Talk:Simvastatin

In depth discussion

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

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

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

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

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

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

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

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

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

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

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

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

Clarification of RfC

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

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

Based on this 2012 article which states

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

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

And this 2018 review which states

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

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

Support

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

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

2. support very clear per review--Ozzie10aaaa (talk) 21:51, 30 March 2020 (UTC)
3. support enough evidence from the abovementioned reference--Avicenno (talk) 10:45, 31 March 2020 (UTC)
4. support I am a physician in the US. The website goodrx.com shows many pharmacies will sell this for about $10 for 90 20mg tablets, a 3 month supply. That is clearly relatively low cost, relative to other drugs, to the cost of lunch 3 days in a row, and to the cost of 3 days of coffee at Starbucks. Kd4ttc (talk) 21:06, 31 March 2020 (UTC) Addendum: Additionally, simvastatin is not a product subject to prohibitions of price discussion policy. It is a chemical entity which is available for much less than in the past. In comparison, is is very reasonable to note in Wikipedia that a computer with 4K of memory running at 1 MHz cost $10,000 in the 1970’s, while the equivalent computer is now available on IC chips for about a $1. Therefor this is not a price comparison between products but a revelation that pricing of simvastatin products in general has dropped significantly. Kd4ttc (talk) 19:11, 4 April 2020 (UTC)
5. Support Given the two sources cited, there is no doubt about the factual accuracy of the suggested text. Editors are supposed to accurately and neutrally summarise the sources they use to write content, and it is obvious that the text complies with that without being original research or synthesis. The only remaining question is whether the information is WP:DUE. My answer is that when a drug's cost has fallen from $1,200 to $40/patient/year, it's clearly attracted sufficient attention to warrant mention in an encyclopedia. --RexxS (talk) 17:39, 1 April 2020 (UTC)
6. Support I too have taken a look at the two sources (PMID 23066263 and doi:10.1016/j.jacc.2017.11.056, above). Based on these sources, I support adding in a statement that "Simvastatin is relatively low cost" or, just, "simvastatin is low cost" to the end of paragraph 4.JenOttawa (talk) 00:52, 2 April 2020 (UTC)
7. Support. Agree with JenOttawa...Appears clear in the 2018 paper cited above. Including this in the lead appears "balanced", ie. simvastatin's notability weighs heavily on its low cost, as well as other factors. This low cost is referenced in numerous review articles and textbooks. Whispyhistory (talk) 11:49, 2 April 2020 (UTC)
8. Support I think we got to see both the big picture and the zoom on the RfC here. The big picture is that price information is a VERY IMPORTANT for the public in these time. Now, I don't mean it's important that they have the right price for medication. This is not the role of WP. What they want, what they see as important, is to gather information on the price, and have an ideal of the price. So, more precisely, I mean that they will look for this information, and they EXPECT to see something in the article. And the sooner the better. And considering how CODIV-19 affect our societies, I'd say their quest for information is very understandable. That's the big picture. Now, for the zoom, here, in this RfC, I think we can only confirm that stating concisely that the price is « relatively low » and giving as much attention and precision in the #Cost section as needed to be neutral, impartial and pertinent, is in accord with the letter and the intent of the RfC. --Antoine2711 (talk) 20:32, 2 April 2020 (UTC)
9. Support per others above. Flyer22 Frozen (talk) 01:51, 3 April 2020 (UTC)
10. Support per RexxS. COI: I have been taking Simvastatin since the mild stroke I had after which I voluntarily handed in my admin tools and a bunch of ill-spirited people claimed here it was under a cloud. Kudpung กุดผึ้ง (talk) 05:54, 3 April 2020 (UTC)
11. Support Drug pricing is not only important from a United States perspective. It has an impact on all types of health care systems regardless of whether from a monopsony perspective of a single buyer, or for prescribers or individuals. Swedish regions make different recommendations, often choosing atorvastatin over simvastatin, but centrally the discussion has been one of price difference between simvastatin and atorvastatin. Just to exemplify, this 74-page report from 2009 exclusively discusses pricing of various lipid-decreasing drugs, and is from the Swedish Dental and Pharmaceutical Benefits Agency (TLV). It mentions simvastatin 37 times, including on several pages which compare and discuss the price in detail. There will be more up to date sources from the agency as well, as well as up-to-date discussions from the regions — but the current discussion is rather about cost benefit analysis between atorvastatin and newer non-generic drugs.
    Working also in global health, I can say that pricing is extremely important as to where and when drugs are recommended and offered, as can be seen in the article Evaluation of prices, availability and affordability of essential medicines in Lahore Division, Pakistan: A cross-sectional survey using WHO/HAI methodology doi:10.1371/journal.pone.0216122 , which states Affordability of majority of the medicines was comparable between India and Pakistan, nevertheless, the number of daily wages needed to get the standard treatment with originator brand of Simvastatin was found to be two times higher in Pakistan compared to India and Lebanon.#:The 2016 book "The Price of Global Health" ISBN:9781472438805 discusses Simvastatin in detail on page 67, stating how its price specifically contributes to high use internationally.
    In light of this, it seems using the 2012 and 2018 sources to support a high importance statement in this article is acceptable. Carl Fredrik ^talk 13:21, 3 April 2020 (UTC)
12. Support, because drug pricing is a tremendously important aspect.--Muddymuck (talk) 13:34, 3 April 2020 (UTC)
13. Support I have commented in these price discussions for years. I also compiled past discussions on the subject at WP:PRICE and in doing so have seen the existing discourse. The proposal in this case is good and matches what I see as orthodoxy. I see nothing new in the opposition as compared to previous discussions. I stand by what I have said repeatedly in the past, want to continue the status quo of keeping prices especially in this particular sort of case, and see no reason to discuss this again. I want to keep the existing status quo and wish that people would delay requesting changes right now so that we can edit COVID-19 content. Blue Rasberry (talk) 19:51, 3 April 2020 (UTC)
14. Support same argument as at Ethosuximide talk page. Its a reasonable mention in this article. Given that we can't find consensus for a Wiki wide rule I think we're obligated to look case-by-case. Ian Furst (talk) 17:57, 7 April 2020 (UTC)
15. Support easily accessible and transparent drug pricing is important information to include in an article for many different audiences, both for high income and for low and middle income countries for different reasons. John Cummings (talk) 18:35, 8 April 2020 (UTC)
16. Support there needs to be at least some mention of relative/absolute drug pricing on medications; imagine if there was no mention of the price on the Onasemnogene abeparvovec page! Myoglobin (talk) 15:52, 9 April 2020 (UTC)
17. Support per RexxS and Blue Rasberry - sources are reliable, satisfy WP:V, and the price drop is notable enough to warrant inclusion. ^Atsme _Talk 📧 02:03, 12 April 2020 (UTC)
18. Support As per DocJames and Bluerasberry --AbhiSuryawanshi (talk) 22:41, 15 April 2020 (UTC)
19. Support given that we're not actually stating any prices here and it's citing reliable secondary sources. Seppi333 (Insert 2¢) 03:36, 22 April 2020 (UTC)
20. Support I don't support specific drug pricing in articles, but in context of this drug's history I think a general statement about price is significant and fine in the lead. I don't particularly like the statement suggested and would prefer something that does reference context like, "In 2020 Simvastatin was inexpensive relative to other drugs.", but the proposed phrase is OK. To clarify Littleolive oil (talk) 04:58, 7 May 2020 (UTC)

