Wikipedia talk:WikiProject Medicine/Archive 136

Tuberculosis
Just a notice that it's possible that the article or Covid-19 related ones will have some related editing, since it's in the news. While I don't think the danger of tuberculosis should be minimized, the concern in relation to the Covid pandemic also shouldn't be. One person's experience doesn't amount to world statistics, but while I never personally met someone known to suffer from tuberculosis, I know at least two people close to me who almost died from this pandemic that has not yet reached its peak (one still in critical state under sedation on a ventilator, but who at least fortunately could get access to proper ICU care, thanks to the somewhat successful flattening of the curve in my area)... — Paleo Neonate  – 08:43, 6 May 2020 (UTC)


 * Pageviews at Tuberculosis are down (noticeably) compared to March. WhatamIdoing (talk) 16:22, 6 May 2020 (UTC)
 * Thanks for bringing to attention. this may be of interest. Whispyhistory (talk) 19:33, 6 May 2020 (UTC)
 * I was wondering whether there was a section or page on the differentials of COVID-19...Whispyhistory (talk) 19:41, 7 May 2020 (UTC)

Biomedical material based on non-MEDRS sourcing
Hi - I recently declined a draft article about a medical issue associated with breast feeding which was supported largely by links to Reddit and other online forums. Its author told me that they thought that was alright, because Reddit was cited as a source at Dysphoric milk ejection reflex. I have taken a quick look, and am not super-concerned about the solitary link to Reddit (it's not supporting any significant assertion), but some of the other sourcing looks a bit on the ropey side - in the 'Misconceptions' section there are a number of biomedical assertions sourced to support groups' websites and what appear to be blogs (expert blogs perhaps). I wondered whether someone with better subject knowledge than me, and perhaps access to better sourcing, might be willing to take a look and see whether any of this material needs removing or bolstering with better sources. Cheers Girth Summit  (blether)  10:50, 9 May 2020 (UTC)
 * User:Girth Summit the article Dysphoric milk ejection reflex appear to be written by the author of a self published book using the self published book.
 * There are zero secondary sources on pubmed. And only 4 primary sources one written by the other. Doc James  (talk · contribs · email) 15:09, 11 May 2020 (UTC)
 * , that's a bit worrying. Is this an AfD do you think, if we have zero MEDRS-compliant sources? Girth Summit  (blether)  15:12, 11 May 2020 (UTC)
 * I have found a textbooks that touches on it . User:Girth Summit likely needs a rewrite. Doc James  (talk · contribs · email) 15:17, 11 May 2020 (UTC)
 * OK, if there are sources I'll leave it in your hands then. Let me know if I can help. Girth Summit  (blether)  15:19, 11 May 2020 (UTC)
 * Added the one source. Otherwise are welcome to jump in. As it is covered in the textbook consider it to reach notability. Doc James  (talk · contribs · email) 15:41, 11 May 2020 (UTC)
 * Doc James did great work cleaning this up. It reads much better now. Clayoquot (talk &#124; contribs) 23:11, 11 May 2020 (UTC)

Online medical symposium - COVID-19 - Wiki NYC
See the event page.
 * Meetup/NYC/Symposium on Wikipedia and COVID-19

Hello, I wanted to share a video of an online medical symposium. I am one of the speakers. Enjoy!

Here is more context: I am a member and regular attendee of events with Wikimedia New York City. Since about 2014 this organization has hosted about 100 in-person Wikipedia events every year. See documentation on the organization's page. In the context of COVID-19 people still wish to meet, but that has to happen online. The organization is developing various models of online meetups, including for socializing, coworking, running governance meetings, and now this, a symposium.

I am sharing this here because this is medicine themed, and also because there is a good appetite for more of these. Organizing this 2-hour talk from planning to publishing probably took 50-80 labor hours from all the people involved which is more than many of us expected. In the future that number could go down, but if anyone asks and for reference, please set expectations to that amount of labor from experienced event organizers for this kind of presentation with multiple speakers and some typical organizing. In my opinion Wiki NYC is efficient with events, and stripped to no preparation this could have just been published casually, but now what we have the experience we can replicate this with either more or less planning.

I am sharing this here because I think there is a great demand for online medical talks. I think this live broadcasting model made for some fun engagement.

Check it out now, and sometime, let's find a way for this WikiProject to join in organizing some talks about whatever people here want to share. Thanks.  Blue Rasberry  (talk)  22:12, 11 May 2020 (UTC)
 * very informative, thanks Blue Rasberry--Ozzie10aaaa (talk) 00:50, 12 May 2020 (UTC)
 * I really enjoyed this, and I think there is great scope for more outward-facing material that informs people about how Wikipedia works and may even bring in new wikipedians and partner organisations. Also check out Wikipedia weekly and Wikipediapodden podcasts. There have also been a few conferences/symposia in the past (example). Also consider joining an upcoming online conference which may include a couple of days of wiki workshops focused on covid-19 and bioinformatics (more info at WT:MOLBIO). T.Shafee(Evo &#38; Evo)talk 04:48, 13 May 2020 (UTC)

A thank you
This was just posted at Talk:Introduction to viruses: {{quote frame|1=

Thank you!
As an intelligent, non scientific adult who is keen to better understand this pandemic, I'm grateful to all of you -- writers, editors - who have developed this article. Plain language intended for non-scientists is exactly what we need. Too many scientific Wikipedia articles are written by scientists for scientists - and continue to mystify the masses. THank you,thank you, thank you. — Preceding unsigned comment added by 2607:FEA8:BEA0:D640:B036:6B5:AF34:D50 (talk) 10:50, 11 May 2020 (UTC) }} Adrian J. Hunter(talk•contribs) 13:09, 11 May 2020 (UTC)


 * Thank you for sharing this. Pinging User:Graham Beards, although I suspect he'll see it the original first.  WhatamIdoing (talk) 14:39, 11 May 2020 (UTC)
 * Yes, I saw it earlier today. I was really pleased to read it. Graham Beards (talk) 16:07, 11 May 2020 (UTC)
 * Nice! Also rather raises the question as to whether its useful to have additional Introductory science articles. There seems to be a value to them (|Virus pageview example), especially since the underutilisation of simple English Wikipedia (pageviews example, which still includes pretty complex phrases). However the risk is content duplication of the main articles, outline pages, index pages, and portal pages which can have significant maintenance and updating overheads. Some articles have also included an introduction/lay summary section (e.g. Higgs_boson). T.Shafee(Evo &#38; Evo)talk 04:40, 13 May 2020 (UTC)
 * I think it's useful, but it's probably most useful when the subject is fairly technical and needs to be understood for a variety of articles (e.g., for viruses, but not for the common cold), and when the editors are deliberately writing for educational purposes, rather than as a comprehensive description of the subject. We don't have very many editors with a background in science education.  WhatamIdoing (talk) 05:02, 13 May 2020 (UTC)

Shepard Hurwitz
Hello medical experts. I came across this article about a doctor, and I wasn't able to find much in newspapers or books to improve the referencing or add any information. Maybe someone with access to medical journals can do better?&mdash;Anne Delong (talk) 10:25, 12 May 2020 (UTC)
 * journals, but nothing else--Ozzie10aaaa (talk) 21:08, 13 May 2020 (UTC)

Image needing MEDRS?
Views on this image? It does cite sources on Commons. HLHJ (talk) 01:04, 7 May 2020 (UTC)


 * Images are generally supposed to illustrate content that is already explained in the text. In that situation, it's not necessary to duplicate the references in the caption.  When the content isn't explained in the text – well, maybe it should be?  But if it isn't, then you can add the refs in a short caption if you want, although I think that many editors think that is not, strictly speaking, required (as the refs are one click away, and so it is "verifiABLE" even if it's not "already cited").
 * For WP:Accessibility reasons, it might be good to crop the image, and put some or all of the text in the caption. Imagine, e.g., having the first three faces with a caption that says "Surgical masks, homemade masks, and scarves provide a little protection for the wearer and some protection for people around them", and the last two faces with a caption that says "Respiratory masks provide high protection to the wearer. The ones without a valve provide high protection to other people, but the ones with a valve provide no protection to other people".  WhatamIdoing (talk) 03:24, 7 May 2020 (UTC)
 * I'm uncomfortable whether this image is in fact permitted. Looking at the first source these look extremely similar. I appreciate they have been "redrawn" that doesn't stop them being a copyvio. The model, the masks and the arrangement of the poster are all essentially identical. Further, the rigid masks look actually rigid in the original whereas in the copy they are just a solid block of cream colour. -- Colin°Talk 07:56, 7 May 2020 (UTC)
 * They look too similar to the copyrighted originals for me. My biggest issue though is that I can't read the text at thumbnail size. The need to follow a link to another page to read the information is poor design, particularly for mobile users and those with low bandwidths. Wouldn't a wikitable containing text with images just of the masks be smaller and more convenient for readers? --RexxS (talk) 22:55, 7 May 2020 (UTC)


 * Thank you all for your comments. The illustrator, Sciencia58, has responded. She says she modified it from an image copyrighted by the Robert Koch Institute, available from this source, and only the area around the eyes is unchanged. She also modified the captions with reference to the recent literature cited. It is possible that the Robert Koch Institute might be willing to donate the image. I will ask them if people here concur.
 * Separately, having individual images of the different types of masks might be useful for a table, which I agree might be a good format, and it would mean we could add new data and even new masks (like the sheer-nylon-stocking-over-cotton mask, active-coating cloth masks, or cloth masks with electret filter inserts) more easily. I agree with Colin that shading helps depict the rigid masks (which I've only seen in white). I think that Sciencia58 has done a better job than the original at distinguishing the surgical mask from the cloth mask by depicting the drape. Adding patterns to the cloth masks (tartan, say, or a traditional cotton sprigged print) might also make their materials more obvious.
 * I'm most concerned about MEDRS for the captions. They seem to be sourced from this BAUA page. BAUA (the German Federal Institute for Occupational Safety and Health) may count as MEDRS, but public health agencies seem to have have issued contradictory statements on this topic. The literature is understandably mostly proxy measures rather than actual infections of anything (why has no public health authority randomized paired communities to mandatory-homemade-masks-in-public and none? if you don't know, it seems the ethical thing to do). Is an electret-filter-interlayer surgical mask no better than a homemade cotton mask or bandanna? I f s there evidence that rigid electret respirators are better in practical use than electret surgical masks? Are there any MEDRS on this? These are very important questions. If we can make MEDRS-supported statements about the effectiveness of different types of masks for COVID-19 prevention, we should add that in prose to Face masks during the COVID-19 pandemic. HLHJ (talk) 00:44, 8 May 2020 (UTC)
 * I am most concerned that this image equates surgical masks to mere bandanas, whereas in practice surgical masks are as good as respirators. Therefore, I think, the image is misleading. And that's why I removed it from English Wikipedia. --Amakuha (talk) 10:37, 8 May 2020 (UTC)
 * User:Amakuha, that looks a bit tricky. They mostly didn't get statistically significant results for their top-line results (except for bacterial infections, where N95s were superior).  There are only four sentences that include a p-value of the accepted level:
 * The results of subgroup analyses indicated that statistically significant superiority of N95 respirators over surgical masks against influenza like illness (RR = 0.37, 95% CI 0.20‐0.71, P < .05) in the community (only one RCT).
 * However, the sensitivity analysis after excluding the trial by Loeb et al showed a significant effect of N95 respirators on preventing respiratory viral infections (RR = 0.61, 95% CI 0.39‐0.98, P < .05).
 * Meta‐analysis with fixed‐effects model revealed that compared with surgical masks, N95 respirators significantly reduced bacterial colonization in hospitals (RR = 0.58, 95% CI 0.43‐0.78, P < .05)
 * However, the sensitivity analysis after excluding the trial by Radonovich et al showed a significant effect of N95 respirators on preventing respiratory infection (RR = 0.53, 95% CI 0.35‐0.82, P < .05).
 * All of the sentences saying that the two types are comparable are not statistically significant results. In every instance of statistically significant numbers, it appears that the N95s are better than the surgical masks.  I think that it might be fairer to interpret the lack of statistically significant results for viral infections as meaning "no strong evidence that they're better" or "a chance that they're equally effective" than "masks are as good as respirators".  WhatamIdoing (talk) 15:50, 8 May 2020 (UTC)


