Wikipedia talk:WikiProject Pharmacology/Style guide/Archive 1

Archive 1

Update

I've updated and expanded this page a bit. If anyone would like to discuss my changes, or edit further, please go ahead! :) Fvasconcellos (t·c) 16:55, 13 May 2007 (UTC)

Off-label use

I've written a bit about the problems inherent in discussing approval and off-label uses here: Wikipedia talk:Manual of Style (medicine-related articles)/archive1#Turning practical and specific pointers to vague. Any comments? I believe that such issues are not relevant to an encyclopedic text and the MOS should state so. However, I haven't found much interest in the idea, and I don't want to go ahead and and add it if there's reasonable opposition. Any comments? KonradG 03:59, 15 May 2007 (UTC)

Non-standard section naming

One of the main issues with all of the articles about drugs is the issue of consistency. Naming and organization of sections needs to be standardized, which is what this project page attempts to address. Here are a few observations I've made concerning this issue:

• Section naming
  • Indications - frequently titled "Uses". This section title may be preferable, since one of the overall goals of an encyclopedia is to explain a topic to someone with little prior knowledge of the subject. A frequent criticism of pharmacology/drug articles is that they are jargonistic and difficult to read. Opinions?
  • Pharmacology - often titled "Mechanism" or "Mechanism of action"
• Section organization
  • Sections are almost always in an entirely random, haphazard order, particularly in articles that receive little attention.
• Drugbox vs. Chembox
  • Where is the line of demarcation between "chemicals" and drugs? I find that it is entirely blurred. Whenever appropriate (i.e., whenever a compound is used in humans) there should be a drugbox, rather than a chembox, the latter of which provides less pertinent info.

Fuzzform (talk) 21:51, 19 December 2007 (UTC)

I think Mechanism of action is more self explaining, but pharmacodynamics may be a more fitting name in case there already is a pharmacokinetics section. Pharmacology is too unspecific. Otherwise, I agree. Mikael Häggström (talk) 10:45, 1 January 2011 (UTC)

I'd prefer to keep things consistent, and see no problem with having "Mechanism of action" alongside "Pharmacokinetics". It probably would be better to have an easy-to-understand term for pharmacokinetics, but I can't think of one. --ἀνυπόδητος (talk) 11:37, 1 January 2011 (UTC)

Neither do I - there's so many components of it, so any alternative, as I see it, would be something like Uptake, distribution, metabolism, excretion etc. Kind of too long. Mikael Häggström (talk) 15:38, 1 January 2011 (UTC)

Capitalization

Maybe this is addressed elsewhere, but what is the capitalization convention for drug names? I assume that generics begin with lower case letter, whereas brand names begin with upper case. —Preceding unsigned comment added by 71.91.0.40 (talk) 22:28, 30 August 2009 (UTC)

It's conventional to do so, but I don't know the original guideline that decided it. Mikael Häggström (talk) 10:33, 1 January 2011 (UTC)

Brand names are trade marks and as such capitalised (MOS:TM). I don't think there is a guideline for not capitalising generic names, nor that we need one. They are just names of substances like "water" or "ethanol". --ἀνυπόδητος (talk) 11:37, 1 January 2011 (UTC)

History could be more at bottom

I think history sections are relatively unimportant, so they could very well be placed much lower in section order, such as between Interactions and Legal status. Mikael Häggström (talk) 10:35, 1 January 2011 (UTC)

I agree with you. By the way, thanks for your input at WP:PHARM, we really are in need of it! --ἀνυπόδητος (talk) 11:37, 1 January 2011 (UTC)

Thank you even more for the PotatoBot! ;-) Mikael Häggström (talk) 15:40, 1 January 2011 (UTC)

Organizing the sections

A few comments:

1. Wondering if "Interactions" would fit as a subsection of "adverse effects" as they are sort of a type of AE?
2. I propose we remove "Pharmacodynamics" and just call the section "Mechanism of action" a more widely known term.
3. I propose that we discourage the "See also" section much as we do in disease articles. Navigational templates go in the external links section.
4. A section on the social and cultural significance of the drug. Illegal use could go under this section.
5. I propose that we move the history section near the end. Most people when they are look up medication on wondering what it is and what it is used for and thus we should present this info most prominently.

--Doc James (talk · contribs · email) 20:08, 17 March 2011 (UTC)

BTW I am tempted one of these nights to try to bring all the medication articles into a consistent format. Thus wish to get this as concrete as possible before I begin. Doc James (talk · contribs · email) 20:13, 17 March 2011 (UTC)

Support #2 ("Mechanism of action" instead of "Pharmacodynamics") and #5 (History section near the end).

Not sure about #1 (Interactions and adverse effects).

#3 (See also) shouldn't be used to list related drugs (these belong in the navbox as you said), but the section might be useful for other purposes.

#4 (Social and cultural significance) would be nice but I can't think of many drugs with notable social impact; and such a section might attract WP:TRIVIA on the lines of "Frasier used this drug against his flu in episode #1255". --ἀνυπόδητος (talk) 21:23, 17 March 2011 (UTC)

What I refer to is interactions being a subsection of the main section adverse effects. Not having both in the heading.

At WP:MED we have "See also: Avoid the See also section when possible; prefer wikilinks in the main article and navigation templates at the end." I was thinking something inline with this.

Society and culture would deal with things like controversies surround medication (propofol would be an example). The amount of medication used in different countries (ADHD meds are used primarily in the USA). There of MEDRS compliant sources for this stuff. I am not encouraging trivia.Doc James (talk · contribs · email) 22:12, 17 March 2011 (UTC)

Yes, I like the phrasing you implemented for the See also section. I know you don't want to encourage trivia, but a section entitled "Society and culture" still might attract some. I added a clarification; feel free to revert or rephrase if you're not happy with it. --ἀνυπόδητος (talk) 09:15, 26 March 2011 (UTC)

Discussion of pregnancy and lactation

We have this is in the drug box but for a more detail discussion we should have a section on it aswell. Not sure under which heading it would best fit.Doc James (talk · contribs · email) 14:34, 18 March 2011 (UTC)

What about Contraindications, or a subsection of it if there is more to say than a paragraph or so? This should always fit unless the drug can be used during pregnancy/lactation without limitations. Putting it in the Therapeutic uses section seems somewhat contradictory if the drug is contraindicated. Also, I'd only use one section to prevent the sections from getting too short; there aren't many cases where we have more than a couple sentences on lactation. --ἀνυπόδητος (talk) 09:06, 26 March 2011 (UTC)