Oppose

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

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

• Oppose, not only because the wrong question is being asked, but also per Seraphimblade new data presented below. Further, adding this to the lead breaches the policy at WP:NOTPRICE; there is nothing noteworthy about mentioning the prices of this drug in the lead, and adding this content breaches the community-wide RFC that was just closed and that upheld WP:NOTPRICE and WP:LEAD. This is an attempt to skate around the RFC conclusion, while at the same time, obfuscating the issue with an unclear RFC question that was put forward with no prior discussion. If another RFC is desired to determine whether, by some definition of "relative" we want to include some mention of cost in leads, then that RFC should be correctly discussed and formed and put forward to the community. For now, there is nothing about this particular cost or drug that warrants any mention of price in the lead. And on top of all of that, putting forward an RFC where participants cannot carry on a normal talk-page discussion (and moving their comments when they do) is not conducive to consensus building. SandyGeorgia (Talk) 01:38, 2 April 2020 (UTC)
• Oppose The "universally accepted and relatively inexpensive drug" source text is a passing mention in an article speculating on research for the local application of simvastatin to aid periodontal regeneration. Surely if the best we can find is an obscure dental research paper from eight years ago, that suggests the drug price is not nearly as commented on in 2020 as policy requires. The WHO essential medicine paper from 2018 is newer, but its reference to "lower cost" was in a paragraph discussing how the price is now lower than it was when under patent. Being on the EM list does not make a drug affordable, nor does it require, as seems to be suggested below, that WHO member states are compelled to provide WHO essential medicines at low cost to their citizens. Sadly most essential medicines are unaffordable in the developing world, especially so for ones you take for the rest of your life while being old enough to be retired. All drugs on the WHO EM list have their cost assessed, as do all drugs by all health providers. So the basic obvious mention here does not itself constitute extensive discussion or commentary in mainstream media. Take for example, WHO/HAI Egypt 2013. They found that simvastatin retailed at 16.45 times the international reference price for generic and 32.90 times for originator brand. Anyone saying a drug is "low cost" needs to caveat that with the POV of the author and their publication audience. What may seem low cost to a dentist or the price of a few Starbucks to a US physician, can easily exceed affordability in the developing world. What I would probably support, if high quality sources can be found, is a claim that Simvastatin is (or among) the cheapest statins. General adjectives on affordability are always going to be geographically/economically local. Any source that claims Simvastatin is globally available at a low affordable price, really hasn't done their homework. -- Colin°^Talk 11:03, 12 April 2020 (UTC)
• Oppose There appear to be WP:V and WP:OR problems with the content, so it should not be included. As sourced, the content appears WP:UNDUE and fails MOS:LEADNO. As these problems all duplicate those identified in WP:MEDMOS2020, we should be working to rectify any confusion from that RfC, rather than creating article-level RfCs that will just cause WP:CONLOCAL confusion. The lack of discussion here didn't get us far. --Hipal/Ronz (talk) 17:14, 14 April 2020 (UTC)

Neither

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

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

Discussion

Comments about RFC

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

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

First, there was essentially no prior discussion about what should be in this particular RFC about this particular drug, after the price text was (twice) removed per the RFC, [2] [3] and then later reinserted (twice) by James.