 * Thanks for pointing it out! Of course, you are right. But I just wanted to point some things out.
 * Firstly, I meant the viral infection context (because the image is related to SARS-CoV-2). Bacterial infections (and, thus, general infections) are of lesser interest in regards to the image.
 * Secondly, I indeed made a mistake of taking the result for influenza as basis for my statement.
 * Thirdly, I am not strong in understanding why would p-value matter that much. I see these numbers from different good randomized control trials (RCTs) for the flu, and they strongly suggest to me that surgical masks are indeed not worse than N95. (see the table)
 * Lastly, my argument was only that surgical masks can be quite effective, almost reaching the levels of protection of N95 (especially if SARS-CoV-2 interacts with masks like a flu). --Amakuha (talk) 17:36, 8 May 2020 (UTC)
 * Another literature review (though for some reason Pubmed does not class it as one): "Most studies on prior respiratory virus epidemic to date suggest surgical masks not to be inferior compared with N95 respirators in terms of protective efficacy among health care workers"(temporarily-free PDF). Of course, this says nothing about the risk to patients, a remarkably common flaw in the medical literature on PPE. Have not looked at it closely yet. HLHJ (talk) 18:52, 8 May 2020 (UTC)
 * That review wasn't very useful, but this one is very useful:
 * I've added a lot of info from it to the article (review very welcome). Including the aforementioned sheer-stocking mask, for which I have requested an image.
 * On the topic of discussion, it says:"Compared with surgical masks, N95 respirators perform better in laboratory testing, may provide superior protection in inpatient settings and are equivalent in outpatient settings" and "However, studies comparing efficacy of different types of medical-grade masks in the inpatient setting have conflicting results. One non-inferiority RCT of nurses working in medical and paediatric inpatient units found that use of a surgical mask compared with a fit-tested N95 respirator resulted in non-inferior rates of laboratory-confirmed influenza.[22] Several other RCTs found that rates of respiratory infection illness were lower in healthcare workers who used fit-tested N95 respirators compared with those who used surgical masks.[23–25] Similarly, N95 respirators have been shown to provide superior protection against respiratory bacterial infections or bacterial-viral coinfections when compared with surgical masks.[26] The literature regarding mask fit in the inpatient setting is limited to one study. An RCT comparing fit-tested and non-fit-tested N95 respirators found no significant difference in ability to protect against respiratory illness, despite in vitro evidence of significant reduction in filtration efficacy with peripheral air leakage.[24][27] Furthermore, non-fit-tested N95 respirators were significantly more protective than surgical masks.[24]"
 * The review is also pretty clear that improvised cloth masks are not as good as commercial disposables, thought it hints at the possibility of making reusable cloth masks to an equally high standard. HLHJ (talk) 04:38, 9 May 2020 (UTC)
 * We have an adaptable PD image at File:Three Key Factors Required for a Respirator to be Effective.pdf. A full set of individual SVG images of different types of mask would be useful; text to be updated as the info comes. HLHJ (talk) 14:56, 9 May 2020 (UTC)
 * I think we should avoid sounding too certain about any of this. We don't know that surgical masks are either inferior or equivalent to N95 respirators.  It's possible that both are true, e.g., that they're equivalent for one setting/population/circumstance and inferior in another setting/population/circumstance.  It's also possible that the effect size varies by setting/population/circumstance.  Perhaps it will turn out like Anti-lock braking systems, which probably save lives overall but which promoted riskier behavior in taxi drivers, so the safety device produced net harms in that population (when they were a new idea; I doubt that it was the case after even a couple of years' experience).  People who think they're wearing the "good" PPE may engage in riskier behaviors, too.  They may wash their hands less, touch their faces more, spend more time close to contagious people, etc.
 * This started not so much with a concern about surgical masks being differentiated from N95s as with surgical masks being equated to a loose scarf. I don't know if that has been studied at all outside the lab.  WhatamIdoing (talk) 06:43, 10 May 2020 (UTC)
 * This started not so much with a concern about surgical masks being differentiated from N95s as with surgical masks being equated to a loose scarf. I don't know if that has been studied at all outside the lab.  WhatamIdoing (talk) 06:43, 10 May 2020 (UTC)


 * Materialien für Masken - Filterwirkung.png

I made some more changes in the coloured image. I also completed the labeling so it doesn't look like the homemade ones are equivalent to the normal surgical masks. Today I made this grafic comparing different materials. I can make the same in english later. One this grafic one can see, that the surgery masks are more effectiv. The authors of the literature source write that they did not want to use too dangerous pathogens for this test in order not to endanger the people present. The filter effect in the series of experiments with the virus-containing aerosol can be considered exemplary. The results are transferable to aerosols containing other viruses. Table in the literature source: The filter effect with the bacterium (left column) is higher because bacteria are considerably larger than viruses and can only be present in droplets of a corresponding size. The larger droplets are better captured by the substance used. Sciencia58 (talk) 12:05, 12 May 2020 (UTC)


 * Can you please delete all older versions of this image and this image  and delete this one completely . The latest versions in German and English are different enough from the template. The older ones aren't. Sciencia58 (talk) 10:32, 12 May 2020 (UTC)
 * I don't know if they will get deleted. Commons has strange rules, and "not accurate" is usually not considered a reason for deletion there.  WhatamIdoing (talk) 04:58, 13 May 2020 (UTC)
 * Materials for homemade masks - efficiency.png

Here it is, showing the differece between surgical masks and homemade masks, but also showing, that the homemade masks are better than nothing. Sciencia58 (talk) 12:08, 12 May 2020 (UTC)


 * I made some more changes to the labeling of the coloured image above, now it should be in accordance with the technical literature and the grey table. Sciencia58 (talk) 18:53, 12 May 2020 (UTC)


 * I agree with WhatamIdoing on the uncertainty. Face masks during the COVID-19 pandemic currently says "Although they [improvised cloth masks] are less effective than medical-grade masks... Improvised cloth masks seem to be worse than standard commercial disposable masks, but better than nothing. There is, however, little good evidence on them... However, in practice, with respect to some infections like influenza surgical masks appear as effective as respirators (such as N95 or FFP masks)". The MEDRS at the moment are largely low-level descriptions of individual studies. On your graph, Sciencia58, I'm afraid it may also be afflicted by that uncertainty. It seems scarves are often high-porosity and not very useful filters, although scarves vary widely. T-shirts and bedsheets also vary widely. See this reliable-looking but non-peer-reviewed source.
 * Frankly, I doubt we can give hard-and-fast info until someone develops standards-supported washable mask material (this is actually happening, it seems). General rules, like a preference for fabrics with small-diameter, rough-textured fibers, fine weaves/nonwoven textures, and no large pores, would probably be more useful than raw primary lab data. However, supporting such statements with MEDRS is currently difficult. We have a problem that the medics writing the medrs have no idea how to functionally describe cloth; they need some textile-engineer co-authors.
 * There is also exactly one RCT of cloth masks, and it gives only one datapoint describing the masks, a generic filtration efficiency, which is very low compared to the other measurements of cloth masks in the literature. It also seems to have a fair number of statistical problems. The evidence base in the effects of cloth masks on actual disease spread is almost non-existent, despite the widespread non-epidemic use of unstandardized cloth masks, essentially mass-produced improvised cloth masks, in poorer countries. HLHJ (talk) 05:10, 13 May 2020 (UTC)


 * The number of layers of fabric and whether the mask fits tightly all around so that no breathing air escapes at the sides or upwards also plays a role. The word scarf has little meaning because there are thin and thick scarves. If an infected person has a thick scarf over his mouth and nose, he can certainly reduce the amount of droplets released. The fact that homemade masks get damp on the inside when worn is proof that they absorb released droplets. For the time being, we have to live with the fact that we do not yet have any studies that clearly describe the types of materials of cloth-masks. We are currently working on this article in the German Wikipedia . Christian Drosten says, and this is also my experience, that wearing a mask is very effective in promoting social distancing because it reminds other people that they have to keep their distance. So wearing a homemade fabric mask is also an important social gesture, because we are not used to behaving like this and quickly forget it if we are not reminded. My overview with the colored pictures should only serve to make it easier for the layman to recognize and distinguish the mask types and to know the designations. In the past this was only relevant for medical staff, today everybody has to be familiar with it. The more precise distinctions can be found in the article texts. The 2020 study found that oral and nasal protection significantly reduces the release of influenza viruses and seasonal corona viruses, especially when not only the staff, but especially the infected person is equipped with it, and that transmission can thus be reduced . This also applies for homemade masks, although they are less effectiv. It should be emphasized in the article texts, that it is about protecting the other people. Sciencia58 (talk) 06:11, 13 May 2020 (UTC)


 * The bad thing about SARS-CoV-2 is that it is already contagious at the end of the incubation period. I do not know when my first cough will come. Coughing is a reflex, it can come as a surprise to myself. So I can be glad to have a cloth around my mouth and nose. Video: Sciencia58 (talk) 06:43, 13 May 2020 (UTC)


 * Thank you for this link . Sciencia58 (talk) 07:06, 13 May 2020 (UTC)


 * No problem. Actually, all of that SmartAir website is interesting; COVID-19 masks from the perspective of the HVAC engineers of a social enterprise against air pollution.
 * I would be utterly fascinated by MEDRS on the effect of masks on social distancing compliance. I like the idea of having coloured pictures of mask types, but if they were individual images without caption text in the image, it would be easier to update as the research advances. I won't be around here for a bit, but I favour getting clearly copyright-unencumbered pictures of mask types like yours. HLHJ (talk) 00:30, 14 May 2020 (UTC)

Lente insulin Comment
Hi there. I think I may have bit off more than I can chew. Long story short, a few weeks ago, I was poking around and realized that Wikipedia only had a couple sentences on ultralente insulin and no article at all on lente insulin. I spent a couple weeks (in my "free" time - much more loosely defined during COVID as when the conference call is being derailed and I can't be bothered to pay full attention) reading up on how to make an article... and decided to just go for it. I'm not sure if I could've created this as a Draft: article because the pages already existed (lente redirected to list of diabetes terms and ultralente was a short stub) - if so I apologize (and if it needs changed please fix my mistakes). But, now that I've actually gotten into writing the information, trying to follow PHARMMOS and MEDRS which are the two things I've found that look to me to be the policy behind medical related articles... it's hard. I'm not sure I'm doing exactly what I'm supposed to with regards to the sourcing, the citations themselves, and the sectioning of the page - heck, I'm not even sure if I'm making a step in the right direction.

Is there any way someone experienced in medical articles could either pop and take a look, or even better be willing to help me make the Lente insulin article? Any advice at all would be helpful, no matter how small. I have lots of extra time on my hands due to COVID and figured since I noticed this wasn't something in Wikipedia I'd try to help fix that - but it's very daunting to try and do everything properly. bɜ:ʳkənhɪmez (User/say hi!) 00:32, 12 May 2020 (UTC)


 * Welcome to Wikipedia, Berchanhimez, and welcome to WikiProject Medicine. (A WP:WikiProject is a group of editors that wants to work together.)  I am just amazed and impressed with what you've already accomplished.  You should be proud to have managed so much in just two days.  Congratulations. WhatamIdoing (talk) 05:09, 13 May 2020 (UTC)
 * I had to look up how to give you a notifitcation (I think this is it? ) but thanks! It came after a lot of reservation (I never had enough time to actually get into it aside from minor unregistered typoes and stuff) until COVID and this situation gave me the time and I noticed an article that wasn't there. I'm guessing that means that I'm at least doing moderately okay? bɜ:ʳkənhɪmez (User/say hi!) 06:02, 13 May 2020 (UTC)
 * It's looking pretty good, and it looks like a couple of other editors have made a few edits, too. What's next on your list?  WhatamIdoing (talk) 20:02, 13 May 2020 (UTC)
 * Oh, Berchanhimez, do you have any interest in seeing this new article mentioned on the Main Page? The Did you know section is for brand-new articles.  WhatamIdoing (talk) 20:04, 13 May 2020 (UTC)
 * User:WhatamIdoing - that would be neat to have it, but I'm not really sure what that would entail. bɜ:ʳkənhɪmez (User/say hi!) 20:06, 13 May 2020 (UTC)
 * Berchanhimez, the DYK process is very old and therefore a bit kludgy, but I think you can manage it. Start with the directions at Template talk:Did you know.  It's not as hard as it looks.  You need to come up with a "fun" question that begins with the words "Did you know..."  This is your first DYK nomination, so you don't need to worry about reviewing anyone else's.  Don't worry about getting the process wrong.  If it doesn't end up in the right place, there will always be someone who can help you sort it out.  WhatamIdoing (talk) 23:22, 13 May 2020 (UTC)