When it comes to pregnancy and lactation they are usually not classified as absolute contradincations and are more nuances as in no good human research is available but animal research indicates... Thus risk / benefits need to be balanced.--Doc James (talk · contribs · email) 23:44, 26 March 2011 (UTC)

We have two terms Indications and Therapeutic uses

Indications sees more legal status. Therapeutic uses seems more evidence based. Best to go with one IMO and the second is better. Doc James (talk · contribs · email) 10:48, 20 March 2011 (UTC)

There are cases where we won't get around having two terms to be accurate – if there are (eg. experimental) uses that are not indications (ie. not approved). I agree that Therapeutic uses is the better term; and if we need to elaborate, "approved uses" might be more understandable than "indications". --ἀνυπόδητος (talk) 08:56, 26 March 2011 (UTC)

IMO this should be a discussion of the research on a usefulness of drugs for certain conditions rather than a list of approved uses given by regulatory bodies. Both can / should be mentioned under therapeutic uses by indications might lead one to think only approved / indicated by regulatory bodies should be mentioned. We will of course follow WP:MEDRS and require review articles as sources.--Doc James (talk · contribs · email) 23:55, 26 March 2011 (UTC)

I agree comopletely. I just meant that, if we want to tell people which uses are approved and which are still experimental, or off-label, (at least GAs should have this information), "approved uses" is a better term than "indications". All of this information belongs in the Therapeutic uses section, of course. --ἀνυπόδητος (talk) 10:15, 27 March 2011 (UTC)

An afterthought: What about diagnostic and preventive uses (eg. vaccines)? --ἀνυπόδητος (talk) 10:19, 27 March 2011 (UTC)

Discussion also here Wikipedia_talk:Manual_of_Style_(medicine-related_articles)#Indications_vs_Therapeutic_uses --Doc James (talk · contribs · email) 10:30, 27 March 2011 (UTC)

How about using Clinical indications some have brought up concerns regarding therapeutic uses. It is sort of a compromise between the two above. Doc James (talk · contribs · email) 11:43, 1 April 2011 (UTC)

Economics

James, could you elaborate on that section? Note that the section General considerations says "Do not include dose, titration or pricing information except when they are extensively discussed by secondary sources, or necessary for the discussion in the article." --ἀνυπόδητος (talk) 09:19, 26 March 2011 (UTC)

I was more thinking "what is the global sale of this medication" and how has it changed and how is it distributed. Good sources for this BTW.--Doc James (talk · contribs · email) 23:03, 26 March 2011 (UTC)

Mechanism of action

I think this section needs a major overhaul:

Describe what endogenous compound is affected by the drug, and whether it is inhibitory or excitatory. For example, in case a neurotransmitter is the endogenous compound affected, the neurotransmitter class (e.g. catecholamines) should be stated.

My suggested change:

If known, describe the specific biological target of the drug (for example which receptor subtype, ion channel population, isozyme, etc. the drug binds to) and if the drug blocks or activates that target. If relevant, mention what endogenous substance (neurotransmitter, hormone, substrate, etc.) is mimic or blocked by the drug. Also describe the downstream consequences of modulating that target (what signal transduction pathways are impacted, what genes are up or down regulated, etc.) and how modulating the activity of the target ultimately translates into the desired therapeutic effect (for example vasodilation resulting in decreased blood pressure).

This is the first time I have ever commented on this style guide, so I thought it is better to ask before implementing any changes. Boghog (talk) 19:42, 28 March 2011 (UTC)

Agree that what you suggest is an improvement. I support you making this change to the guideline.--Doc James (talk · contribs · email) 19:46, 28 March 2011 (UTC)

Further clarification of section headings

• Should we go with "illicit use" or "recreational use" for the section dealing with the use of drugs for their mild altering properties? I am leaning towards recreational use as it is less POV. Also people may use stuff life gravol recreationally but this is not illegal...

--Doc James (talk · contribs · email) 14:07, 2 April 2011 (UTC)

Wondering where we should discuss use in preg/lactation

I am thinking these subheadings should be dealt with under "medical uses" Many drugs have side effects in preg but are used when the benefits outway the risks.Doc James (talk · contribs · email) 14:11, 2 April 2011 (UTC)

OK, fair enough. I was thinking that the FDA package insert regulations might provide some useful ideas for organizing this style guide. For example, package inserts must contain a section on "use in specific populations" with subsections on "pregnancy", "labor and delivery", "lactation", "pediatric use", and "geriatric use". Boghog (talk) 14:30, 2 April 2011 (UTC)

Yes agree that would be even better. We could list these as potential subsection under "medical uses" We already have the pregnancy category in the lead so these section would be optional. Doc James (talk · contribs · email) 14:31, 2 April 2011 (UTC)

Would "In children" and "In the elderly" be at an easier reading level? Feel free to revert if you disagree... Doc James (talk · contribs · email) 15:23, 2 April 2011 (UTC)

We need a section on "Measurement in body fluids"

I have added it after adverse effects but not sure the best place to put it... Doc James (talk · contribs · email) 14:13, 2 April 2011 (UTC)

Does that really need a top-level section? What about just putting it as a subsection of Chemistry if notable? --ἀνυπόδητος (talk) 14:43, 2 April 2011 (UTC)

Yes I guess that would work too. It is significant with respect to many aspect of the article however including overdose and adverse effects, verifying compliance, and recreational drug use.Doc James (talk · contribs · email) 14:48, 2 April 2011 (UTC)

Move "Available forms" to society and culture section

The "available forms" depend on the manufacturers more than anything and varies between cultures. Also if we are going to list generic names and dosage forms this information is less important. Thus I feel this section would be better lower in the article. Comments? Doc James (talk · contribs · email) 14:19, 2 April 2011 (UTC)

Are we going to include generic names and dosage info? The guide says "Do not include dose, titration or pricing information except when they are extensively discussed by secondary sources, or necessary for the discussion in the article." which has been discussed far and wide. Also, there is a really long discussion somewhere that resulted, if I remember correctly, that we shouldn't include long lists of trade names. Consensus can change, but please be aware that adding dosage and generic names to the guide will need a thorough discussion first. --ἀνυπόδητος (talk) 14:42, 2 April 2011 (UTC)