Second, the text proposed for discussion does not encompass the full disputed text. [4] Any conclusion reached about that one sentence is not helpful for any purpose, and an RFC to discuss that one sentence is not be likely to yield any useful conclusions.

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

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

Sources
References

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

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

• SandyGeorgia Thanks for the clarification. The way I read the guideline regarding price discussions is for comparisons of something like pricing comparisons of Macintosh vs Windows computers is not something to go into Wikipedia, but that it is very reasonable to say that the price of computers has come down a lot since the 1960s, when computers were priced in the 10s of millions of dollars are now only a thousand dollars. Simvastatin is not really a product. It is a chemical entity which is offered as a product by a number of manufacturers. That products containing simvastatin used to cost over a thousand dollars a year and now just cost less than $50 a year is analagous to saying products that provided computing capability that used to cost $10 million now just cost about a $1000. Kd4ttc (talk) 19:04, 4 April 2020 (UTC)

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

Comments by User Doc James

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

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

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

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

Comments by WhatamIdoing

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

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

I hope you won't mind me jumping into your section to comment, but I must say that I doubt that anybody reading the summative statement "Simvastatin is relatively low cost" would understand it to mean anything other than low cost when considered against the range of prices of other drugs. Surely anybody who wasn't sure what was meant would just read the section on cost in the body of the article:

Simvastatin is relatively inexpensive. The wholesale cost in some LMIC is around US$0.01 to 0.15 per 20 mg dose as of 2014. The defined daily dose is 30 mg per the World Health Organization. The price decreased from roughly US$1,200 to $40 per year of medication in LMIC following the patent expiring in 2006. In the United States, it costs about US$10 to 20 per month since patent protection ended. In the UK in 2008, the typical per-patient cost to the NHS of simvastatin was about £1.50 per month. (40 mg/day costs UK NHS £1.37/month in 2012) The price in Canada is about $CAD 130 to 160 per year as of 2016. Under provisions of the Patient Protection and Affordable Care Act (PPACA) in the United States, there is no cost for simvastatin 10mg, 20mg, and 40mg for adults aged 40–75 years based on United States Preventive Services Task Force (USPSTF) recommendations.

or follow the links to the 10 cited sources. --RexxS (talk) 23:11, 3 April 2020 (UTC)

Comments by Seraphimblade

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

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

Comments by RexxS

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

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

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

Comments by Bluerasberry

Halt this, postpone due to COVID-19, keep the current status quo until after COVID-19. Blue Rasberry (talk) 19:52, 3 April 2020 (UTC)

General discussion

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

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

@RexxS: [5] The only remaining question is whether the information is WP:DUE. My answer is that when a drug's cost has fallen from $1,200 to $40/patient/year, it's clearly attracted sufficient attention to warrant mention in an encyclopedia. The only remaining question is whether the information is WP:DUE. My answer is that when a drug's cost has fallen from $1,200 to $40/patient/year, it's clearly attracted sufficient attention to warrant mention in an encyclopedia. Thanks for specifically citing policy, WP:DUE. However, the question at hand is whether or not it belongs in the lede. It's already in the article. No one is questioning whether or not it warrants mention. The question is whether is deserves emphasis in the lede. While the large RfC did not have a section specific to the lede, there was enough discussion that it was including in the closing statement. In light of all that, why does the content in question deserve inclusion in the lede, at the end of the final paragraph? --Hipal/Ronz (talk) 21:14, 4 April 2020 (UTC)

@Hipal: WP:LEAD: " As in the body of the article itself, the emphasis given to material in the lead should roughly reflect its importance to the topic, according to reliable, published sources." The article cites 48 sources, of which 10 are related to the Cost section. Moreover, Google Scholar finds 141 articles that discuss "cost of simvastatin" and 673 containing "cost effectiveness of simvastatin". There are pages and pages of mainstream sources with the latter phrase in the title, so these are not mere passing mentions. That reflects the importance of the cost of simvastatin to the topic. This RfC asks whether we should devote five words in the lead to the topic of cost. Compared with the 14-word sentence in the lead "Simvastatin was patented by Merck in 1980, and came into medical use in 1992.", which summarises and contradicts a mostly unreferenced section of the article, it is more that DUE to include those five words summarising cost.

Now, on what policy grounds do you refuse to accept any wording whatsoever about cost in the lead?

No one is questioning whether or not it warrants mention. Then why did we see editors removing the whole cost section or part of it? --RexxS (talk) 22:39, 4 April 2020 (UTC)

Please strike as misrepresenting my position, Now, on what... --Hipal/Ronz (talk) 16:14, 5 April 2020 (UTC)

Because the proposed content is so vague and general, it's unclear it it belongs in the lede without context. The sources don't appear to provide such context.

It's unclear that the references provide the necessary context to support such a broad statement.

There are basic WP:V and WP:OR problems with the content as referenced.

Even if there were no WP:V and WP:OR problems, the material appears grossly undue, unsuitable for the lede.