Thanks, I’ve tried to do that so maybe it can make something happen. There’s a lot more to Wikipedia than just writing - but I’m glad I’m able to make a meaningful contribution! Thanks for your help! Will keep working on the article and eventually on some others that I’ve noticed as well. bɜ:ʳkənhɪmez (User/say hi!) 01:38, 14 May 2020 (UTC)

Paediatric multisystem inflammatory syndrome
Commented at Talk:Paediatric multisystem inflammatory syndrome. 86.134.212.26 (talk) 10:27, 14 May 2020 (UTC)


 * Behind this bland title is the "COVID toes in kids" thing. WhatamIdoing (talk) 18:26, 14 May 2020 (UTC)


 * (no kidding WAID? - scarcely MEDRS-compliant though... ;-) 86.134.212.26 (talk) 19:30, 15 May 2020 (UTC)

Operation Warp Speed
Dear WP Medicine, I have just created this article. I am overwhelmingly a military editor, so my expertise is all in that area. Please feel free to fix, amend, update, etc. Buckshot06 (talk) 01:06, 16 May 2020 (UTC)
 * Thank you Buckshot06. :) I added some more content to the article (diff), added a short description, and assessed the article as Start-class.  - Mark D Worthen PsyD   (talk)   (I'm a man—traditional male pronouns are fine.)  04:32, 16 May 2020 (UTC)
 * Thankyou. I hope for the sake of the people of the United States of America that some or other arrangements actually improve the response to this pandemic. The USA is being pretty hard hit right now. Buckshot06 (talk) 06:58, 16 May 2020 (UTC)

Circumcision etc
Got a new account repeatedly trying to alter Morris's bio - could use eyes. As a circumcision researcher he attracts a lot of attention. More generally, the circumcision articles could do with being on more watchlists I think. They're on mine and the work this entails makes me think I'm being punished for some transgression in a past life ... Alexbrn (talk) 08:18, 15 May 2020 (UTC)
 * In the meantime, I didn't notice your name here, perhaps you just need the bit to do your job more effectively? CV9933 (talk) 11:14, 15 May 2020 (UTC)
 * Surely my past life transgressions aren't so bad as to deserve an RfA? Alexbrn (talk) 11:25, 15 May 2020 (UTC)
 * Saying that your name belongs on the list of unsuccessful RfAs does seem a bit cruel. Natureium (talk) 02:33, 17 May 2020 (UTC)
 * Who said that then? CV9933 (talk) 12:11, 17 May 2020 (UTC)
 * I think this comment is because you linked to the list of Unsuccessful adminship candidacies. I do like Alex's idea that we're using RFA to punish editors.  No good deed goes unpunished, and maybe some bad ones could be handled the same way.  "Oh, you screwed up big time?  It's off to WP:RFA with you, pal."  WhatamIdoing (talk) 23:24, 17 May 2020 (UTC)
 * Don't you Yanks have some sort of prohibition against cruel and unusual punishment? --RexxS (talk) 03:59, 18 May 2020 (UTC)
 * I think that only restricts the government's actions. Friends and loved ones are still allowed to be cruel and unusual.  WhatamIdoing (talk) 04:33, 18 May 2020 (UTC)
 * Why are we whispering? I was just making an observation that there are some tough topics to deal with and Alex steps up to the plate to deal with them even though most of us would shy away. You need the tools to help with that. It’s a pity that in an RfA, not only do we expect candidates to draw the sword from the stone, we also expect them to do it on a pogo stick with a Ford Transit strapped to their back.CV9933 (talk) 10:16, 18 May 2020 (UTC)
 * 1) Because it's fun.  2)  I thought it was any cargo van, not specifically a Transit.  WhatamIdoing (talk) 18:15, 18 May 2020 (UTC)
 * Ah, FGM for men. -Roxy the effin dog . wooF 19:06, 18 May 2020 (UTC)

What are Immunoglobulins (Antibodies) and its role in Covid-19 neutralization?
Israel Develops An Antibody That Attacks The Corona Virus In A Monoclonal Way.The news was published on 7th may 2020.

https://www.crosstownnews.in/post/50678/good-news-israel-develops-an-antibody-that-attacks-the-virus-in-a-monoclonal-way-.html

(KJRMOR (talk) 19:11, 16 May 2020 (UTC))
 * This describes the use of an antibody (traditionally antiserum) to generate (short term) passive immunity, which might be helpful for people who already have the disease (particularly if given early). The term passive vaccine has been used to describe such approaches. Using monoclonal antibodies is likely to be safer than using the serum from recovering patient. Such as an approach is a potentially helpful way of treating the disease, so it's great to hear that such approaches might be becoming a reality for COVID-19. Whether or not it can be given soon enough to actually help patients is something that remains to be seen. I don't see much on Wikipedia on passive immunization for COVID-19; has anyone else spotted it? If not, perhaps adding something about this topic would be helpful. Klbrain (talk) 08:04, 19 May 2020 (UTC)


 * Monoclonal antibodies are useful in treatment of infectious diseases. Doctors have used passive immunization, to stop or to treat infections for over a century for diseases like rabies, diphtheria, tetanus, hepatitis B. "Immunoglobulin’s" are mostly useful in passive immunity .DrY.Sreehari and his group of scientists invented an injection for Covid-19.The injection under clinical trail, the injection based on mechanism passive immunisation . IgG antibodies in this injection neutralizes Virus.. High-Dose Intravenous IgG useful in Treatment of Severe Surgical Infections IVIg is safe and effective in treating several humandiseases.

(KJRMOR (talk) 17:55, 19 May 2020 (UTC))


 * Antiviral monoclonal antibody already covers this topic in a general way. As there are on-going efforts to develop a Covid-19 MAbs, they should probably mentioned in this section. Boghog (talk) 20:49, 19 May 2020 (UTC)
 * There are a number of groups working on such MAbs including Vanderbilt-AstraZeneca and Regeneron Pharmaceuticals. Boghog (talk) 21:00, 19 May 2020 (UTC)

== RFC on pharmaceutical drug prices /currently at ArbCom==

The RFC has concluded. Here is my interpretation. Drug price information should nearly always not be included in the lead. The method used, of creating drug prices from raw database sources fails Verifiability. The presentation of the price for one particular formulation of the drug, often from very few suppliers, claiming this to be generally representative of all formulations of a drug, an entire world region (e.g. developing world), and all possible indications of use of the drug is false and misleading to our readers. Were those claims to be reworded to be specific, they would fail WP:WEIGHT. This applies no matter where a price appears in the article. The inclusion of price in the body, should that even be necessary to make a point, requires extensive discussion in secondary sources, which is what WP:NOTPRICE has always insisted. Prices should not be added to info boxes.

I see there has been discussion at Infobox drug about including GoodRX prices and/or links. There is no consensus for this, and I'm sure the wider community would be against infobox links to a commercial US-only price-comparison service. From what I understand, there are approximately three people in a population of 300 million in the US who have not heard of or use GoodRX, so there lacks any encyclopaedic value in an international project. Finding the cheapest local price for your medicines is not the job of an encyclopaedia.

I would be interested to know what plans those editors who added drug prices to our articles... Doc James ... have for their removal in compliance with the RFC conclusion. I hope they will acknowledge the community result and desist from adding prices to medical articles except in the most unusual and non-controversial cases. -- Colin°Talk 18:42, 28 March 2020 (UTC)
 * Colin, I agree this is the best place to hold a discussion, but before continuing the discussion here, it would be wise to hear from if the restriction that all discussion of drug pricing was confined to a single remit, WT:MEDMOS, is relaxed now that the RFC is closed.  Can drug pricing RFC followup be discussed here instead, or does it have to stay back at WT:MEDMOS ? Sandy Georgia  (Talk)  19:17, 28 March 2020 (UTC)
 * Yes now that the RfC is complete I don't think the moratorium or requirement of discussion at a single venue apply though MOSMED discussion is still probably best held there, but that's just my personal opinion. Best, Barkeep49 (talk) 20:36, 28 March 2020 (UTC)
 * Barkeep49, the only reason the price discussion was ever on WT:MEDMOS was because a, now blocked, editor added price advocacy statements to WP:MEDMOS and edit warred over them. The inclusion of price in an article isn't a MOS issue, and though the prices had been inserted into the lead (without any mention of cost in the body) in violation of WP:LEAD, what goes in the lead or the body isn't a medical matter. Drug prices have previously been discussed on this page, and most of the issues that led to the RFC result are general core policy matters, not a question of style (i.e how to format text). The discussion is over anyway, and what matters now, is what members of this project are going to do about the result. Hence, it's a project matter. -- Colin°Talk 20:48, 28 March 2020 (UTC)

Concerns about timing of this discussion due to the COVID-19 pandemic

 * I don't think this discussion will be given much attention right now in the middle of the COVID-19 pandemic. It would be wise to avoid drastic actions of any kind until WP:MED-editors are able to return to their normal duties and interests. The pandemic is currently, and quite understandably, taking a disproportionate amount of time from editors here. Carl Fredrik  talk 19:22, 28 March 2020 (UTC)
 * I'm not sure that is broadly true; some editors have more time than usual right now, because of stay-at-home, and others have given up on the COVID articles, as most of them are being edited in irretrievably hopeless ways, MEDRS out the door, and mostly politics. They are being mostly edited by non-medical editors.  That is, I don't see the need to hold off this discussion, which is not likely to be very complicated considering the RFC close. But I am worried about where to hold the discussion. CFCF, could you please refrain from adding excess markup to your talk page posts?   Sandy Georgia  (Talk)  19:28, 28 March 2020 (UTC)
 * I think there is going to be a wide variation on the impact of the pandemic on different editors, ranging from folks like (who I know has been the Covid-19 inpatient attending for some time and expects not to be relieved until sometime next week) to many students who will have time on their hands for the rest of the academic year. Jenny is managing to do some editing, despite having to home-school her three kids and work at the same time. James is getting ready for a massive upturn in his work demands for obvious reasons. I'm really lucky in that it hasn't affected me much, but I think we'll have to accept that not all of the regulars will be responding quickly to on-wiki events. --RexxS (talk) 21:09, 28 March 2020 (UTC)
 * I have to second 's observation here: most clinicians will be preparing for a massively increased work-load, with many non-clinician MDs and nurses likely also facing having to care for COVID-19 patients. So your point,, about it not being "broadly true" is all the more reason to avoid discussion right now. MD/RN-editors are less likely to respond and the outcome might therefore be severely biased , discounting their views. My initial point was more about how this discussion wouldn't be prioritized in the current editing climate which is focused towards COVID-articles, but the above is an even more pressing reason to shelve the issue for the time being, in order to avoid disruption. Carl Fredrik  talk 21:34, 28 March 2020 (UTC)
 * I agree with RexxS that there will be a wide variation, and that "not all of the regulars will be responding quickly". That will be the new normal for, likely, a long time to come, so while it is good reason to allow more time for discussions to unfold, and wait longer for responses, it doesn't mean we stop discussing or stop editing.  Many will recall that quite a few participants in the formulation of the RFC were absent for days to weeks at a time, even before the pandemic; we don't stop regular editing because some editors are less available, although I agree we need to allow much more time for responses, and before implementing anything. No, people carrying on with their regular editing, as they always have, do not have to stop doing so.  At any rate,  was asking on James' talk page what to do about the infobox for drug prices, and it seems that we can give them that answer (no prices in infoboxes). The database sources are not supported per WP:V.  What else needs to be decided now, besides who is going to get all of the 530 database prices out of the articles?  Can someone do that by bot, or do we need to manually go through all 530?  CFCF, could you please stop adding excess markup to your posts?  Most of us can read without the added emphasis. (do you see how irritating it is to be Told We Must Pay Attention To Certain Text Because It Is Bolded, Underlined or All Capped?) Sandy Georgia  (Talk)  21:48, 28 March 2020 (UTC)


 * I ask you not to comment on the format of my discussion where I highlight the most salient points, a practice which I believe to be very much in line with the WP:Talk page guidelines. Carl Fredrik  talk 10:53, 29 March 2020 (UTC)


 * You have been asked to stop. Similarly, please stop personalizing discussions: focus on content. Separately, please stop adding non-neutral headings to discussions.  A neutral heading for this discussion would look more like "Timing of discussion"; it is not helpful to add your personal opinions to headings.  Sandy Georgia  (Talk)  16:44, 29 March 2020 (UTC)