I do not wish to add this information. Just that I have been looking at the medication articles and a lot of them contain this sort of information. I do not consider it terribly important / encyclopedic and with sufficient support would be happy to just delete most of it. I guess we could move that section to the society and culture section and have a caviate that it must be sufficiently notable to be included as you mentioned. An example of what I propose is here Bupropion#Society_and_culture Doc James (talk · contribs · email) 14:53, 2 April 2011 (UTC)

Sounds fine to me. You have the Guide's (and the Project's) support for deleting dosing info and overly long lists of trade names (especially in the lead where they are really ugly and distract from more important things). Such additions mainly come from anon editors who see two or three trade names and add a fourth, and a fifth... --ἀνυπόδητος (talk) 15:00, 2 April 2011 (UTC)

"Medical use" verses "medical uses"

I not clear on wiki guidelines but should we generally use use or uses? I know for article titles it is generally singular... Doc James (talk · contribs · email) 15:22, 2 April 2011 (UTC)

"off label"

Under medical uses / indication there is often a section called "off label". This is a regional thing which typically refers to FDA none approval. IMO as it is not global it should be discouraged... Comments? Doc James (talk · contribs · email) 23:06, 8 April 2011 (UTC)

Brand names

Currently we have the brand names in the infobox; see Lisinopril. Thus I do not think we need them bolded in the lead or elsewhere for that matter. Brands already start with a caps so do not deserve bolding. Have moved this content to the section on society and culture latter in the article. Doc James (talk · contribs · email) 23:25, 25 April 2011 (UTC)

Was discussing this further here on how many bolded terms should be in the lead for medications. I am thinking the best presentation would be bolding the generic and the first brand name. A couple more brand name can then be added to the drugbox with the remainder going lower in the article and being capatalized but unbolded. Comments? Doc James (talk · contribs · email) 02:02, 13 June 2011 (UTC)

Related question: Editors have been adding long lists of international brand names to many drug articles, eg [Azithromycin]. I don't think they belong, because it's too much detail, it's of no use to most readers, they don't usually give WP:RS, it's hard to verify, it may be WP:ADVERTISEMENT, and I think they could easily find it with a Google search if they need it.

I think it violates WP:MEDMOS "Extract the pertinent information rather than just dumping low-level facts in a big list." Is there a more specific guideline that it violates? Should this be in the guideline? --Nbauman (talk) 15:17, 26 October 2011 (UTC)

Articles pertaining to classes of medications

We should have a section in articles that deal with classes of medication listing all the meds in said class. Wondering what we should generally call this section and where in the article it should go?--Doc James (talk · contribs · email) 17:45, 29 April 2011 (UTC)

Bold in lists

Hi all. I can find nothing in the MoS or in the proposed guideline for the project that warrants lists of medications be in bold print. I've been undoing some bolding, and removed it from some others (in the A-B range). Drmies (talk) 19:06, 23 June 2011 (UTC)

Wonderful. Discussion of a tool to help with this can be found here [1] Doc James (talk · contribs · email) 21:59, 23 June 2011 (UTC)

Haha, geekness from OhConfucius--how unexpected! Well, I'm glad I'm not going against the grain here. I will probably continue, in bits and pieces, in a semi-automated way--using Notepad. Thanks, Drmies (talk) 23:34, 23 June 2011 (UTC)

Fine! Just make sure you don't remove bolding from the initial trade name(s) – there might be two or three, eg. if the drug is marketed under different names in US and EU. Cheers, ἀνυπόδητος (talk) 06:26, 24 June 2011 (UTC)

Yes but to keep the initial list manageable it should only contain the first brand name(s). Subsequent one should go lower in the article if included and not be bolded IMO. Doc James (talk · contribs · email) 14:45, 24 June 2011 (UTC)

The style guide made me think that only names in the lead were bolded, and these lists don't have leads (well, they have a templated lead, but I don't touch that). Drmies (talk) 21:25, 24 June 2011 (UTC)

Sorry, I thought you were talking about lists of trade names in drug articles. Unbolding names in List of drugs is fine by me; I've no idea why they were bolded in the first place. Thanks! ἀνυπόδητος (talk) 08:35, 25 June 2011 (UTC)

By the way any easy way to determine the first brand names used? Doc James (talk · contribs · email) 16:21, 25 June 2011 (UTC)

"Proposed" tag

Please identify any issues that need to be addressed prior to upgrade to guideline status. LeadSongDog come howl! 20:27, 6 December 2012 (UTC)

I don't think there are any major issues and I would support upgrading to guideline status. Parts of it could be expanded adapting appropriate parts of WP:MEDMOS. In particular, there should be mention of common pitfalls and a section on infoboxes (e.g., {{Drugbox}}). I will work on this over the next couple of days. Boghog (talk) 21:12, 6 December 2012 (UTC)

• Support removal of the tag for the style guide as it is right now. I just removed it, actually. If there are outstanding issues then list them somewhere, perhaps in the "general considerations" section of this guide, or in a separate list elsewhere to which that section links. This guide can be developed but it is quite good now. Blue Rasberry (talk) 19:24, 12 March 2013 (UTC)

Brand Names

I have been adding brand names to articles (e.g. mirtazapine (an old one I'm going to fix it up to meet these requirements), mianserin, amisulpride, zotepine) and the countries in of which the different brands are marketed and I think there's a need to standardise what I'm doing. I think I should probably keep to brands used in countries in of which English is at least popular (e.g. in Israel English isn't an official language but it's popular none the less). This way I won't be cluttering the lead to much while still providing relevant information. Unless, of course the drug isn't utilised in any English-speaking countries (e.g. zotepine, melperone). Fuse809 (talk) 12:10, 3 November 2013 (UTC)

I would strongly encourage you not to do that. Don't clutter the lead sentence at all, never mind "too much". The lead sentence is a sentence, not a place to stick minor non-notable technical factoids. There's a real temptation to put things like etymology, pronunciation, variant names/spellings, etc into the lead sentence but this is nearly always a mistake. Our articles are meant to be read. We have the whole page in which to put this information, and we have redirects so that people searching for alternative names get sent to the right article. Occasionally, the brand name is highly notable -- this is likely to be the name used when first marketed. An example would be Valium. US readers seem to be more familiar with brands than other countries, perhaps because prescription medicines are marketed directly to consumers than to physicians. The guideline currently suggests only the initial brand and manufacturer, which I guess is a reasonable compromise, but even then may be complicated for some drugs and so not always good advice.