These are all problems identified in WP:MEDMOS2020. --Hipal/Ronz (talk) 19:07, 8 April 2020 (UTC)

How to run an RFC

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

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

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

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

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

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

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

• I was pinged.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Restart

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

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

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

Yes I agree it would be nice to have discussions on the presentation of prices based on avaliable sources. Some appear to argue that any presentation of prices is impossible.[6] And appear to believe that the prior RfC came to that conclusions despite the fact that it did not. Thus we are here. Doc James (talk · contribs · email) 17:19, 3 April 2020 (UTC)

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

Your behaviour will also be under scrutiny there as well. I haven't seen a single constructive comment from you in the entire series of debates, and I expect that your part in trying to defeat attempts at consensus building is noted. This RfC will answer a rather small but important point about the interpretation of the current consensus on including pricing information in an article when that information is well represented and discussed in multiple reliable sources. That will move the debate forward, and you should not be continually lobbying for its withdrawal because you don't like the likely outcome. --RexxS (talk) 22:57, 3 April 2020 (UTC)

I think Hipal's behavior will hold up just fine (unless there's something I haven't seen, which I doubt). Meanwhile, in terms of how RFCs are run, we have Blue altering other people's posts to install a count (not a vote), while editwarring to keep his alterations of other people's entries. One wonders what has overcome the denizens of WP:MED, that these matters have taken on such importance. SandyGeorgia (Talk) 23:24, 3 April 2020 (UTC)

And I think Hipal's behaviour is reprehensible, as their only contribution to this topic is to snipe at other editors. Anyone can count the number of times they've done that and it will not go unnoticed at ArbCom.

As for the rejigging of indents, the peculiar setup of the discussion and the continual demands to close down constructive debate, I agree with you completely that the denizens of WP:MED seem to be afflicted with something like cabin fever. This disagreement is incredibly trivial in the grand scheme of things, and there are so many more important things we could all be doing. --RexxS (talk) 00:22, 4 April 2020 (UTC)

Perhaps we can conclude, then, that discussion of behaviors related to a pending arbcase might stay off of this particular page (particularly when loaded with words like reprehensible).

Separately, we have discussion of the actual RFC here impeded by the highly unusual way the RFC was structured, with other editors altering and moving commentary further complicating the situation. Have we now concluded that we can begin to hold normal threaded conversations in this discussion about this page? Because we have quite a mess of unaddressed issues and misstatements above. SandyGeorgia (Talk) 15:19, 4 April 2020 (UTC)

As I said, this will be more evidence for ArbCom. --Hipal/Ronz (talk) 15:48, 4 April 2020 (UTC)

This might be a good time to remind everyone to read WP:TALK. SandyGeorgia (Talk) 16:44, 4 April 2020 (UTC)

(edit conflict) We can conclude that discussions of the possible ArbCom case play no part in attempting to answer the question posed by the RfC. Please feel free to suggest how we might refocus on the topic, because the unconstructive trolling clearly hasn't stopped. I would recommend that you reply to any unaddressed issues and misstatements by posting in the way that you are most comfortable with. Posting closely below the comment you wish to address helps an external reader to understand the point and counterpoint; whereas posting in your own section helps to reduce the lengthy back-and-forth that has characterised almost all of the discussions around the issues of drug pricing. --RexxS (talk) 16:45, 4 April 2020 (UTC)

I recognize what you say, I say, WAID says, and multiple editors above say about where to post is an accurate reflection of how talk pages are used, but when I do that, my posts are moved, changed and even editwarred. Which means I don't want to continue to respond, as then *I too* end up edit warring just to be able to post. To be able to "refocus on the topic" as we should be doing, we first need to be able to respond without having our edits altered. Some acknowledgement that the two parties who are altering other people's posts will stop doing that would be helpful at this point. SandyGeorgia (Talk) 16:58, 4 April 2020 (UTC)

I've already asked for this RfC to be withdrawn. Sometimes it's best to start from scratch. A biased framing is no where to start.

I don't think we can make headway when the behavioral problems are so entrenched, but a clean slate would be a good start.

RexxS, I ask you to WP:FOC. If you need to discuss my behavior, do so on my talk page.

Lengthy back and forth is sometimes necessary, often just to get everyone coming from the same perspective. --Hipal/Ronz (talk) 17:01, 4 April 2020 (UTC)

Hipal, The majority of editors participating in this RfC don't agree with you, and repeatedly making the same meta point is not constructive.

We can make headway if we focus on the subject at hand, make constructive arguments, and seek commonalities. The RfC has 16 constructive responses, none of which come from you.

I'm confident my constructive contributions here will stand scrutiny far better than yours. If you have a complaint about my focus on content, you should take your own advice and do that on my talk page.

Lengthy back and forth is never necessary when it only consists of the same editors talking past each other with no attempt to find common ground.

This RfC will also answer the question whether a summary of pricing information (not prices) is reasonable to have in the lead when multiple reliable secondary sources discuss the costs of a drug. The next stage will be to clarify the extent to which a drug article can properly summarise what reliable sources have to say about its cost, as that section has been removed three times without good reason (improperly using Wikipedia:Manual of Style/Medicine-related articles/RFC on pharmaceutical drug prices to justify the removal). --RexxS (talk) 18:56, 4 April 2020 (UTC)

We disagree.