 * You added a non-neutral header and move my comment, implying that it was my personal "RFC interpretation", cutting it off from the necessary context. As for the other things you accuse me of, it's disingenuous, untrue and WP:UNCIVIL. We must be able to have disagreement, even disagree about personal actions and edits without calling it personalization and resorting to ad hominem, which is what you are doing when you question the format or language in my edits. That's just a case of the pot calling the kettle black. Carl Fredrik  talk 17:05, 29 March 2020 (UTC)

Uncertainties about bias // Implementation
I'm not sure what sort of bias could be produced by not having people with a physician's or nursing license involved. The result of the RFC begins with the sentence "Editors are generally opposed to inclusion of prices in the lede." I can't really think of how, e.g., a good editor who is a nurse and an equally good editor who is not a nurse would interpret that sentence differently. AFAICT the only "discussion" to be had at this stage is whether any editors want to WP:VOLUNTEER to implement the RFC's conclusion in a systematic, organized manner, or not (NB: "or not" includes letting any interested individual volunteer do it all himself/herself, doing it haphazardly, doing it when a given page is being overhauled anyway, etc.  It doesn't include rejecting the RFC's conclusions or trying to have the discussion about whether it's a good idea all over again). As for my own opinion on Colin's actual question, the RFC's conclusions ought to be implemented in the affected articles. Separately, someday I'll take them into account when I propose some content about prices for MEDMOS (and maybe also a sentence or two for MEDRS). But I don't actually care whether we organize the process of updating these articles. WhatamIdoing (talk) 06:09, 29 March 2020 (UTC)


 * , I'm not implying that you would be intentionally biased in any way. But the very nature of systemic bias ensures that we do not know how it would affect us. I am pointing out that the current time is very exceptional, and that large-scale edits or discussion on other topics should be avoided, if there is likelyhood a large portion of ordinary editors will not be able to engage in discussion. Wikipedia isn't about "snagging consensus" as soon as one sees the opportunity, and we would certainly be better off if we did not have to redo any discussion because of even the accusation of a one-sided consensus. Carl Fredrik  talk 09:30, 29 March 2020 (UTC)
 * WhatamIdoing, I think we should create a list of drugs that have notable high-cost issues and we can together all examine if there are problems surrounding the presentation or sourcing of prices on those drugs that need MEDMOS/MEDRS guidance. It may be that editors are doing a reasonable job with that, or existing general guidelines already inform, or the few problematic articles can be resolved without the need for further legislation in a guideline page. As I noted at the RFC, I think we have focused too much on a dollar.cent price figure and not enough on providing encyclopaedic information to our readers about general comments on affordability, availability and relative cost vs other treatments, which are probably best made at the disease article's treatment section. So I'd caution against specifically dealing with "price" at MEDMOS. The word "price" has us reaching for the $ symbol on the keyboard, and perhaps mostly we don't need it to inform our readers.
 * As for volunteering, someone once said "If you want a job done well, do it yourself". So I guess... -- Colin°Talk 09:04, 29 March 2020 (UTC)
 * And — I would point out that regardless of the outcome, major editing across many articles, should be avoided if there is any suspicion that it would be controversial. This isn't about "restricting" what people can edit about, but more about advanced warning that major revisions at a time when consensus is difficult to gauge, can be very disruptive if we later have to revert all of it: because it went too far; or because it was judged to misinterpret consensus at a later stage.  We should always strive for the broadest possible consensus, which is not possible at the moment, and this issue being a non emergency, it can clearly wait — whereas a lot of other things can't.  I implore you to be cautious and avoid major changes across multiple articles right now . It looks like you're going to get what you wanted, but without room for discussion right now, there is serious risk of overshooting. This is directed to you, or to anyone involved, because I don't want anyone to come back and say "no one said anything" or "I didn't know". The COVID-pandemic is an exceptional situation for WP:MED, and major changes to our body of other articles would benefit from being put on hold.  Carl Fredrik  talk 09:41, 29 March 2020 (UTC)
 * Carl, the RFC, in which you chose not to participate, is over and there is already a clear conclusion of community consensus weighed by two uninvolved admins. The only "discussion" now is about who wants to do the work, and a request that those who have previously edit warred over this matter acknowledge the consensus. The prices will be removed from the lead of nearly all drug articles, and prices sourced to raw database sources will also be removed from the article body. Carl, it is clear what you are doing here. Get over it, move on. I do not intend to discuss the matter further with you. -- Colin°Talk 10:14, 29 March 2020 (UTC)
 * — Those accusations are to me a clear rejection of WP:assume good faith. You rightfully point out that I chose not to participate in the RfC, but there is no reason why that would matter. I am not rejecting the RfC — but pointing out that large-scale major edits over many articles, which may be controversial — are not appropriate at the moment, and are not supported by the RfC. As anyone is able to see upon reviewing the link at the very top here: The closing message of the RfC is not as straight forward as you make it. There is mention of "no consensus" in several places and the phrase "unlikely to find consensus", not "consensus against". There are also use of phrasing such as "in most cases", which imply a need to go through articles on a case-by-case basis . Each article that is assessed must of course take into account the RfC-result, but from what I understand you were suggesting a quick run-down of all articles in one fell swoop. What I'm saying is for those cases where consensus isn't 100% clear (quite a substantial number where secondary sources are included): don't go overboard. For example, how should we treat secondary sources discussing medication prices, such as those from the World Health Organization? Those things aren't simple and we need to properly discuss them, taking time in expense that we simply don't have right now. I can't debate this further now, because it is a complicated issue and one that requires quite a lot of reading and familiarizing with sources. The reason why I'm saying this is because the RfC didn't come with a clear "Do this" result, and even if that is not your intent: using the current timing may be perceived as an attempt to avoid scrutiny by a sizable proportion of those editors who did not agree with your take in the RfC. TL;DR: The RfC resulted in a mixed consensus, not a ratification of 's position. Carl Fredrik  talk 10:45, 29 March 2020 (UTC)
 * Perhaps you will consider re-reading the RFC after a few days; let's not re-litigate it post-closing. The time to enter an opinion was during the RFC, not after.  Sandy Georgia  (Talk)  15:08, 29 March 2020 (UTC)


 * That reiterates my point — the RfC is extremely lengthy, and if one is expected to read the entire thing to interpret the closing and to implement it, it will not be done quickly. I'm not interested in entering an opinion, which should be evident in that I did not engage in the RfC — but I am interested in ensuring that the current situation with most MD/RD-editors being away doesn't mean a lot of poor choices are made with incomplete consensus — which we later have to revert. WP:THEREISNODEADLINE Carl Fredrik  talk 16:58, 29 March 2020 (UTC)
 * It was the job of the admins to read the "extremely lengthy" RFC and their summary and conclusions are not long at all; it is quite consise, and not hard to understand. We don't re-litigate a closed RFC, which was widely advertised.  For now, could you please take on board the need to avoid battleground, and allow neutral discussion,  under neutral headings, to continue about how to best implement the consensus?  Thanks, Sandy Georgia  (Talk)  17:01, 29 March 2020 (UTC)
 * If it was the job of the admins, then why did you ask me to re-read it?
 * All I've said was:
 * 1) That the timing is wrong for introducing major changes in the middle of a pandemic where many editors are not present
 * and
 * 2) That the RfC certainly isn't as straight forward when 2 out of 3 points in the closing summary point to a lack of consensus or no consensus.
 * I have no further comments.
 * Carl Fredrik talk 17:11, 29 March 2020 (UTC)
 * Separately, you have personalized unnecessarily in this post. I am not going to requote the unnecessary wording that risks derailing the discussion from matters at hand, but I do suggest you may want to strike that portion, and comment on content, not contributor going forward. Sandy Georgia  (Talk)  15:14, 29 March 2020 (UTC)

Implementation
Back on topic. I think we should create a list of drugs that have notable high-cost issues and we can together all examine if there are problems surrounding the presentation or sourcing of prices on those drugs that need MEDMOS/MEDRS guidance. Colin, unless I am misunderstanding, you are proposing here that we should separately do something to examine those cases where our drug articles do have notable high-cost issues that should be covered? During the RFC formulation, we did find that in many instances-- where articles should be discussing pricing as a V, WEIGHT, reliably sourced issue-- they were not. In the rest of the cases, on implementing the RFC, there are several things I think we need to have feedback on:


 * First, we should hear if the people who made the edits to the 530 articles have a plan to remove them themselves. That would solve the implementation problem with no further need for discussion or a lot of work from other editors.
 * Second, if not, then we can discuss how to approach the 530 articles. Can that list be edited down to include just the articles and the text?
 * Then third, we need an approach to doing the work. Because many people are under stay-at-home orders, I don't think it will be difficult to find volunteers, but we should not initiate work until there is an agreed approach.  Sandy Georgia  (Talk)  15:03, 29 March 2020 (UTC)  Adding clarification:  This is NOT to say that we need agreement to implement the RFC-- only that we need to hear first whether those who added the disputed text are willing to delete it themselves, or whether we will need to find another way to divide up the work, whether alphabetically, etc.  Sandy Georgia  (Talk)  17:49, 29 March 2020 (UTC)
 * My remark concerns WhatamIdoing comment about (at a future date) to "propose some content about prices for MEDMOS (and maybe also a sentence or two for MEDRS)." That's very much a no-rush matter. As with all guidelines, we need to look at current practice, best practice, bad practice, and work out even if guidelines are needed. That's why I suggested making a list of articles that might be worth reviewing. And yes there are social, economic and health-service issues surrounding pharmaceutical treatments that our articles neglect, so editors might want to work on that as an area to improve and suggest for MEDMOS. -- Colin°Talk 16:35, 29 March 2020 (UTC)
 * OK, I see now why you added that. We may already need a re-boot to focus on how to implement the RFC, as the discussion went off-track quickly. Perhaps WhatamIdoing can use her skills to figure out how best to re-focus the discussion.  Sandy Georgia  (Talk)  16:46, 29 March 2020 (UTC)
 * Yes, that will have to happen later, possibly months from now. For one thing, I'll want to re-read the entire 49,000-word-long RFC first.  I'm a fast reader, but that step alone will likely take a couple of weeks.  WhatamIdoing (talk) 16:51, 29 March 2020 (UTC)
 * In re "major editing across many articles, should be avoided if there is any suspicion that it would be controversial": Carl, I don't think that it's generally considered "controversial" to (conservatively) implement the conclusion of an unusually long, unusually well-attended RFC.  Do you?  I mean, we have pretty much unanimous agreement (including from the person who originally added it) that when the database gives a price for a single African country, that nobody ought to write that it's the price in the entire developing world (=80% of the world's population).  I really struggle to see how anyone would think removing that is controversial or in need of yet more discussion.  At least a third of the prices sourced to that website are similarly bad.  I can understand that drug price content feels less urgent to you (and to many people) than the COVID-19 articles, but does it genuinely seem controversial to you?  WhatamIdoing (talk) 16:47, 29 March 2020 (UTC)
 * — No, that does not sound controversial, but it was also not what I understood the intent of the original post to be. There was nothing about conservative implementation of the least controversial points from the RfC. I'm totally fine with it, as long as we implement what is actually not disputed first, and then we can discuss the things that remain disputed, or that the RfC failed to answer later. From what I understand, the only really clear point is the first one about the general opposition towards prices in the lede. I don't have time to comment further, and truly hope that it isn't a mistake to drop the issue for now. I believe I've made my points heard about being careful and going slowly, and can't contribute more. Carl Fredrik  talk 17:22, 29 March 2020 (UTC)
 * This RFC was specifically about content sourced to Special:LinkSearch/*.mshpriceguide.org. While the discussion covered much wider range (there's no way to keep Wikipedians from talking about whatever they think is important), the primary conclusions are about (mis)using that single source, and especially about having misleading content from it in the introduction of an article.  I think that fixing up that much could be implemented (especially in the most obvious cases) by anyone at any time.  Most price content should move out of the lead (all editors to use best judgment, nobody to engage in WP:POINTy or mindless editing, etc.), and the price content from that one specific source should be reviewed with an eye towards removal (if the database had limited information for that drug) or correction/clarification (all the rest).  The removals will be easier, so it might make sense to do those first, but There is no deadline.  It's been there for five or six years, so another couple of months doesn't really matter.  For the rest (e.g., infoboxes), that's all food for thought at a future date.  WhatamIdoing (talk) 18:40, 29 March 2020 (UTC)
 * To answer WAID, the conclusions of the RFC are pretty clear, and I am not seeing this "controversy". I have suggested that CFCF might want to revisit the conclusions of the admins after a few days' reflection-- sometimes things can be seen more clearly with a few days' distance. On the other hand, I don't think anyone is advocating moving forward without a deliberative discussion and approach about how to go about approaching the work that needs to be done. That text in the leads sourced to these databases goes is indisputable from the RFC close. The closing admins also concluded that pricing text anywhere in the articles does not enjoy consensus that it meets policy (V or WEIGHT). Those wanting to add content need to demonstrate that the content meets policy, not the other way around.  These are not controversial statements. The text in these articles now does not enjoy consensus is the conclusion, and where there is little discussion of pricing in secondary sources, it generally should not be included.  That how to undertake this work on 530 articles needs to be discussed goes without saying, because it is a lot of work. The idea that we can't even talk about this because a small number of medical editors are attempting to keep up with NOTNEWS yet InTheNews edits across hundreds of COVID articles is a sample of confirmation bias. I am seeing editors engaging on non-COVID medical articles to an extent that I hadn't seen in years, so it is apparent to me that there are plenty of editors with more free time now. We can move forward to discussing how to implement the RFC conclusions; IMO, it would be preferable to first hear whether the editors who added the text will help get it removed, and I accept that it may take additional time, due to the pandemic, to get an answer to that query. Our time will also be better spent if we deal with the housekeeping issues here, lest we see another five-month detour through ANI.  Sandy Georgia  (Talk)  18:18, 29 March 2020 (UTC)
 * I don't think we need to have big discussions. I think we just need to move slowly.  Nobody should try to edit hundreds of drug articles today, or even this week, because it's not nice to flood people's watchlists.  We should fix the "obvious" problems first.  It may take a long time to get decent price content into articles, but that's okay; we can make some of it better soon.  For right now, just getting mediocre-to-bad content from the one source out of the introduction is a simple, feasible edit that dozens of us are capable of doing.  Probably the fastest way to do that is to go to User:Colin/MSHData, sort by the number of suppliers, and start with the ones that have zero suppliers or just one supplier.  All of those require (mostly) removal or (sometimes) correction.  If anyone is interested in doing this, but isn't sure what to do, then pick an article from the list, make your best-guess edit, and bring the diff here with your questions (or ping me for an informal second opinion).  We could probably even ping the closing admins with a few diffs to make sure that the changes we make are what they expected.  We do more complicated editing every day of the week.  We shouldn't overcomplicate this.  WhatamIdoing (talk) 18:55, 29 March 2020 (UTC)