If you must add this information to articles, please do so outside of the lead section -- it isn't lead-worthy information. But consider this: you need to source every brand name individual. Your list becomes a trivia-magnet for others to append to. So you end up having to watchlist the article to stop other people adding the wrong or even-less-useful-to-English-speakers brandname to a drug (almost always appropriating your footnote number when they shouldn't have). Drugs that are off patent will have a multitude of brand names. Too many to list. If someone adds the wrong brand to the wrong article, we've got the potential to do someone harm. So on balance, I don't think adding non-notable brand names is the most useful thing we do here.

One other important consideration: "Martindale: The Complete Drug Reference" is a copyright text. If you add lift brand-name information for lots of drugs from that one source, then you are likely to be breaking copyright. It may seem you are lifting only tiny bits but it all adds up. We've had issues with people taking excerpts from the DSM for disease definitions -- and they will sue over this. IMO, it isn't our job to replace Martindale. Let's focus on encyclopaedic facts that will be most useful to the general reader.Colin°^Talk 13:52, 3 November 2013 (UTC)

As suggested in this style guideline, I think there is a middle ground. If there are a very limited number of notable brand names, IMHO, these should be included in the lead since general readers may be more familiar with the brand name than the INN. This is particularly true if the innovator brand if still on patent and generics are not yet available. On the other hand, long list of brand names should be in a separate section (and/or in the tradename section of the drugbox) if included at all. Please also note that there was a systematic effort to create redirects from brand names to INNs (see discussion). These brand name redirects should be included as bolded terms somewhere in the article Boghog (talk) 14:25, 3 November 2013 (UTC)

There is no requirement to include bold brand names in the article anywhere any more than there is a requirement to include bold misspellings that are redirects. All text content like this must be sourced and conform to policies such as WP:WEIGHT. The bolded name thing is meant for common variant names for an article topic, not for trivia collections of worldwide brand variants. Consider our article on Dishwashing liquid does not list all worldwide brands (only a few famous ones like Fairy). Remember that the drug is not the same thing as the brand any more than a disease is the same thing as its virus - though often articles get sensibly combined. For example Tylenol vs paracetamol, Pepto-Bismol vs bismuth subsalicylate, etc. Also consider your opinion that readers are more familiar with brands possibly reflects your US experience -- consider that readers unfamiliar with US brands will actually be confused by a lead mention of a brand they have never heard of. -- Colin°^Talk 17:56, 3 November 2013 (UTC)

I can use inferior sources if you want Colin, like drugs.com but nonetheless brand names are part of WP:PHARMMOS in the lead and hence I think I would be safe in saying that this is the general consensus of the community and hence there's no need to debate that part. What I am asking about is about adding in small brackets the ISO 3166 code of the nation in of which the drug is marketed; is this permissible? I try not to clutter the lead, I only use at most like 6 brand names. Plus the information I'm getting from Martindale is readily available from other sources I'm sure. If you want to go all copyright on me I'm sure more exclusive information has been taken from books and put into articles. If you have solid evidence that I've overdone it I will concede and remove material I put up but other than that I think there's more important issues here to discuss. Fuse809 (talk) 18:35, 3 November 2013 (UTC)

An exhaustive list of brand names could be in a section on society and culture and IMO should not be in the lead. The lead should typically contain the INN name and USAN name if there is one. And maybe the first brand name. All subsequent brands names should go later and not be bolded. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:31, 30 November 2013 (UTC)

Applying style guide to articles on drug classes

This style guide seems to apply to pages about individual medications, but it does not seem to work well on articles about drug classes encompassing multiple medications. I've noticed this as it applies to the Antidepressant article, where it was recently re-ordered according to this style guide when it really does not make sense for such an article, as well as similar articles on Antipsychotic, Antibacterial, or Chemotherapy. For one, the history section should be listed first (as it was even in this style guide until it was changed in 2011) in those articles, as it would be for almost any other Wikipedia article that is put in a logically chronological order for ease of readability. There should also be a section early on describing the various medications or subclasses within that medication class. Only then would it make sense to start talking about the uses and side effects that the individual medications within the class have. While this style guide does say "The ordering of section may vary depending on the article type", I think it should more explicitly address articles about drug classes if there is consensus about this. - Maximusveritas (talk) 16:49, 29 November 2013 (UTC)

I agree. The scope of these general articles is broader than medicine. For article with broad scope, it is more important to put the subject in context, and then talk about their medical applications. Boghog (talk) 19:16, 29 November 2013 (UTC)

For articles about subjects that are still in current use consensus has been to put the history section latter in the article. IMO this makes the most sense and keeps the layout similar to both disease and medical related articles. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:32, 29 November 2013 (UTC)

If that's the clear consensus on that point, that's fine, but it still makes no sense for these articles on drug classes to start off with a detailed discussion of efficacy and side effects. There should be at least a section describing the various medications or subclasses within that medication class before that. Also, it seems like the "Medical uses" section too often gets overtake with a discussion of research done on the medication rather than provide a clear description of the FDA-indicated and off-label uses for the medication, so a clearer delineation there would be helpful. - Maximusveritas (talk) 00:32, 30 November 2013 (UTC)

We can discuss this at the WP:MEDMOS. I am of the opinion that people care more about what it is used for and what the adverse effects are than the number of specific agents which exist and what their brand names / sub classes are. I would put this after "medical uses" and "adverse effects"

Medical uses in most of the world do not depend on if the FDA has approved it or not. The FDA is one national organization. Whether or not a medication is approved for X, Y and Z by this organization belongs in a section on society and culture.

Agree that a lot of primary source material gets added and needs to be removed. We should be basing our articles on secondary sources per WP:MEDRS but that is an issue across all of our medical content and it is a constant effort to just partially address it. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:28, 30 November 2013 (UTC)

Cost

The cost of drugs is a major issue, with prices on the order of $100,000 for a course of many drugs. This often deserves a separate section. What should I call it? The guideline says that "Economics" shouldn't include prices. Why not?

I've been using the subhead "Cost," but another editor changed it to "Controversy." But that seems too vague. It doesn't tell the reader what the section is about, and it doesn't tell the reader that cost is even an issue.