Our common ground should be our policies and any applicable larger consensus. The majority of editors participating here are not addressing that common ground. The question posed in this RfC does not, and editors are falling in line with that mistake. Where are the constructive arguments, when the RfC is designed to prevent discussion? How do we seek commonality, if we start without any reference at all to existing policy, a relevant RfC, and general consensus? --Hipal/Ronz (talk) 20:49, 4 April 2020 (UTC)

WP:NOTPRICES: "An article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention. Encyclopedic significance may be indicated if mainstream media sources (not just product reviews) provide commentary on these details instead of just passing mention. (my emphasis) As we already know, scholarly sources discuss simvastatin costs. The failure of a minority of editors here to acknowledge this demonstrable fact prevents common ground to be reached.

WP:LEAD: "The lead should stand on its own as a concise overview of the article's topic." There is a failure by some participants to accept that the lead summarises the rest of the article. That is from our Manual of Style. It is blocking consensus to mistakenly or wilfully insist that only content establishing notability belongs in the lead.

WP:CON: "The main resources for this are as follows: ... Requests for comment (RfC) Placement of a formal neutrally worded notice on the article talk page inviting others to participate which is transcluded onto RfC noticeboards. Are you contending that the question in this RfC is not a "formal neutrally worded notice on the article talk page inviting others to participate"? Because I'm convinced that it is. You're going to have to give reasons why you think it is not.

There are three policies/guidelines that must be the basis of establishing common ground. Contrary to your assertion, the majority of participants do address those. You can read my support !vote to see the constructive arguments in favour of the question. Sixteen editors seem to have been able to enunciate their positions with some clarity. How can you claim that "the RfC is designed to prevent discussion" when that is patently untrue. --RexxS (talk) 21:56, 4 April 2020 (UTC)

Thanks. Too bad none of those policies were brought up prior to this by anyone wanting to include the material, nor in the framing of the RfC itself. At least you brought up UNDUE.

Yes, that's the common ground we should be working from.

My concerns are LEAD and CON. I'm not against all inclusion, nor is this RfC, so NOTPRICES is simply background. --Hipal/Ronz (talk) 16:22, 5 April 2020 (UTC)

Re CON: The format of this RfC discourages discussion and collaboration. The RfC statement ignores all background, all policies, all relevant RfCs, all general consensus. LEAD should have been prominent in the RfC statement. The recently closed RfC should have been identified and quoted. Related disputes should have been identified. Without these basics, at best this RfC will result in CONLOCAL. --Hipal/Ronz (talk) 16:29, 5 April 2020 (UTC)

I'm afraid I don't know what you're referring to as far as your LEAD comments, There is a failure by some participants to accept that the lead summarises the rest of the article. and mistakenly or wilfully insist that only content establishing notability belongs in the lead. Diffs please supporting this representation of editors' viewpoints. Also, are there any statement in support of the content that cite LEAD other than your own? --Hipal/Ronz (talk) 16:36, 5 April 2020 (UTC)

"I'm afraid I don't know what you're referring to as far as your LEAD comments" - then please read the RfC; you'll immediately see examples of what my comments are referring to. My support !vote didn't cite LEAD. It's not necessary to for me or any other supporter to cite particular guidelines when it is clear from the context what they are. The fact is that the content under discussion meets the standard set in LEAD as I have already shown. Neither you nor any of the oppose !voters have given any reasoning behind your opinion that it does not. --RexxS (talk) 18:32, 5 April 2020 (UTC)

It's not clear, which is why I asked for clarification. Please do so. Stating that it is clear and asking me to reread is unhelpful at best. --Hipal/Ronz (talk) 19:18, 5 April 2020 (UTC)

Closure

The RfC has run for the conventional 30 days, and no contributions have been made for two weeks. The guidance at Wikipedia:Administrators' noticeboard/Requests for closure, is "Many discussions result in a reasonably clear consensus, so if the consensus is clear, any editor—even one involved in the discussion—may close the discussion." I propose that it should be closed as clear support to add the wording, but if anyone contends that an uninvolved closer is needed, then perhaps they should suggest an uninvolved editor to act as closer, or list the RfC at WP:ANRFC? --RexxS (talk) 17:46, 5 May 2020 (UTC)

With this case before the arbs, I believe any action towards closure would not be the most helpful route to take. SandyGeorgia (Talk) 18:07, 5 May 2020 (UTC)

Indeed. We don't appear to have a consensus at all, which is little surprise as the original RFC structure encouraged voting instead of discussion, and in the discussion, participants weren't even allowed to reply to each other in the usual manner. It's a mess and WhatamIdoing's criticisms have not been addressed or resolved. It seems to me more important for some to retain James's text + sources exactly as proposed, than to work together to achieve a consensus text based on the WP:WEIGHT of contemporary literature on simvastatin in 2020. WEIGHT doesn't work by googling "simvastatin low cost" and picking whatever you find, no matter how tangential (dentistry) or unsupportive of the text (WHO). It works by reading the up-to-date literature on the drug and seeing what aspects those authors consider notable and worth mentioning. Nobody has done that, as far as I can see. -- Colin°^Talk 18:51, 5 May 2020 (UTC)

This is a pure content issue, and I disagree that the closure here can possibly be in any way dependant on the Arb Case. Conversely, the result of the closure will likely be of interest to the drafters.