 * I support this take by . Carl Fredrik  talk 19:50, 29 March 2020 (UTC)


 * WAID, I don't suspect there is a current risk that anyone will run out and edit hundreds of articles any time soon. We do need to get the work done, but I think/hope we all understand that we need time to hear from all involved considering the current world environment. I do suspect we all appreciate the need for a systematic, deliberative, and coordinated effort, when we are talking about 530 articles. I don't want to see us getting in each other's way, duplicating work, duplicating checking of work, confusing editors who didn't know about the RFC, or in a situation where multiple editors are reviewing the same articles. I also submit, as an optimist perhaps, that the last time we found ourselves (WPMED) in a similar position, the editor who had added all of the disputed content voluntarily removed all of it themselves, so there remains a chance we don't have to undertake this work. If we do, we can approach this systematically to save time. That is:I suggest a sorting of the list of the 530 articles (by source used, then by article name), placed somewhere in project space, and set up in a format that each editor can indicate what they have addressed, and include a diff. (Similar to how Copyvio investigations proceed.)  I also suggest we come up with a shared, common edit summary for this work-- one that links back to the RFC-- for two reasons: 1) recall that there were several dozen editors who had tried to remove this price data in the past but who were apparently unaware of the RFC (and were intentionally not pinged to the RFC per canvassing), who may be watching articles and unaware of why the changes are being made, and; this allows the rest of us to easily see the common edits and know what has already been done, avoiding duplication of work. Again, a reminder that we have seen work on similar problems where edit summaries were not used, and that will make it harder on everyone. Starting with the MSH-sourced articles first may make sense, but the RFC also concluded that there is no consensus for drug prices to be in articles at all, so we should proceed carefully enough that we have a broader system in place to deal with all 530 database-sourced prices when the time comes. Again, all of this work could be negated, though, if the editor who added them voluntarily removed them. Sandy Georgia  (Talk)  20:49, 29 March 2020 (UTC)

Housekeeping
It appears that we as a Project are going to have to take on some housekeeping issues here, unless we want another trip to ANI. Less than a week after the RFC closed, we are seeing a return to earlier behaviors. Our task is to decide how to implement the close of the RFC; not to re-litigate conclusions reached by the neutral admins who closed it. I am concerned that there is already opposition to even discussion of how to implement the RFC, and particularly at a time when many editors are stuck at home and have enough free time on their hands to go about getting the work done. I am particularly concerned that we are already seeing personalization of issues, unstruck battleground accusations that one editor is "going to get what you wanted" (what the RFC concluded), and non-neutral framing and re-editing of section headings that impede productive discussion of how to implement the RFC. The entire discussion has now been reformatted with non-neutral section headings impeding discussion. I do not intend to try to continue to address the reformatting of the sections to one editor's interpretation, but think that we might consider, as a group, ways to get it to stop so we don't end up at ANI again. We need some ideas here on how to reign in these issues so that discussion can proceed. Sandy Georgia (Talk)  17:59, 29 March 2020 (UTC)
 * My suggestions:
 * The first section heading here, "Wrong time to be having this debate (COVID-19 pandemic)" is quite a leading heading, discouraging discussion. I suggest it be changed to a neutral "Timing of discussion".
 * Ditto for second, and I suggest changing, "Uncertainties about bias // Implementation" to a more neutral and general "Implementation concerns".
 * My final suggestion is that we, as a group, make a determination here to get this re-formatting of sections and other people's posts to stop. We should be sufficiently grown up that we shouldn't need to go to outside admins to hold a productive discussion without excess markup, reformatting, and posts advocating that we cannot even hold a discussion.
 * Sandy Georgia (Talk)  18:33, 29 March 2020 (UTC)
 * The one who has been doing most of the reformatting of others' discussions and sections here has been you, SandyGeorgia, having intentionally ignored responses and indenting — placing lengthy comments above or at the same level as those of others, repeatedly squirreling away what you find "irrelevant" or "personalized" under various trivializing headers.
 * Adding unrelated and loaded euphemisms to headers is also not useful, as you did in:, implying that the section was independent from the rest of the discussion, and represented a minority or fringe view:  — after which you followed with a comment that simultaneously moved the section away and ignored the concerns: , starting with: "Back on topic". Or here, where you again implied that others were "off topic" in the edit summary upon concerns over whether it was a good idea to be debating when so many editors were absent: ; adding a pointy break:
 * Growing up, I was taught the phrase: "people who live in glass houses shouldn't throw stones", which seems apt here. Carl Fredrik  talk 21:45, 29 March 2020 (UTC)
 * You are entitled to your opinions and partial diffs. More significantly, thank you for partially addressing some of the headings you introduced (although removing mine, which you should refrain from doing again). Now, there is work to be done. Will you join in refraining from personalizing discussions, taking care with section headings, and allowing discussion to proceed? That would help all of our efforts. Once again, you may have the last word. Sandy Georgia  (Talk)  21:58, 29 March 2020 (UTC)

Conclusions
Per "There is no consensus on whether drug prices should be included in articles at all". Sure I guess they can go in the body of the article. I will get around to starting a clearer RfC eventually after WP:COVID19. Doc James (talk · contribs · email) 23:43, 29 March 2020 (UTC)
 * James, perhaps I am misreading, so could you expand/clarify? Your posts sounds as if you are saying you reject the conclusions of a widely advertised, community-wide RFC, so plan to re-do another RFC, formulated by you, which I find hard to understand. Sandy Georgia  (Talk)  23:50, 29 March 2020 (UTC)
 * Per "There is no consensus on whether drug prices should be included in articles at all" means that consensus was not achieved on some stuff. Yes that is correct. Personally I think that this RfC was a mess and hard to make heads or tails of. Doc James  (talk · contribs · email) 00:28, 30 March 2020 (UTC)
 * That is a concerning response, James; it appears that I was reading your response correctly the first time? It seems that you are saying you don't like the conclusion, so you plan to re-do the RFC yourself. I hate to drag them back in here, but perhaps the closing admins will have an opinion on that approach. . Sandy Georgia  (Talk)  00:43, 30 March 2020 (UTC)
 * Considering we have an RFC saying there is no consensus that the content added meets policy, are you accounting for the fact that the burden is on the editor wanting to add content to demonstrate that it meets policy? With a five-month-long process, wide open to the community, it is hard for me to understand how you can say that you need to re-do it yourself. Sandy Georgia  (Talk)  00:46, 30 March 2020 (UTC)
 * Sure feel free. We need to work to clarify the situation around the body of the text. Doc James  (talk · contribs · email) 00:52, 30 March 2020 (UTC)
 * , just for the record I am not a closing admin on this. Wugapodes and Ymblanter did all that work. I felt it needed fresh eyes given the work I'd done to facilitate its launch. That said as long as an editor is including pricing information referenced secondary sourcing in the body of the article that seems appropriate given the conclusion of the RfC. Best, Barkeep49 (talk) 00:52, 30 March 2020 (UTC)
 * Yes, I realize that ... lumping you all together under one term was a shortcut. But, considering you did facilitate the launch, and close the ANI, how should we interpret James' intent to re-do the RFC himself?  Sandy Georgia  (Talk)  00:54, 30 March 2020 (UTC)
 * I think it's possible an RfC that seeks consensus on an area that had no consensus could be productive. Or could be disruptive, all depends on a lot of factors. Given my faith in James I would expect it to be productive rather than disruptive. Further, James has indicated he's not going to launch soon (and given COVID could be intense for a few more months) so it's not something we need to has out now. Best, Barkeep49 (talk) 01:00, 30 March 2020 (UTC)
 * Thanks User:Barkeep49... There are also the concerns around an editor being pushed out of Wikipedia during the drafting of the prior one and multiple people raising concerns about the formating. But will leave that to later. Doc James  (talk · contribs · email) 01:03, 30 March 2020 (UTC)
 * "An editor being pushed out" is a dubious way to phrase that. Sandy Georgia  (Talk)  02:06, 30 March 2020 (UTC)

I read it as drug prices are not given any special priority for inclusion in articles, nor are drug prices exempt from the application of NOT and POV. --Hipal/Ronz (talk) 01:41, 30 March 2020 (UTC)
 * Basically, the "no consensus" close means we follow existing policy, that being WP:NOPRICES. Prices may be included in articles (body or otherwise) in exceptional circumstances where reliable and independent sources clearly consider them of significance and extensively discuss them, but not as a matter of course. And we very much should not be extrapolating from databases. Seraphimblade Talk to me 01:48, 30 March 2020 (UTC)
 * Or per the link "An article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention." Doc James  (talk · contribs · email) 02:05, 30 March 2020 (UTC)
 * Per both of you (Ronz, Seraph), this much is clear. To most of us :) Sandy Georgia  (Talk)  02:06, 30 March 2020 (UTC)
 * unless there is an independent source and a justified reason for the mention. No. We tried that and it failed. NOT and POV apply. Please avoid anything that comes across as WP:IDHT at this point.
 * I realize that this is a quote from NOT, but in the context of this RfC, it's not enough. Editors all along were saying they had "justification". It's clear now that they did not. Let's be more clear and careful in how we proceed. --Hipal/Ronz (talk) 02:24, 30 March 2020 (UTC)
 * Perhaps the three of you could help in the earlier sections of this discussion, that revolve around how to best proceed next. Sandy Georgia  (Talk)  02:30, 30 March 2020 (UTC)

I'd hope there would be no problems with removing prices from article ledes, with the few exceptions where prices themselves were clearly part of the notability of the drug in question (eg Pyrimethamine). --Hipal/Ronz (talk) 03:32, 30 March 2020 (UTC)
 * Our conclusion is that whether prices can go to the body of a specific articles is determined on case per case basis, and there is no general consensus on this. In practice, probably, as usual, if some users agree and some disagree, they should go to the talk page and sort it out, taking into account whether pricing sources are primary or secondary, their quality, the formulation of the statement etc.--Ymblanter (talk) 05:25, 30 March 2020 (UTC)