I think the cost could go under "Economics," or even a new subhead, "Cost." What do you suggest?

Are these subheads suggested (like WP:MEDMOS) or mandatory? --Nbauman (talk) 06:44, 5 April 2014 (UTC)

I agree that costs should go under the economics subheading of the "society and culture" section. We will need to specify which country and year the cost is from as they differ substantially. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:25, 5 April 2014 (UTC)

Hi Nbauman-Agree its too expensive, but NPOV says "Wikipedia aims to describe disputes, but not engage in them". My interpretation may be extreme, but I tend to take that as meaning that the opinion of the editors should not be communicated by the way in which we describe the controversy. A section entitled "Cost" seems to me to communicate that the editors think its too expensive.

Also, I just kinda like the template and think its worth sticking to. Am very comfortable with Jmh's suggestion.

Thanks for the heads up that you were posting here. Formerly 98 (talk) 04:30, 6 April 2014 (UTC)

I see cost as being fairly neutral. Costs can be low or they can be high. We can just state the price in USD or whatever. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:29, 6 April 2014 (UTC)

I see costs as being notable or non-notable. If drugs are readily available at prices patients can afford, like the $4 a month hypertensives or $20 antibiotics at CVS, that's not notable or worth mentioning.

But when a drug is so expensive that WP:RSs repeatedly mention the price as being difficult to afford, or the original investigators themselves write letters to peer-reviewed journals complaining that their own patients can't afford the drugs that they themselves developed (as with Imatinib), that's notable.--Nbauman (talk) 01:26, 7 April 2014 (UTC)

The WHO often lists the least expensive medication for a specific condition. For example phenobarbital is $5 USD a year for epilepsy. This is notable. We really just need to let the sources lead. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:18, 7 April 2014 (UTC)

I'd reiterate that cost information needs to be country specific. Here in the UK I have no idea what the various drugs I and my family take cost, which is probably typical for the EU, so I suppose the issue is most in the minds of editors from the US and other countries where patients are ever-conscious of it. The information should always be dated too. The date(s) of patent expiry might be good to give also - we seem to have remarkably little on how long they last at Chemical patent and other articles (Patent term is better), or how the application dates work across borders. Is there a general article on Cost of pharmaceuticals or something? There should be. Pharmacoeconomics is very technical and assumes a high degree of knowlege of the issues. Johnbod (talk) 14:45, 7 April 2014 (UTC)

As I understand it, the purpose of Wikipedia is not to help comparison shopping, it's to report notable information.

If the doctors who developed a drug like imatinib write a letter to a major journal like Blood criticizing the manufacturer for charging so much, and it's reported by many news sources, isn't that notable? --Nbauman (talk) 03:54, 8 April 2014 (UTC)

Probably, just as Cost of pharmaceuticals is a notable subject. I'm not sure what your point about comparison shopping was. Not that only the US price is of any significance, I hope. Johnbod (talk) 04:14, 8 April 2014 (UTC)

Even if the patient does not pay someone does. Therefore the cost may still be notable outside the USA. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:13, 10 April 2014 (UTC)

I read the U.S. and U.K. journals, and wherever PubMed leads me. Most of the controversy about price that makes it into WP:RSs is about the U.S. price, because it's usually a U.S. company that sets prices of new drugs sofosbuvir that are notably high, and that sets the scale for the international prices. I include American sources, like the WP:RS peer-reviewed journals and experts as quoted in major newspapers like the NYT. I also include NICE, BMJ and Lancet because they have a UK perspective. I would include Canadian and Australian sources if they are notable and add insight to the discussion. I include MSF if they comment. If AstraZeneca or GSK were involved in a notable drug pricing issue, I might just include the UK prices. (And sometimes prices aren't notable because they're high, but because a manufacturer like GSK decides to reduce the price for resource-poor regions.)

I don't think it meets Wikipedia guidelines to say, "Sofosbuvir costs $84,000 in the U.S., £35,000 in the UK, CN$______ in Canada, AU$_______ in Australia, S$_______ in Singapore, ¥______ in Japan..." (which I sometimes see) because the price by itself isn't notable. A list of prices with no other significance is WP:INDISCRIMINATE, especially in the introduction, and makes it difficult to read. That's what I meant by comparison shopping. Do we all agree with that?

Some drug pricing, like the WHO price, might go in the Infobox, but I'm not discussing that now.

Back to the original subject. We have included this notable discussion from multiple WP:RSs of the price of sofosbuvir in the article Sofosbuvir. I'd like to put it under a heading of "Cost", so that people will easily see that it's covered in the article. I'd like to either put it under "Society and culture" or (preferably) under a subhead by itself. The heading of "Controversies" doesn't tell the reader what the section is about. There are lots of controversies about drugs. This one is about cost. I'd like to change it in the Sofosbuvir article and in the WikiProject Pharmacology/Style guide.

A section labeled "Costs" doesn't indicate that the Wikipedia editors think the drug is too expensive, it indicates that multiple WP:RSs think the drug is too expensive (or otherwise noteable).

Have I convinced you? Have I answered all of your objections? Do you still have objections or alternative suggestions? --Nbauman (talk) 19:55, 12 April 2014 (UTC)

I'm not sure anyone was disagreeing with you on the basic issue, but I'd certainly disagree that only the US price is notable. Of course. So much shouty bold repetition you have run into a spelling mistake! To state the bleeding obvious, the cost of drugs is at bottom an economic not a medical matter, and the extensive coverage of the complex general question will be found in economic books and journals and the financial press, as well as coverage of specific cases. Issues of first vs third world pricing are as prominent as those within the first world in my experience. For example the inability of African countries to afford drugs for HIV, and the concessions made by companies on this, has received enormous coverage over many years, and WP has some coverage of this, for example HIV/AIDS_in_Brazil#International_conflict. The Economist and the Financial Times often cover it, and no doubt academic economic journals, the Wall Street Journal and so on. Going back to what the Style guide actually says, it is (after cautioning against trivia): "Economics Global sales, distribution, etc.; but generally not prices in different countries." I don't see this precludes material on cost, for which the US cost will be typically the most convenient proxy, nor significant international price differentials where they have been the subject of coverage in RS, as will sometimes be the case. Johnbod (talk) 20:31, 12 April 2014 (UTC)

I was just reading the following article:

http://jama.jamanetwork.com/article.aspx?articleid=1860480
Daniel J. Clauw
Fibromyalgia: A Clinical Review
April 16, 2014 JAMA. 2014;311(15):1547-1555. doi:10.1001/jama.2014.3266.