I already addressed WAID's criticisms, and the sources quoted in the background to the question are reliable and discuss a notable aspect of the drug. If you're really looking to to achieve a consensus, what is your suggested compromise for (1) the text in the body and (2) the text in the lead? --RexxS (talk) 23:22, 5 May 2020 (UTC)

and discuss a notable aspect of the drug I'm afraid that's disputed. --Hipal/Ronz (talk) 23:54, 5 May 2020 (UTC)

And that dispute is just what this RfC will decide. --RexxS (talk) 00:16, 6 May 2020 (UTC)

No, that's what some editors want to continue to project from this RfC, in violation of CONLOCAL and WP:ADVOCACY. That's why the ArbCom is happening.

So to resolve this dispute, we need to address LEAD directly, in the context of the relevant policies. People need to do the work, not just make assertions or vote. It requires work that so far, as Colin says, Nobody has done that, as far as I can see. --Hipal/Ronz (talk) 02:49, 6 May 2020 (UTC)

There's no violation of CONLOCAL or ADVOCACY. The ArbCom is happening because a handful of editors are trying to misuse an RfC about drug prices to remove properly sourced content about drug pricing. You are impugning the contribution of uninvolved editors by claiming that they have not considered the applicable policies. The discussion above shows that WP:LEAD's requirement for the lead to "stand on its own as a concise overview of the article's topic" is met by a sentence summarising the Society and culture section. You've had over a month to make your case and failed to do so. The consensus on this issue is clear in supporting inclusion of "Simvastatin is relatively low cost" to the lead. --RexxS (talk) 19:14, 6 May 2020 (UTC)

Saying something doesn't make it so. No one has done the necessary work, and the RfC is a CONLOCAL and ADVOCACY attempt, as the evidence clearly shows in the diffs below. --Hipal/Ronz (talk) 19:38, 6 May 2020 (UTC)

You have no idea who has done the work and it's ludicrous to claim you know what other editors have done, but this RfC will settle with certainty that you were in breach of policy when you removed well-sourced content. The RfC will indeed be a finding of local consensus, and there's absolutely nothing wrong with that because it does not run counter to any other wider consensus, as you know by now. --RexxS (talk) 21:53, 6 May 2020 (UTC)

We can see what work editors have presented, and what evidence has been presented. One of the problems here is that this RfC was caged so most editors would not find past work and discussion. We should not assume anything else in determining the outcome of this RfC. --Hipal/Ronz (talk) 22:08, 6 May 2020 (UTC)

Should a random admin wander by and want to involve themselves in an issue currently before the arbs, here is a small bit of the relevant evidence:

• Barkeep49
• WhatamIdoing
• SG
• Colin
• Hipal
• Colin2

SandyGeorgia (Talk) 10:46, 6 May 2020 (UTC)

Here's the WP:RfC rationale:

Requests for comment (RfC) is a process for requesting outside input concerning disputes, policies, guidelines or article content. RfCs are a way to attract more attention to a discussion about making changes to pages or procedures, including articles, essays, guidelines, policies, and many other kinds of pages.

It is utterly inappropriate to subvert that process by attempting to intimidate potential closers. The case can no longer accept extra parties or further evidence, so any potential closer need have no fear of being dragged into it. No one with any respect for our dispute resolution processes will think badly of any editor who performs the close in a neutral and accurate manner. --RexxS (talk) 19:14, 6 May 2020 (UTC)

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

Revisit the price mention in lede?

I'd hoped we could get past what's obviously more than just CONLOCAL problems with the above RfC. Do we need to do a proper RfC that doesn't ignore all larger consensus on the matter? --Hipal/Ronz (talk) 18:35, 13 October 2020 (UTC)

I am disappointed to see text that fails WP:V and WP:WEIGHT being restored by RexxS. Hipal, this doesn't require another RFC, merely for editors to accept basic core policy.

When asked above by WAID, what "relatively low cost" means, RexxS replied "low cost when considered against the range of prices of other drugs". But which other drugs? Other statins? Other cholesterol-lowering drugs? Or all other drugs for any purpose? Considering one may take this drug every day for the rest of one's life, "relatively lower" than other drugs is a really big ask. RexxS points to the body text, but it uses the same trash sources as the lead, and still doesn't answer the question.

The problem we have is that simvastatin was in 2007 the first statin to go generic, and was then way way cheaper than the blockbuster drug atorvastatin, which was not only very expensive but the biggest selling drug of all time (or something like that). This was notable as statins were very important drugs and the cost disparity was enormous. It took until late 2012 for atorvastatin to fall in price as generics became more widely available. The trash dental paper from 2012 that speculates, wrongly as it turned out, about statins being "A new era in local drug delivery" and having a "role in periodontal regenerative therapy" is fit only for the bin. It isn't a paper about the cost or affordability of simvastatin, but was found only because an editor searched for "simvastatin low cost" on Google and that turned up. It appears possible to edit war and threaten sanctions on anyone not using the very best on-topic covid sources while simultaneously citing the opinion of some misguided dentists in an article on a drug for heart disease. I can tell you for nothing that my dentist is not the first person I would ask for opinions on affordability, unless I was thinking of buying an Audi or a holiday in the Maldives.