Ymblanter and Wugapodes, the "no consensus" part of your closing remarks is being seized upon as suggesting the RFC failed to reach a conclusion on the central points. My interpretation of your words is that there is indeed no consensus that prices should routinely be inserted in articles or never inserted in articles but that, as always, per WP:NOTPRICES, this is determined per drug article based on "secondary sources discuss[ing] pricing extensively" [ for that drug ] or as policy states it "mainstream media sources (not just product reviews) provide commentary on these details instead of just passing mention". Can I ask you to urgently clarify this. In my view the RFC achieved several things: In particular, it is not sufficient to find secondary sources mentioning the the cost of a drug (whether in dollars or abstractly) and then include a different price sourced to a primary database of product prices. The prices themselves must be sourced to secondary sources who make extended commentary on that price. -- Colin°Talk 07:34, 1 April 2020 (UTC)
 * Prices should nearly always be removed from the lead.
 * Prices should not be sourced solely to primary databases of raw product prices, which when interpreted leads to WP:OR, WP:V and even if carefully written have WP:WEIGHT issues.
 * WP:NOTPRICES is reaffirmed as fully applying to drug prices.
 * The suggestions by some that prices might appear in info boxes, sourced to wikidata, is likely to be a non-starter and be rejected.
 * Yes, this is what we concluded (with an obvious comment that we only summarized the discussion at this RfC - for example, if there are some magic databases which can be taken over without interpretation, this might be a different story, but it was not a subject of this RfC).--Ymblanter (talk) 07:46, 1 April 2020 (UTC)
 * Ymblanter, thank you very much for your quick confirmation. There are no magic databases. The RFC focused on the MSH Price Guide database as a representative example of such databases. Drugs.com and BNF are similar, though with an even greater choice of formulations and dose strengths as you'd expect from developed nations. The BNF also lists, for each formulation and strength, prices from many suppliers to the NHS, generic and branded, which are not all the same. The NADAC prices are even worse (you can't link to a particular drug, which must be searched for by hand) and offer an oddly limited set of formulations and dose. Both NADAC and Drugs.com give official list prices (wholesale and retail respectively) and it is well known that these prices are not in fact the ones paid by pharmacies or by customers. GoodRX has more accurate retail prices, after discount coupons, though the mix of prices varies depending on which of their many partner retailers you shop at, and where you live in the US. The BNF website is unavailable outside of the UK and GoodRX is unavailable outside of the US, making their data harder for readers to verify. The mix of wholesale and retail, list and discounted prices further complicates their use on Wiki articles where prices get juxtaposed. Further, none of these sources are able to list the official price paid by health services for the extremely expensive cancer drugs (BNF give the official list price the drug company wants you to see, and includes a warning to indicate this) -- the huge discount negotiated is a commercial secret. -- Colin°Talk 08:02, 1 April 2020 (UTC)


 * Portions of this discussion have been copied to Wikipedia talk:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices, where I have asked a question. --Tryptofish (talk) 23:08, 13 April 2020 (UTC)

Drug price databases rejected as the sole source
The RFC's conclusions also say "Where pricing information is included, claims should be sourced to reliable, secondary sources and not solely primary source data from price databases." This statement does not restrict itself to the introduction. It applies to all drug price content in the entire article.

In keeping with my understanding of this conclusion, I removed a claim in Simvastatin that was sourced solely to primary source data from the MSH price database. James put it back in the article with slightly different wording at Simvastatin. It is still sourced solely to primary source data from a drug price database (a database that, because they're re-organizing their website, can only be accessed via tables in a PDF at the moment).

Ymblanter and Wugapodes, when you said that it's not okay to source drug price content solely to the drug price databases, did you mean to include, well, sourcing this drug price content solely to the MSH drug price database? Do you think that including that sentence, with that single source, is in keeping with the community's consensus or against it? WhatamIdoing (talk) 15:43, 30 March 2020 (UTC)
 * We believe that the RfC established that sourcing prices only from a database involves original research. If there are some issues (like, I do not know, one database which covers some ground and does not require interpretation) which have not been discussed during this RfC then they should be discussed at the talk page. I can not really comment on the specific case.--Ymblanter (talk) 15:48, 30 March 2020 (UTC)
 * Sure we can adjust these so no interpretation is required. Claims around pricing were not sololy based on price databases but based on multiple sources. Doc James  (talk · contribs · email) 19:40, 30 March 2020 (UTC)
 * Doc James, the sentence I'm discussing about today is the one that currently says:
 * The wholesale cost in some LMIC is around US$0.01 to 0.15 per 20 mg dose.


 * That looks like exactly one (1) citation, to a drug price database, as in a claim that is "sourced solely to primary source data from a drug price database". Are you claiming that you took this information upon some other, uncited sources?  Or do you agree that this single sentence is, in fact, cited solely to a single drug database?  WhatamIdoing (talk) 21:12, 30 March 2020 (UTC)
 * The discussion of prices generally is supported by a number of citations. The topic of prices is not just supported by that reference. Doc James  (talk · contribs · email) 21:21, 30 March 2020 (UTC)

Additionally there was no consensus to scrub prices for medications based on the popular press such as the BBC. Doc James  (talk · contribs · email) 19:44, 30 March 2020 (UTC)
 * To add to Ymblanter's point, I took that language from WP:MEDRS which says to prefer secondary sources to primary sources. If primary sources like price databases are used anywhere in an article, they should be used with caution in line with our existing guidance on the use of primary sources. — Wug·a·po·des​ 21:15, 30 March 2020 (UTC)
 * Per WP:MEDRS we also state "recognised standard textbooks by experts in a field". A book published by the World Health Organization definitely fits that criteria. So yes we are using appropriate caution. Doc James  (talk · contribs · email) 21:42, 30 March 2020 (UTC)
 * That a price database (primary source) is published for convenience in PDF format, does not turn it into a "recognised standard textbook by experts in a field". A textbook is a tertiary source that builds upon primary and secondary material. This is basic stuff. The database-sourced prices must go. "Adjusting so no interpretation is required" was discussed extensively at the RFC and gives WP:WEIGHT issues. This was confirmed by the closing admins "In addition, there are concerns that proper explanation of the situation for the indicated price would give the price undue weight." -- Colin°Talk 07:18, 1 April 2020 (UTC)

In James's Arbcom statement he writes (initially quoting the RFC's closing admin remarks) "Where pricing information is included, claims should be sourced to reliable, secondary sources and not solely primary source data from price databases." I do not take to mean that the price database cannot be used ever. If that was the case it would say this source published by the World Health Organization should never be used despite MEDRS stating source from the WHO are among the ideal

This is not an accurate assertion of what MEDRS says. MEDRS mentions the WHO in the section "Summarize scientific consensus" and specificity holds up "statements and practice guidelines" from various bodies, including the WHO, as the place to find such consensus sources. MEDRS does not claim that any document published or produced internally by WHO is a suitable or even ideal source. The RFC concluded that the current practice and indeed any use, of product price databases as the sole source of a price in our articles is not allowed. It, as you put it, "cannot be used ever" as the sole source of a price. This was clarified by the admin above. All these price database are published by respected bodies and nobody questions they are accurate databases of individual product prices from a set of suppliers at a particular point in time. Exporting a raw price database into a PDF document does not turn it into a consensus statement or practice guideline from WHO. I ask that James remove his misleading statement about MEDRS and WHO. Further, I request that if James wishes to better understand the RFC conclusion, that he post that request here, and not at arbcom. -- Colin°Talk 07:39, 2 April 2020 (UTC)
 * Dengue fever, carrying a bronze star, is sourced largely to the World Health Org. Sandy Georgia  (Talk)  06:08, 3 April 2020 (UTC)

Simvastatin
I'm very concerned that this introduction of pricing iformation is far outside anything allowed by the RfC. --Hipal/Ronz (talk) 20:16, 30 March 2020 (UTC)
 * That is not a numerical price. Anyway I guess we have our next RfC. Doc James  (talk · contribs · email) 20:21, 30 March 2020 (UTC)
 * I'd rather just go to ArbCom. --Hipal/Ronz (talk) 20:23, 30 March 2020 (UTC)
 * I'm not seeing the issue either, I don't see how it violates:


 * Where secondary sources discuss pricing extensively (insulin being a frequently cited example), that information may be worth including in the article; where there is little discussion of pricing in secondary sources, it generally should not be included. Drugs which fall into the grey area between these extremes should be discussed on a case-by-case basis. Where pricing information is included, claims should be sourced to reliable, secondary sources and not solely primary source data from price databases.


 * All that says is that inclusion is subject to discussion — which we rightfully can have here or at Talk:Simvastatin, if necessary.
 * Immediately bringing up ArbCom over: a single edit, which relies on secondary sources in line with the RfC summary — certainly feels like WP:INTIMIDATION. I mean this is just saying "that edit's not allowed", without even going into what makes the edit forbidden — which is a conduct violation per WP:BUREAUCRACY (a policy). In addition, the skipping of discussion and simply pointing fingers — is explicitly against the RfC, which says: discuss. What it does look like is WP:Wikihounding.
 * P.S. It's definitely Wikihounding, because there is even a clear discussion post here Talk:Simvastatin, predating the bringing forth of concerns here; a discussion in which the user threatening taking things to arbitration has made no attempt to engage in.


 * Carl Fredrik talk 20:44, 30 March 2020 (UTC)
 * As I said, ArbCom. We put it off, hoping the RfC would allow us to avoid it, but clearly that's not the case.
 * Of course, editors can at any time WP:FOC and demonstrate some understanding of the RfC and applicable policies. --Hipal/Ronz (talk) 21:18, 30 March 2020 (UTC)
 * I think that http://www.onlinejacc.org/content/71/5/564 is a good source. However, I'm concerned that the source doesn't actually seem to say that this specific drug has a relatively low cost (also:  relative to what?).  Instead, it says that most drugs (not necessarily this one) aren't affordable to most people outside of high-income countries, that WHO decided that statins (not necessarily this one) are generally cost-effective, and that MSH's International Medical Products Price Guide said the wholesale cost of simvastatin dropped to $40 per patient per year, compared to the $1200 that was charged while it was under patent protection.  Editors can't take "most drugs aren't affordable", "statins are cost-effective", and "this price went down" and add that up into a simplistic statement that it has a "relatively low cost".  WhatamIdoing (talk) 22:09, 30 March 2020 (UTC)
 * Relatively inexpensive in the grand scheme of medication prices. This source is clearer if you need "Simvastatin, used for the treatment of hypercholesterolemia, is a universally accepted and relatively inexpensive drug." Doc James  (talk · contribs · email) 22:16, 30 March 2020 (UTC)


 * James, could you please begin to use edit summaries? Editors removing the text per the RFC most kindly used full and descriptive edit summaries about why the text was being removed.    This is helpful for the several dozen editors who tried over years to remove drug price text and may not know why these edits are happening. Since there are 530 articles to be reviewed, these edit summaries are helpful.  When reinstating text already removed once, per the RFC-- knowing that this reinstatement is controversial-- an edit summary should be more descriptive than "adjusted". Thanks, Sandy Georgia  (Talk)  22:08, 30 March 2020 (UTC)

RfC

 * Started the RfC here Talk:Simvastatin. Doc James  (talk · contribs · email) 21:34, 30 March 2020 (UTC)

Atorvastatin
Too near the edit to Simvastatin: --Hipal/Ronz (talk) 22:07, 30 March 2020 (UTC)
 * James, edit summaries once again:. When you are inserting text that is known to be controversial, an edit summary of "adjusted" is insufficient.  Sandy Georgia  (Talk)  22:11, 30 March 2020 (UTC)

List of pharmaceutical prices edited
So much for a systematic method of processing through the RFC conclusion. These are the articles edited so far, best I can tell. The list is likely incomplete because of an absence of edit summaries; please add any (alphabetical) I missed. Sandy Georgia (Talk)  22:47, 30 March 2020 (UTC)
 * I have not had a chance to look at Pyrimethamine or Trimethoprim; will leave them to others. Sandy Georgia  (Talk)  00:36, 31 March 2020 (UTC)
 * Finished, below. Sandy Georgia (Talk)  02:05, 31 March 2020 (UTC)


 * Talk:Atorvastatin
 * Talk:Ethosuximide
 * Talk:Pyrimethamine
 * Talk:Simvastatin
 * 
 * Talk:Pyrimethamine
 * Talk:Simvastatin
 * 
 * 
 * 