They have a table, "Summary of Treatment Guidelines," and one of the columns is headed "Cost". So cost is a medical matter, which is discussed in medical journals. The NEJM and BMJ have detailed discussions of prices. Blood had a letter from a group of distinguished investigators complaining that the drugs they had developed were too expensive for their own patients. It becomes a medical matter when a patient doesn't take a drug for a life-threatening condition, because he can't afford it, which often happens in the U.S. The New York Times just had an article about that. http://www.nytimes.com/2014/04/18/business/treatment-cost-could-influence-doctors-advice.html Doctors and medical journal editors know that pricing is too important to leave to the Wall Street Journal, especially now that Rupert Murdoch owns it. --Nbauman (talk) 03:21, 19 April 2014 (UTC)

I have removed the recommendation not to deal with cost from the guideline.[2] Doc James (talk · contribs · email) 03:27, 22 August 2015 (UTC)

Why (or why now)? I'm in favour of discussing it where it is exceptionally high, & discussed as such in sources (see above), but we do not want people adding the (inevitably) USD prices of standard cheapish out-of-patent drugs, & proposing their favourite sources etc. Or international tables... Something needs to be added to say so. Johnbod (talk) 03:55, 22 August 2015 (UTC)

The cost of all essential medicines are well discussed as this is part of the criteria for determining which medication will become an essential medicine. Noting if something is generic or not is also important IMO.

The variation in cost between much of the world is not that great so it is useful information. Nearly all the article by the AHFS giving pricing information for the USA [3] While this source gives pricing info for the middle and developing world.[4] Doc James (talk · contribs · email) 04:20, 22 August 2015 (UTC)

I agree patent status is important, & worth mentioning. I don't think we should just remove all MOS controls on the topic. Inappropriate factoids often get added by well-meaning editors, & editors need a simple MOS reference to quote when removing them. Johnbod (talk) 12:52, 22 August 2015 (UTC)

Cost sourced to an online pharmacy should be removed as it is an inappropriate source. Cost sources to MSF, WHO, journal review articles, or other textbooks IMO is appropriate if properly phrased. Doc James (talk · contribs · email) 16:53, 22 August 2015 (UTC)

• Support changing policy to encourage addition of cost information Here are some other points.

1. Current policy either discourages reporting cost or is ambivalent. I do not think anyone had strong feelings about refusing to report cost, but rather, I think the rationale was that reporting cost is difficult to do routinely and might require importing a pricing database, which we never had.
2. This is being discussed at Template_talk:Infobox_drug#Cost_information and perhaps other places
3. Before we do any reporting of cost, we need to get consensus on what kinds of sources to accept. The International Drug Price Indicator Guide provided by the WHO is a good source. Doc James suggested this source elsewhere. I like it because it is popular, widely respected, associated with the WHO, comprehensive, is reliable as we can expect, and because it makes a value judgment giving an international price estimate. I think this is a conservative choice which many people would respect as a source.
4. Price should be reported in multiple places. Previously discussion about price went in the "economics" section under the "Society and culture" heading per WP:MEDMOS. I still would like to use that section, but mostly prose information goes there based on sources actually discussing the prices of drugs. Beyond that, I would like to see prices routinely reported in Wikipedia for all drugs, regardless of whether secondary sources raise the issue. To start, prices could routinely be reported in {{Infobox drug}}. If that works, then perhaps price could be mentioned again in the body of the article, even in the usual case where we only have primary sources backing this. I am unclear about this - starting with the infobox then discussing other applications might be the best way forward.
5. It would be nice also to store price databases in Wikidata when d:Wikidata:Arbitrary access becomes available in English Wikipedia. This should happen before the end of 2015. A consequence of "arbitrary access" is that easy to translate information, like a numerical price, can automatically be updated in all language Wikipedias. So if price for a drug is reported in English, then it would be reported also in ~300 other languages. Among other things, this means that if there is any problem with price information being wrong or outdated it is much more likely that a complaint in any language would correct the English price listing.
6. If it needs to be established, then I give my opinion - price information is necessary for understanding the nature of a drug. Most people in the world (even in wealthy countries) do not have access to all of the health care they would like. More than other factors, price determines whether a person can access healthcare they need. It is not possible to understand any medical treatment without also knowing something about the price. Wikipedia general rules suggest in places that reporting primary data is inappropriate, but I think in the case of drugs reporting some pricing information is a good exception to this rule because it is very common for people using medical treatments to need pricing information as routine background information for understanding the treatment.

More conversation on this is useful, but at least, let's include prices in the infobox as part of a trial of this. Blue Rasberry (talk) 19:07, 22 August 2015 (UTC)

Etymology

I've noticed that this style guide makes no mention to where etymology-type information (like the reasons/derviations for the INN, USAN, BAN, etc.) should go in an article. Like for paracetamol, I'm not sure if the naming information should be all (like a summary might be worthwhile) in the lead and a link to the section of the article that goes into etymology. Likewise for metamizole I'd like to know where I should mention its derivation: met, is short for "methyl"; ami, is short for "amine" and zole is short for "azole". Much of this information is based on chemical knowledge and explanatory notes on the World Health Organization's website, so I'm not sure how to reference it if your answer is "feel free to add this -here-" in the article.