The WHO source, although dated 2018, is a historical narrative and the section on simvastatin discusses the rationale for its inclusion in the WHO Essential Medicines list in 2007 (i.e. when it was the only generic statin). The "lower cost" mentioned in that paper, is not relative to other drugs, but relative to its own price in 2006. The other source used by the lead, Drugs.com, does not comment on the price at all.

So, if we were writing this text today, one might comment in a history section that between 2007 and 2012, simvastatin was relatively low cost compared to other statins, which were all still on patent. This fact is not true today (it costs much the same as many other statins, and is no longer chosen for reasons of cost). The cost today is unremarkable to the point that we have no recent sources commenting on it at all, low, lower, relatively lower, whatever, never mind thinking the relative cost is important enough to highlight in a lead section. If this factoid had any WP:WEIGHT, an an article on on of the most significant drugs in history, then it would be no problem at all to find a handful of sources dated 2020 commenting on its current "relatively low cost". The WP:ONUS, on those restoring contested text, is to find them and cite them. -- Colin°^Talk 21:10, 13 October 2020 (UTC)

I recommend another RFC per Wikipedia:Arbitration/Requests/Case/Medicine#Standard discretionary sanctions. SandyGeorgia (Talk) 21:57, 13 October 2020 (UTC)

@Colin: Do you intend to re-litigate every RfC that you don't like the outcome of until you get a result you like? Nobody has the right to simply reject a lengthy RfC, closed by an uninvolved administrator less than five months ago. You made your case then and the community rejected it. What's changed since then? Nothing. It's about time you started learning to live with the consensus that RfCs establish, the same as the rest of us. --RexxS (talk) 22:04, 13 October 2020 (UTC)

Five months is sufficient, and a lot has changed since then. Whether or not you all opt for a new RFC, please don't walk yourselves into another hot spot. SandyGeorgia (Talk) 22:09, 13 October 2020 (UTC)

If there are no arguments against the concerns that it should not be presented as current information, then it needs removal or a rewrite. A RfC counts for nothing if it doesn't address the problems. ArbEnf applies. --Hipal/Ronz (talk) 22:32, 13 October 2020 (UTC)

I would appreciate if RexxS, as the restorer of the disputed text, supplied current sources that support the text he restored. He is required to do that per policy. If he cannot or will not do that, then the text can be removed again. The previous RFC was held under a quite different political situation. We could very much do with editors putting aside the politics and advocacy and even the entire issue of whether prices should be in articles or leads or whether that includes numeric amounts in a currency or adjectival statements. This text, that was restored, is quite simply not true, and there are no recent sources given that support it. It was true (if ambiguous) for a few years (2007-2012). It isn't today. And that's all there is to it. -- Colin°^Talk 09:08, 14 October 2020 (UTC)

At this point, I'm thinking another bold removal might be better than digging up all the behavioral problems in the RfC and it's enforcement. --Hipal/Ronz (talk) 16:25, 19 October 2020 (UTC)

I have removed confusing claim of "relatively low cost" from the lead, and the Cost sub-section in the body. As noted by several above, it isn't clear what the supposed "low cost" is "relatively" to. Simvastatin was once relatively low cost compared to some other statins, but this is no longer the case, and the cost of Simvastatin is unremarkable. I have searched and found no recent sources commenting on the cost of simvastatin. There are sources commenting on statin therapy in general, though the vast majority of them are out of date. They come from an age when many were on-patent, expensive, and health boards and insurance companies needed strong convincing case that these therapies were financially worth it, or that it was proper to prescribe a branded statin vs a generic. One middle-aged analysis I found was more concerned with the cost of low, medium and high intensity therapy, and within each of these groups, several statin options and dosages were possible. It seems therefore that in 2021 it is more proper to discuss the cost of statin therapy at the statin article, and not really sensible to focus on one drug option. That article could also perhaps discuss the period in time when some statins were generic and some on patent and the latter were nevertheless blockbuster selling drugs. At an individual level, the "was once expensive branded and now cheap generic" story is true of most drugs.

An encyclopaedia is not a collection of random numbers from arbitrary points in history. The reader does not benefit from being offered a cherry-picked cost in one country from 2008. It is not only out-of-date but cannot be compared to costs elsewhere or with other statins or with other therapy choices. It is OR to juxtapose several of these numbers. There is no WP:WEIGHT to the numbers if contemporary secondary sources are not discussing them. The PPACA "no cost" sentence was confusing and this is one of seven statins and many other drugs listed in the source, so again raises the question: why is this remarkable? If it is remarkable, someone will be discussing it and we can cite them.