Ethosuximide
James, I am starting through the list above (others have already looked at atorvastatin and simvastatin). I am concerned that this addition you made at ethosuximide is firmly against the conclusions of the RFC on many levels. The RFC concerned itself with making sure our drug pricing content upholds important policies of WP:V, WP:WEIGHT and WP:NOT. Why would we present 2001 data from one country, Italy ("costs are based on 2001 retail prices in Italy")? How does that help our readers? This is the very situation we just discussed at the RFC, yet you added a statement as of 2008 that used 2001 data from one country, Italy, which is not "most of the world" and is dated? That is specifically what we discussed in the RFC. How does this source verify "Ethosuximide, along with phenobarbital and phenytoin, is one of the few antiepileptic medications that people can generally afford in most areas of the world as of 2008"? What am I missing? Sandy Georgia (Talk)  23:08, 30 March 2020 (UTC)


 * The RfC says:
 * "There is no consensus on whether drug prices should be included in articles at all."
 * Ie there is no prohibition against including medication price information in the body of the article
 * "Where secondary sources discuss pricing extensively (insulin being a frequently cited example), that information may be worth including in the article; where there is little discussion of pricing in secondary sources, it generally should not be included."
 * We have lots of secondary sources that discuss the costs / pricing of medications and thus extensive discussion for inclusion in the body of the text.
 * "Drugs which fall into the grey area between these extremes should be discussed on a case-by-case basis."
 * Sure we can go through these with RfCs one by one.
 * "Where pricing information is included, claims should be sourced to reliable, secondary sources and not solely primary source data from price databases."
 * Yes some secondary sources are required before including any pricing information. These are not hard to find for essential medicines at least. Doc James  (talk · contribs · email) 23:12, 30 March 2020 (UTC)
 * James, yes, I understand your take on the RFC (which others disagree with). That is not the question I asked. You have added a statement saying, "Ethosuximide, along with phenobarbital and phenytoin, is one of the few antiepileptic medications that people can generally afford in most areas of the world as of 2008", that is based on 2001 data from one country, Italy. How does that meet WP:V and WP:WEIGHT?  Sandy Georgia  (Talk)  23:28, 30 March 2020 (UTC)
 * No not based on 2011 data Italy. The text says "For most patients living in these countries, only phenobarbital, phenytoin, and ethosuximdie may be avaliable at prices affordable by the general population" Referring to countries with 40% of the global population. I can start another RfC. Doc James  (talk · contribs · email) 23:34, 30 March 2020 (UTC)
 * James. No, we don't need to bring in more non-WPMED editors to have a discussion about the long-standing standards upon which the reputation of our medical content was built. Is it your opinion that a source that uses 2001 data from one country (Italy) should be used to source a statement about the cost of a drug in "most areas of the world", and relevant to the year 2020? Please, directly answering the question is MUCH preferable to another RFC. TRUE discussion is always the best way to resolve content issues. Why do you consider that this source meets WEIGHT and is relevant ? As medical editors, we are accustomed to closely examining our sources and making sure the data we add is relevant and supported by the text.  Regardless of whether this text is outside of the remit of MEDRS, do you believe that data (2001, one country) supports that text for the purposes of 2020?  Sandy Georgia  (Talk)  23:46, 30 March 2020 (UTC)
 * Do I think a 2008 textbook published by Wiley is a suitable source for discussion of the social and cultural aspects of a medication? Yes, yes I do. I use lots of textbooks for medical content, particularly social and cultural content. Part of the reason why I like the textbook is you can see it via google books. Sure I guess I can move to newer textbooks with less access. Doc James  (talk · contribs · email) 23:51, 30 March 2020 (UTC)
 * James OK, you are happy using 2001 data to make a statement in 2020. Got that part (and I hope we don't source other medical content to that standard), but that is only one part of the question.  How is WEIGHT met by the fact that this seems to be the only mention found to support a statement about cost relevant to 2020? As you know, we would NEVER allow this kind of logic for other content; why do you feel it OK to allow it for pricing? Sandy Georgia  (Talk)  23:58, 30 March 2020 (UTC)
 * Actually this is generally what we do. We find major medical textbooks and we paraphrase them. I am using a high quality 2008 textbook. My job is not verify that the textbook got it right. Also you do not need to ping me (ie if I am not clear enough please stop pinging me). Doc James  (talk · contribs · email) 00:03, 31 March 2020 (UTC)
 * Happy to stop pinging you, since I hate those things myself. But, you are surely aware that it was hard to solicit your participation during the RFC because you disallowed pings and were not keeping up with discussion, so I wanted to make sure you were following this discussion.  OK, I believe I have the answers now.  You believe that 2001 data from one country published in one book almost more than a decade ago meets WEIGHT and V to support a broad statement about prices in many countries.  I guess we will have to agree to disagree on that point.  Thanks for answering, Sandy Georgia  (Talk)  00:16, 31 March 2020 (UTC)
 * I would suggest people read the book themselves and make up their own mind. Will work on another RfC. Doc James  (talk · contribs · email) 00:19, 31 March 2020 (UTC)
 * Please don't. I have a dismal record when it comes to formulating RFCs, but you give me a run for my money, and we don't need another malformed RFC at this particular moment.  Perhaps you will wait until more editors have offered opinions on this one, as it is rather obviously problematic.  Sandy Georgia  (Talk)  00:26, 31 March 2020 (UTC)
 * Apologies already have Talk:Ethosuximide. Doc James  (talk · contribs · email) 00:42, 31 March 2020 (UTC)
 * There are five articles (listed above) edited already, and 530 disputed. Do you plan to start RFCs on every drug article edited, and do you think this is the most useful approach?  Sandy Georgia  (Talk)  01:22, 31 March 2020 (UTC)
 * I imagine we will get closer to consensus as time goes on. Doc James  (talk · contribs · email) 05:07, 31 March 2020 (UTC)

Meta comment: Speaking as one of the long-time unofficial coordinators of the WP:RFC process, we're talking about the problem of overuse/misuse of RFCs again. Some of the proposals are to have a limit on the number of RFCs that any individual editor can start (e.g., no more than three a month) or to require pre-approval of RFCs (e.g., to make sure that there's a decent question, and that editors aren't jumping to a sitewide RFC without trying a normal discussion for a few days first). This ongoing discussion is partly prompted by the behavior by two WPMED-related editors, who have set records for the volume of RFCs started. I would really like to not have any more examples of WPMED-related editors opening multiple RFCs per week. WhatamIdoing (talk) 01:32, 31 March 2020 (UTC)

Pyrimethamine
James added here moved but left existing pricing data specifically sourced to a press release from the manufacturer, which is directly addressed at WP:NOPRICE. Sandy Georgia (Talk)  01:57, 31 March 2020 (UTC)
 * WP:SOAP as well. --Hipal/Ronz (talk) 02:01, 31 March 2020 (UTC)
 * I was actually grouping content by country. The https://www.prnewswire.com was in the article before and I just moved it. Doc James  (talk · contribs · email) 05:09, 31 March 2020 (UTC)
 * Struck and corrected above, with my apologies. I am curious why you did not remove the text, since that sort of content (company press release) is quite specifically addressed in the policy page, WP:NOPRICE, and as far as I know was never disputed during the RFC. Could you clarify whether you also consider the PRnewswire source to be usable for price content?  Also, this is another example where an edit summary would be helpful.  Many (most?) editors when moving content, indicate that in edit summary.  Because you used the same edit summary (adjusted)  that you used when reinstating other price content (in the articles above), I mistakenly assumed this was another reinstatement.  Sandy Georgia  (Talk)  05:22, 31 March 2020 (UTC)
 * I did not look at the sources. That source sucks. I was just grouping content about price by country. Removed it. Doc James  (talk · contribs · email) 05:37, 31 March 2020 (UTC)
 * Glad to hear that! (Oops, I see a problem there, added below). Ok, there are other problems there.  We have an ungrammatical sentence in the lead, so I went to the sources to try to figure out what it meant to be saying.


 * I don't know what is in the first source (request quote). The second source is a Forbes contributor opinion piece, which are generally considered unreliable for ANY text on Wikipedia.  The third source does not verify the content; it mentions the cost of treating one patient at one hospital, as an example, and does not state that $75,000 is generally the cost of treatment.  So, even in a case where there may be reason to include price data in the lead, we haven't done it in a policy-compliant way. This is why a systematic approach to checking all of these problems is needed; it appears that there has been too much very hurried editing of price content.  Sandy Georgia  (Talk)  06:04, 31 March 2020 (UTC)
 * And there's another problem with the text you deleted here. As I mentioned above, the source (a company press release) was not reliable compliant with WP:NOT, but instead of tagging or replacing or removing the citation (the press release), you also removed the entire content, which does seem to be relevant to the pricing problem that happened there. It is not good practice to remove text that can be cited, as in this case, that text can be cited to CNBC. The edit summary was "trimmed press release" which might better have been "removed text cited to press release", as that would trigger other editors to know that an alternate source might be (in fact, should be) sought.   I think a careful examination of the editing in the first five pharmaceutical pricing articles suggests that a much slower approach would be helpful. Sandy Georgia  (Talk)  06:20, 31 March 2020 (UTC)

Trimethoprim/sulfamethoxazole
With this edit to Trimethoprim/sulfamethoxazole, vague text about pricing is left in the lead (unclear to what countries this applies), although IMO the requirements per the RFC and in accordance with policy to include price date in the lead of this article are not met. (WP:LEAD, WP:WEIGHT, WP:NOPRICE). The cost of this drug has not been the subject of significant secondary coverage worthy of mention in the lead. Sandy Georgia (Talk)  02:04, 31 March 2020 (UTC)

Summary: those are the five articles edited so far; this is NOT a systematic or healthy approach to implementing the RFC. Sandy Georgia (Talk)  02:04, 31 March 2020 (UTC)

Notice of ArbCom Request
Given the events of the last day I have filed an ArbCom Case request. Barkeep49 (talk) 03:39, 31 March 2020 (UTC)


 * Arbitration/Requests/Case/Medicine (reposted /PD not ready till May 25)--Ozzie10aaaa (talk) 10:34, 21 May 2020 (UTC)

Propose postponement due to COVID-19
I would like to request delay on this topic until further notice due to COVID-19. This issue concerns WikiProject Medicine and the focus of that project right now is COVID-19. The primary outcome of this issue being discussed anywhere will be distraction from developing COVID-19 content. The matter of price is not urgent and has been pending for years. No harm comes from postponement.


 * Archive this discussion
 * Immediately remove any following price discussion
 * Delay taking action regarding prices
 * Edit COVID-19 or anything else peacefully


 * 1) Support as proposer  Blue Rasberry   (talk)  13:21, 31 March 2020 (UTC)
 * 2) Support Not unreasonable. The issues are much larger than just the pricing ones and we will need to get back to them eventually I imagine. Doc James  (talk · contribs · email) 19:09, 31 March 2020 (UTC)
 * 3) Support With all the information and especially the misinformation going round, I feel that our coverage of the pandemic is extremely important. Dr. Vogel (talk) 19:49, 31 March 2020 (UTC)
 * 4) Support in view of the current covid-19 condition. BTW, it is useful to add drug prices to the Wikipedia pages. For me, it is one way for clinic doctors assess patients' financial burden when purchasing the branded ones and to write letters of support to the welfare department for financial assistance if the patient cannot afford it. I think it will be useful if the Wikipedia includes information whether the drug patent expires or not and whether it is available in generic forms. Generic drugs are definitely cheaper than branded name drugs.Cerevisae (talk) 00:17, 12 April 2020 (UTC)

Since we discuss, not !vote, I will not add to the tally above, as it is clearly not possible to postpone a discussion that is before the arbs. Sandy Georgia (Talk)  17:58, 13 April 2020 (UTC) Agree with SG, although also agree with this proposal in principle: I'm assuming that many—if not most—of the active project participants are probably to a greater or lesser degree on the front line right now, so may have less time for Wikipedia than usual. Take care and good luck everybody. —— SN  54129  11:53, 24 April 2020 (UTC)

Next steps?
I'm hoping that the ArbCom efforts will get the behavioral problems settled out. Meanwhile, I agree that further clarification on the RfC would help. At this point I don't know how many clarification attempts have already happened, nor what outcomes we've had. Tracking them all down and following up seems like good next steps. What do others think? What other steps should we be considering? --Hipal/Ronz (talk) 20:37, 2 April 2020 (UTC)
 * I always advocated for a methodical approach, and was disappointed that editing went forward without having a plan in place, but seeing how much effort was needed at Talk:Pyrimethamine (not even done yet), I even more strongly suggest that we should at least keep a list for now of what articles have been addressed, or edited without being addressed. We at least need to keep track of where we are. Sandy Georgia  (Talk)  20:44, 2 April 2020 (UTC)
 * While I started a cursory discussion at WP:NOT (Wikipedia_talk:What_Wikipedia_is_not/Archive_57), a follow-up at NPOVN makes sense to make sure we've clear consensus for addressing the 500+ articles. --Hipal/Ronz (talk) 16:53, 10 May 2020 (UTC)