Any suggestions will be welcome, so please don't think I'm going to bite your head off for your advice. I know this is just the pedantic side of me, but what is what distinguishes us from other species if it isn't our curiosity. Brenton (contribs · email · talk · uploads) 06:56, 27 August 2014 (UTC)

Being just as pedantic:

• Wikipedia is not a dictionary, and at least some people conclude that etymological information, being information about the word rather than the subject, should not be on Wikipedia but on Wiktionary. (I disagree with this for the practical reason that few people would look there, but I've lost every argument on that subject so far.)
• The more serious problem: How many etymologies can you add without original research (OR)? "Chemical knowledge" is precisely that, and saying that "metamizole" is derived from "methyl", "amine" and "pyrazole" would likely get you an OR tag or be deleted. What about the WHO explanatory notes you mentioned? Are they specific on this kind of thing? --ἀνυπόδητος (talk) 13:34, 14 September 2014 (UTC)

You're right; it would be OR. The WHO explanatory notes are very vague, usually. So yeah I won't try making that edit. I agree etymology when it comes to drug names belongs on drug Wikipedia articles, especially seeing how many librarians or English teachers/professors know anything about drugs besides what they find on its sister project, Wikipedia? And seeing how it's usually those sort of people that would edit Wiktionary that seems kind of silly as a rule. I looked at the metamizole Wiktionary page and it basically just copied info from MeSH or Wikipedia, nothing you couldn't find on Wikipedia was mentioned. Brenton (contribs · email · talk · uploads) 10:54, 5 October 2014 (UTC)

Occasionally one can find the etymology in a reliable secondary source in which case it would no longer be OR. (See for example Drahl C (January 16, 2012). "Where Drug Names Come From". Chemical & Engineering News. 90 (3): 3637.) Also the of the non-proprietary name normally are based on the drug class (see "The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances" (PDF). World Health Organization. 2013.). As long as there is a reliable source to support the etymology, I think including it in the history section of a drug article is fair game because it goes beyond a simple dictionary definition and this information is normally hard to track down, even in dictionaries. Boghog (talk) 12:14, 5 October 2014 (UTC)

Tranylcypromine

The tranylcypromine article includes an, 'Analogues' section, normally I wouldn't have a problem with it, like it's not mentioned in this guide but as all style guides it is just that: a general guide. Hence as these isn't a direct breach of this style guide I'm OK. But the analogues section just lists several references to look at and I'm pretty sure every section aside from Reference list/bibliography sections are meant to be filled with paragraphs and actual writing and not just bibliographic information. I felt I should ask before deleting this information myself, just in case there's a good reason why it's there I'm unaware of. I would normally write on the tranylcypromine talk page as that's what it's there for, but judging by the fact no one has written on it for 8 years I felt this would save a lot of time spent waiting. Brenton (contribs · email · talk · uploads) 11:04, 5 October 2014 (UTC)

Drug class in lead sentence

Thoughts and opinions please on including the drug class in the lead sentence. For example, alprazolam has benzodiazepine in the lead sentence but midazolam does not (it's at the end of the second paragraph). This style guide has no guidance either way. To me, the inclusion of the drug class in the lead sentence is important and akin to the year a film was made, the author of a book, what # president Bill Clinton was, how many feet tall the Willis tower is, the atomic symbol & number of uranium, etc. I think WP has a long history of including various adjectives/specifier in the lead sentence. I am asking because another user reverted an edit of mine because the drug class is "not a well known every day word." Thoughts please. Cburnett (talk) 14:21, 28 September 2015 (UTC)

I don't think it necessarily has to be in the first sentence but it should be in the lead. Sizeofint (talk) 18:02, 28 September 2015 (UTC)

To expand, I think if we restrict the prose in this way we will wind up with a lot of long or awkwardly worded lead sentences attempting to cram in as much information as possible. Sizeofint (talk) 18:08, 28 September 2015 (UTC)

The drug class is part of the basic definition and puts the drug in context. It may be awkward in some cases to include in the first sentence of the lead, but IMHO, it should be mentioned in at least the first paragraph. Boghog (talk) 18:46, 28 September 2015 (UTC)

• IMO the basic type of drug is appropriate in the first sentence, like X is an antibiotics. But we should not be mandating the most specific and most complicated classification of the drug be in the first sentence. The first sentence needs to be in easy to understand English as much as possible. Doc James (talk · contribs · email) 20:03, 28 September 2015 (UTC)

I'm not suggesting it be required in the lead, but not actively discouraged. This stems from Doc James, who commented just above, who struck macrolide from erythromycin ([5]). In an effort to avoid a pointless revert war, I tried to talk with him. He didn't budge and didn't give me much beyond "I'm right, you're wrong." So I'm here to drum up further discussion. I absolutely disagree that 1) the lead must be as easy as possible, 2) that adding macrolide makes it less easy to understand (hello, it's a link...click it and read), and 3) that adding a drug class is absolutely no different than the other examples I gave. Stating that Shawshank Redemption is a 1994 movie, and drama, and American does not make the lead sentence any more difficult to read. Same thing here. Compare the sentence in question:

Erythromycin is an antibiotic useful for the treatment of a number of bacterial infections.

Erythromycin is a macrolide antibiotic useful for the treatment of a number of bacterial infections.

The latter is no harder to understand. Using his reductionist "as much as possible" logic, it should really be:

Erythromycin is a drug to treat infections.

No? Seriously. If the goal is to strip the first sentence down to the bare minimal to convey what erythromycin is then that's it. What makes the current sentence "right" and the other two "wrong" other than James' whim to not revert? Cburnett (talk) 01:39, 29 September 2015 (UTC)

I suppose it depends what reading level we're targeting. For third grade, the last; for a sixth grade, the first; for college and possibly 12th grade, the second. Sizeofint (talk) 04:40, 29 September 2015 (UTC)

It is possible that some readers could get hung up on an unfamiliar word. How much we're supposed to cater to them is up for debate. The macrolide article doesn't really clarify much to the uninformed reader much since it uses a bunch of chemistry terms. Sizeofint (talk) 04:52, 29 September 2015 (UTC)

• My edit summary was "We already say it is a macrolide in the next paragraph"[6] which we do. Why repeat it twice in the lead? We should balance between 3rd and 12th/college in the lead. Ie 6th grade per User:Sizeofint. Doc James (talk · contribs · email) 17:28, 29 September 2015 (UTC)

When is an overdose not an overdose?

Overdose is an established section in drug articles but there seems to be dual meanings of the term. Merriam-Webster defines overdose: "too great a dose (as of a therapeutic agent); also : a lethal or toxic amount (as of a drug)". (Wikipedia itself doesn't help much: the ingestion … of a drug … in quantities greater than are recommended or generally practiced.) This creates a problem with psychoactive drugs (e.g., amphetamine) which are both therapeutic and recreational. Doses may qualify as an overdose in the first meaning but not in the second. This leads to statements that seem either sensational or bizarre, for example persons who overdose on amphetamine are more likely to become addicted. The author simply means larger than therapeutic doses, while in the context of addiction most people assume he means toxic or fatal doses. The duality could be exploited for effect as well.