If there are editors who feel strongly that Wikipedia should discuss the cost of Simvastatin then the solution is simple. Find recent secondary sources that discuss the cost of Simvastatin. -- Colin°^Talk 16:57, 27 September 2021 (UTC)

As an uninvolved administrator, I think this was a bad idea, Colin. The standing consensus is that these sections should be included, and that consensus came from an RfC closed by an uninvolved administrator. To put it bluntly, entirely removing text added by RfC consensus based on the local consensus of those who opposed the original RfC strikes me as tendentious. The proper way forward is with a new RfC, not making an end-run around the consensus process. I think you should reconsider your approach. — Wug·a·po·des​ 22:26, 28 September 2021 (UTC)

Wugapodes, with respect, I don't think there is a single fact or claim in your post that is accurate or relevant or fair. The above old RFC represents the politics and agenda-pushing of a different age. Let's not wikilawyer about process, or overcomplicate basic editing with the need for an RFC. Goodness me, in these covid times, we are overrun with RFCs. I'd much rather editors had a normal policy-and-guideline-based talk page discussion about article text.

If there is merit in restoring any of the removed text, or adding new text about the cost of this drug, editors are free to present their arguments here. I would strongly caution editors against edit warring over the text, or making WP:POINTy edits. Let us demonstrate that we can bring reliable contemporary secondary sources to the table and work towards a consensus that serves the reader, not an agenda. -- Colin°^Talk 08:57, 29 September 2021 (UTC)

Look, I don't care about the price of a weight loss drug (or whatever this is). As an uninvolved administrator who watches this page precisely because of the old disputes, I'm pointing out that someone specifically named in the Arbitration decision resulting from the "politics and agenda-pushing of a different age" should probably be more careful and less cavalier about bold edits that go against an RfC outcome from that time. Do with that admonition what you will. I'm also not keen on returning to the old politics and disputes, so I am being clear, up front, that I'm not going to look favorably on a return-to-form. — Wug·a·po·des​ 18:32, 29 September 2021 (UTC)

Wugapodes, I really did appreciate your involvement in the big drug RFC, the care you took over your concluding text, and responding to our tedious requests for clarifications afterwards. I wonder if perhaps you have come to this edit thinking that there is still a battle ranging and a fire that needs admin attention. If you didn't get the memo, the folk who cared about drug prices set up their own invitation-only wiki elsewhere (they even have charts plotting drug prices over time). A few articles had accumulated price comments and figures simply it seems to serve some WP:POINT, and their text and sources are frankly just silly. This is one.

I think it would really help if you could dial down the negative personal commetary and sanction-baiting language please. Hipal suggested, almost a year ago, that we should just boldly remove the cost stuff. Nobody objected or even cared. If editors do want to include cost information, then I'm happy to see them propose text and sources and engage in a policy based discussion. If it really does come to it, then an RFC might be needed, but I'm not seeing any grounds for that at the moment. First, I'd expect to see editors present relevant secondary sources, and then perhaps fail to reach consensus on those, and need extra opinions. And then I'd like to see our RFC-experts involved in drafting something careful, because we don't need a repeat of a poll that was just a "Are you with me or against me" affirmation of which tribe people belonged to. I don't think it will come to that. The drug price boat sailed away a long time ago. -- Colin°^Talk 20:04, 29 September 2021 (UTC)

Yes, let's take a step back. I'm sorry that I came on so aggressive. I'm not following many pages, so I am only working off what's covered on the ArbCom page. When admin-ing in areas with discretionary sanctions, I try to set clear and firm boundaries which hopefully explains my approach. I appreciate the background information though, as I was still working under the assumption that the issue is contentious enough that discretionary sanctions need to be enforced. It sounds like they might not be, and it might be worth requesting an amendment to remove them. — Wug·a·po·des​ 21:58, 29 September 2021 (UTC)

Wugapodes Thanks for that. It isn't like all drug articles have a warning template about discretionary sanctions (like some covid pages have). I guess only those involved in the med arbcom know about this. Is it advertised elsewhere? If it just exists as a historical warning then perhaps that's enough, in case anyone gets funny ideas about turning Wikipedia into GoodRx.com. -- Colin°^Talk 21:25, 30 September 2021 (UTC)

I think we should critically examine the text and supporting sources. The removed text is vague and not supported by the sources and so it it should go. I see no need to admonish any editor for removing it. The dust settled from this disagreement a long time ago and wikilawyering is not helpful to the encyclopaedia. Graham Beards (talk) 19:00, 29 September 2021 (UTC)

I'm not sure why this wasn't removed long ago for the reasons given, or in the larger cleanup efforts. Glad someone finally stepped in and did so. --Hipal (talk) 20:35, 29 September 2021 (UTC)--Hipal (talk) 20:35, 29 September 2021 (UTC)

I don't think we lost much by removing this completely. Most of it was outdated or misleading. I still want information about drug prices in articles, but I don't think that the best practice is to talk about "the price" (or even "the price in <place>"), because there are lots of different prices (e.g., wholesale vs retail).

Also, I specifically object to the statement about there being no cost in the US under Obamacare rules, because it is neither true nor verifiable. There is a cost, because There ain't no such thing as a free lunch. The cost is just not paid at the time of service. WhatamIdoing (talk) 16:05, 1 October 2021 (UTC)

Statins

What happens if I stop taking simivastasin because I’m having problems with my liver and I take amlopldine which I read should not be mixed. 47.151.163.243 (talk) 07:11, 28 November 2021 (UTC)

Sorry, Wikipedia does not give medical advice. Graham Beards (talk) 11:58, 28 November 2021 (UTC)