk) 16:41, 13 June 2016 (UTC)[reply]

The Wellcome Library and Wikimedia UK are jointly supporting a Wikimedian in Residence. For those unfamiliar with the Wellcome Library, as per their website they are "one of the world's major resources for the study of medical history... [and] also offer a growing collection of material relating to contemporary medicine and biomedical science in society."

We'd love for WikiProject Medicine members to get involved. For example, you could:

1. use one of the thousands of images uploaded to Wikimedia Commons to illustrate an article
2. use some of the library's digitised materials to write an article
3. get involved with editathons by attending, suggesting pages to be added, or events to compliment the editing (the main theme of the residency will be history of mental health and psychiatry, but we're happy to support other contributions too!)
4. … or something else – feel free to suggest things!

Please get in touch via the project page or my user page if you'd like to get involved in any way. Zeromonk (talk) 10:56, 14 June 2016 (UTC)[reply]

great opportunity--Ozzie10aaaa (talk) 10:58, 14 June 2016 (UTC)[reply]

Very exciting! @Zeromonk:, given the multi-disciplinary scope of mental health, you may also want to cross-post to Wikipedia talk:WikiProject Psychology. —Shelley V. Adams ‹blame
credit› 14:37, 14 June 2016 (UTC)[reply]