Areas where clarification and further discussion may be needed

 * Guidelines for content in the lede
 * In my experience, WP:MOSLEAD could give more guidance, so that may be part of the problem. Perhaps we just emphasize and elaborate on MOS:LEADNO? --Hipal/Ronz (talk) 16:21, 6 April 2020 (UTC)
 * Numerical vs non-numerical pricing
 * While some editors may have worked on this assumption, I don't recall anyone ever make it explicit. I'd be surprised if any arguments at all apply only to numerical prices. --Hipal/Ronz (talk) 16:21, 6 April 2020 (UTC)

Wikipedia_talk:Manual_of_Style/Medicine-related_articles/RFC_on_pharmaceutical_drug_prices lists concerns and clarifying remarks. --Hipal/Ronz (talk) 17:42, 13 April 2020 (UTC)


 * Should we attempt to have recent prices in every medicine article, or in every essential medicine article? --Hipal/Ronz (talk) 02:52, 3 May 2020 (UTC)

Scope of problem
I believe Colin did some work trying to get an idea of the scope of the problem (addition to the lead of price information)... I'll try to dig up some info. --Hipal/Ronz (talk) 20:44, 17 April 2020 (UTC) Trying to put together a list of commonly used references: --Hipal/Ronz (talk) 19:37, 20 April 2020 (UTC)
 * British national formulary
 * 498 uses as of 4/29 --Hipal/Ronz (talk) 16:48, 29 April 2020 (UTC)
 * drugs.com
 * 4,118 uses as of 4/29. This appears to be used too much for other content to help us track the scope --Hipal/Ronz (talk) 16:48, 29 April 2020 (UTC)
 * mshpriceguide.org
 * 313 uses as of 4/29 --Hipal/Ronz (talk) 16:48, 29 April 2020 (UTC)
 * Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition
 * 202 uses as of 4/29 --Hipal/Ronz (talk) 16:48, 29 April 2020 (UTC)
 * Centers for Medicare and Medicaid Services
 * 677 uses as of 4/29. This appears to be used too much for other content and in other contexts to help us track the scope --Hipal/Ronz (talk) 16:48, 29 April 2020 (UTC)

From a sampling of Category:World Health Organization essential medicines, I believe Doc James added pricing information to all the medicine articles listed there. --Hipal/Ronz (talk) 19:24, 23 April 2020 (UTC)

I'm estimating somewhere between 550 and 600 articles, given what Colin and I have found. --Hipal/Ronz (talk) 02:47, 3 May 2020 (UTC)

Recent additions/expansions of pricing information
I ran across these while looking at the scope of the problem. --Hipal/Ronz (talk) 20:04, 20 April 2020 (UTC)
 * April 13
 * - April - Talk:Methocarbamol
 * April 15
 * April 12

List of plants used in herbalism
I'm not sure where MEDRS comes into this, but I was concerned to find this edit. Or am I worrying to much? Doug Weller talk 09:43, 22 May 2020 (UTC)
 * The "used" formulation covers a multitude of sins throughout that article. We learn for example than cannabis has been "used worldwide since ancient times as treatment for" conditions such as "ADHD, autism and cancer"!! It would be better to use wording like "was thought to be useful for ..." or "was a folklore remedy for ...". Relatedly I wish we had something in MEDRS/MEDMOS saying "treat" and "treatment" are words to watch, since their secondary connotation of "cure" give them untoward colour in cases such as these. Alexbrn (talk) 14:54, 22 May 2020 (UTC)
 * The edit was completely unsourced and removed it. The article's sourcing is dire and the choice of sources is completely uncritical. Many of them wouldn't pass WP:RS, let alone WP:MEDRS. Not only that, but the information taken from the sources is cherry-picked to avoid the more ludicrous claims, and any sources indicating toxicity or other side-effects are carefully ignored. I took a closer look at just one entry at random, Ageratina altissima, and thought I'd add one more sourced ludicrous claim to the other nonsense in there, as well as noting its well documented toxicity. The problem is that life's too short to research all 150+ plants in the article. --RexxS (talk) 16:10, 22 May 2020 (UTC)
 * I like your "folk remedy" language.
 * That sentence is otherwise a touting disaster. You can't have a proper folk remedy for a condition that was described (only) in the modern era, so ADHD and autism would have to be removed from any such a claim, even if it really was used worldwide in ancient times, which I very seriously doubt. WhatamIdoing (talk) 16:18, 22 May 2020 (UTC)
 * That sentence is otherwise a touting disaster. You can't have a proper folk remedy for a condition that was described (only) in the modern era, so ADHD and autism would have to be removed from any such a claim, even if it really was used worldwide in ancient times, which I very seriously doubt. WhatamIdoing (talk) 16:18, 22 May 2020 (UTC)

Nascent_iodine_(dietary_supplement)
There's a large section devoted to a quote from the Orthomolecular Medicine News Service. This can't possibly be a WP:MEDRS, right? &#32; Headbomb {t · c · p · b} 13:50, 22 May 2020 (UTC)


 * Do you hesitate to remove it because the unreliable source says that this snake oil is, indeed, snake oil? WhatamIdoing (talk) 16:37, 22 May 2020 (UTC)
 * No, I just want a sanity check here, that I'm not missing something before adding that to WP:UPSD. Edgar Cayce and Association for Research and Enlightenment could equality get additional eyes too. &#32; Headbomb {t · c · p · b} 16:49, 22 May 2020 (UTC)
 * The Journal of Orthomolecular Medicine is a distinctly low-quality journal by all the usual metrics. This "news service" is even less reliable.  WhatamIdoing (talk) 18:55, 22 May 2020 (UTC)

Johann Lahodny
Language is completely uncritical for a promoter of ozone therapy, needs expert attention beyond what my non-expert eyes can contribute. &#32; Headbomb {t · c · p · b} 15:52, 23 May 2020 (UTC)
 * I've boldly blanked &amp; redirected to Ozone therapy as the sourcing for Lahodny as a person appeared suitable in relation to Ozone therapy only. Perhaps per WP:NOPAGE he might be worth a mention there where the context would help with WP:NPOV (Add: and even there I'm drawing a blank for RS - might need to AfD this). Alexbrn (talk) 16:17, 23 May 2020 (UTC)

Patricia Stallings
Hello. I have several questions about the fascinating piece of forensic and medical history behind Patricia Stallings, “cited as an extreme case of a metabolic disorder that mimics a criminal act.”

In your expert opinion, was this a failure of medicine, forensics, or some combination of the above? Or could this simply be explained by the primitive nature of the overall, initial investigation given the science of the time? Could anything have been done differently, and are there similar case files for medical disorders that are misinterpreted as criminal acts?

Which brings me to my last question: if there is a body of articles or an appropriate category for such a topic, what would it be called? In other words, I would like to read about other articles like this one, but there is no good medical category for it, or at least, it is not currently categorized. Thank you. Viriditas (talk) 21:11, 14 May 2020 (UTC)
 * I'll tackle the simpler (last) question: a good place to start would be Metabolic disorders, which is a top-level page for a set of similar rare diseases; there is also a set of Lysosomal storage diseases which might be of interest. Klbrain (talk) 20:07, 15 May 2020 (UTC)
 * Thank you, Ill take a look. Viriditas (talk) 21:59, 15 May 2020 (UTC)
 * Viriditas, Auto-brewery syndrome has some potential for criminal charges, though not for anything as dramatic. (People with this get arrested for drunk driving, not for murder.)  Off wiki, this article in The New Yorker talks about the difficulty of differentiating between physical abuse and rare diseases such as Osteogenesis imperfecta, and this article in The Colorado Sun talks about fragile bones as a drug side effect in babies.  WhatamIdoing (talk) 17:30, 16 May 2020 (UTC)
 * Thank you. I’m still having difficulty coming up with a name for a category.  I’m thinking it would describe a broad set of medical conditions that could lead to someone either being accused of a crime or committing one, based on an organic condition. Example: Capgras delusion, a delusional misidentification syndrome thought to be linked to brain damage, has been associated with some people who commit murder, who apparently thought they were killing an imposter of their loved one.  I admit that’s an extreme example, but it’s the kind of thing I want to see in this proposed category. Would “Medical conditions and criminal law” be a good description of such a category? Viriditas (talk) 20:29, 20 May 2020 (UTC)
 * Others could include SIDS, bleeding disorders, and osteogenesis imperfecta I would imagine. Doc James  (talk · contribs · email) 08:14, 24 May 2020 (UTC)

Category:Medical outbreaks by country has been nominated for renaming
Category:Medical outbreaks by country and Category:Medical outbreaks by dependent territory, which are within the scope of this WikiProject, has been nominated for renaming to "Disease outbreaks ...", along with about 185 of their sub-categories. A discussion is taking place to decide whether this proposal complies with the categorization guidelines. If you would like to participate in the discussion, you are invited to add your comments at the category's entry on the categories for discussion page. Thank you. -- Brown HairedGirl  (talk) • (contribs) 18:36, 25 May 2020 (UTC)
 * thank you for post--Ozzie10aaaa (talk) 19:22, 25 May 2020 (UTC)

Insulin pen
What would be the proper process to get this article expanded and at a more general title to cover things like GLP-1 agonists and monoclonal antibodies that are injected via pen administration systems? I don't think insulin pens themselves need a standalone article if it can be included in a more general article title such as medication pens or something. I'm not sure what the process would be to do this - expand the article first at the incorrect title, or move it to a new title then expand it, or whether there should really be two separate articles (one for insulin, one not). Any guidance is appreciated. bɜ:ʳkənhɪmez (User/say hi!) 22:44, 25 May 2020 (UTC)
 * I agree a new, more general article on these devices would be better - Pen needles could be rolled into it, and any insulin-specific bits either given a section, or taken to the relevant insulin articles. What is the usual term? Injector pen or Pen injector? The former seems ahead on ghits, but both are way ahead of medication pen; Pen injector redirects to Autoinjector - surely wrongly.  Something with pen in it, anyway. Is it part of the definition that they are pre-filled with the drug?  I think so.  You could do it various ways, but I would move the current article to the new title, after proposing that/referring to this discussion on the talk.  Johnbod (talk) 23:39, 25 May 2020 (UTC)
 * I’ll do some research into what relevant journals are calling them when I get a chance in the next day or two, and see if I can come up with a conclusive “normal”, but I suspect that it’s going to be no definitive title - because the term itself is very adaptable to the sentence it’s being used in. bɜ:ʳkənhɪmez (User/say hi!) 00:11, 26 May 2020 (UTC)
 * Have you considered sketching out a draft for the proposed new article in your sandbox? You can copy chunks (or all) of existing articles as long as you say where they came from in your edit summary. Write/adapt the sections first and leave the lead until last. The process of doing that may well help you decide on a good title, as you will have read a lot of current sources by then. --RexxS (talk) 01:18, 26 May 2020 (UTC)
 * - I can, but right now I’ve a proposed edit for a template in my sandbox. I suppose I could compose a secondary sandbox for this article, but I was more trying to gauge opinion before starting intense work on this article. It seems at least two (you and the other editor) feel that a combined article for all “pen injectors” is a good idea, so I’ll start work when I have a chance. Thanks, bɜ:ʳkənhɪmez (User/say hi!) 01:28, 26 May 2020 (UTC)
 * did I do it right this time? 01:29, 26 May 2020 (UTC)
 * - the answer is no, for some reason it didn’t fully sign. The mobile editor is... not fun. bɜ:ʳkənhɪmez (User/say hi!) 01:50, 26 May 2020 (UTC)

Category:Epidemics has been nominated for merging to Category:Disease outbreaks, along with similar merges and renamings for its sub-categories.
Category:Epidemics, which is within the scope of this WikiProject, has been nominated for merging to Category:Disease outbreaks, along with similar merges and renamings for its sub-categories.. A discussion is taking place to decide whether this proposal complies with the categorization guidelines. If you would like to participate in the discussion, you are invited to add your comments at the category's entry on the categories for discussion page. Thank you. -- Brown HairedGirl  (talk) • (contribs) 09:37, 26 May 2020 (UTC)
 * thank you for post--Ozzie10aaaa (talk) 12:34, 26 May 2020 (UTC)