Does this surface often? Should a policy be set? I have no solution except that "overdose" should be used sparingly in these cases and the meaning be expressed or clarified by other terms or explanations somehow. Having a section "overdose" sets the stage. Please chew on this. — Box73 (talk) 11:29, 23 January 2016 (UTC)

I have noticed this as well. Our medical drug articles generally use the first sense while our recreational drug articles generally use the second sense. Sizeofint (talk) 17:15, 23 January 2016 (UTC)

People who overdose on ANY addictive drug are more likely to become addicted. Addiction is a dose-dependent biological process for drugs. I don't understand the point you're making in your example. Seppi333 (Insert 2¢) 17:34, 23 January 2016 (UTC)

I think he is saying we have two legitimate meanings to the word "overdose". The first being a larger than therapeutically recommended dose and the second being a dose that can potentially kill you or cause great harm. Normally this isn't an issue. Most therapeutic drugs are not recreational drugs so only the first sense normally applies. Likewise, most recreational drugs are not therapeutic drugs so the second sense applies. The potential problem is when a drug is both a recreational drug and a therapeutic drug as in the case of Amphetamine. Without explaining what we mean by "overdose" in this context it is possible some readers will be confused. Sizeofint (talk) 17:48, 23 January 2016 (UTC)

Being the person who wrote the statement, I don't see an issue when either a "larger than therapeutic dose" or a "near-lethal dose" interperetation is used there. Both are technically correct interpretations of the term "overdose" and both are apt definitions for the example sentence. I agree that if something needs to be clarified (e.g., a meaning of "above therapeutic dose" vs "far above therapeutic doses"), it should probably be specified in the article – unless it doesn't matter which interpretation is used. Seppi333 (Insert 2¢) 18:17, 23 January 2016 (UTC)

Exactly Sizeofint. There is another problem with the lesser definition. Overdose implies distinct adverse effects. Overdose without apparent adverse effects probably wouldn’t be considered an overdose. Doctors occasionally prescribe off label doses but these are not ordinarily considered overdoses. This is an issue for Seppi, because the guy who downs 100 mg of Adderall every Saturday night, without apparent adverse effects, isn’t thought of as overdosing but qualifies for dFosB accumulation and addiction risk. Reading "frequently overdose" in Seppi’s sentence, readers likely react, “High risk of addiction? They’re already addicted—they’re high risk for death.” Seppi is saying something important that shouldn’t be compromised by a technical definition. — Box73 (talk) 07:55, 24 January 2016 (UTC)

NNT, NNH & LHH

Following a discussion here, should we include details of number needed to treat (NNT), number needed to harm (NNH) and likelihood of help or harm (LHH) in our articles? In my opinion, we should not. Please give your opinion so that we can reach a consensus and add it to the style guide. Axl ¤ [Talk] 12:56, 9 February 2016 (UTC)

• Support inclusion I think it is easier to understand than relative risk improvement or absolute risk improvement / reduction, so I support adding this sort of content. It however should be wording in English for example "for every 42 people who have had STEMI, ASA prevents one from dying".[7] The size of benefit is important because when the person says I have stomach ulcers and therefore "cannot" have ASA one can explain the risk to his stomach ulcers is likely much less than the benefits to his life. Or when people think TNK is much much better because it costs $2000 a dose one can compare it to ASA and it will keep ASA from being forgotten. Doc James (talk · contribs · email) 16:33, 9 February 2016 (UTC)
• I support inclusion when it is relatively easy to explain, but omitting it when it's complicated. Something like "For every seven people who treat bacterial conjunctivitis with topical antibiotics, one extra person will benefit and be cured within a few days, compared to no treatment"[8] is fine. "For every 42 people who have had a STEMI-type myocardial infarction, taking low-dose aspirin every day prevents one from dying from a subsequent MI every decade" is probably okay, but if it's more complicated that that, then I'm dubious. Aspirin in particular is a challenge because there are so many possible conditions that could be covered. You could write screenfuls of information about NNTs and NNHs on aspirin.
  I have no opinion on LHH. WhatamIdoing (talk) 18:45, 9 February 2016 (UTC)
• support per reasons given by WAID--Ozzie10aaaa (talk) 22:32, 9 February 2016 (UTC)
• Support broadly the including of NNT/NNTH using prose as proposed above. It is a useful risk communication tool. JFW | T@lk 09:20, 10 February 2016 (UTC)

Need stated policy: INN drug names are not (ordinarily) capitalized

Not infrequently, INN (generic drug names) are wrongly being treated as proper names and being capitalized. This is even occurring when the INN is listed with a brand name, such as Levothyroxine (Synthroid). (A contrived example.) I can't find a direct policy guiding editors, but one should exist. If it does, it should be more apparent, and included here and WT:MOSMED. This current practice may also create confusion between INN and brand names in our audience.

Since WT:MOSMED isn't tended to lately I'm crossposting this here. — Box73 (talk) 17:49, 27 February 2016 (UTC)

Thanks for the heads up. I just added a new Capitalization section to WP:PHARMOS which hopefully addresses this issue. Boghog (talk) 18:14, 27 February 2016 (UTC)

Seeking example of good wiki article for a drug class

Can someone please share an example of a Wikipedia article which demonstrates good use of the section ordering scheme here? Here are some examples which I already checked:

• Triptan
• Opioid
• Muscle relaxant
• Statin
• Nonsteroidal anti-inflammatory drug

The manual of style here at Wikipedia:WikiProject_Pharmacology/Style_guide#Drug_classes recommends adding an "agents" section to the class. I am not sure where to indicate that a term refers to a class of drugs, or what exactly a class is. I do not see an agents section being used anywhere.

If anyone is unsure of how to identify a good example and feels they have no suggestion, please note that here if you would. I am curious if others also are finding this difficult to understand. Thanks for any feedback. Blue Rasberry (talk) 20:04, 28 July 2016 (UTC)

An article on a drug class should include a wiki link to that term in the lead sentence since this provides a definition for what a drug class is. A brief discussion for what to call the section may be found here. It was never resolved what to call the section that lists drugs in the class nor where to place it. One possibility for a section heading is simply "examples". Statin has a available forms section, however this heading name is usually reserved for different formulations of the same drug, not a list of drugs within a class. Boghog (talk) 20:54, 28 July 2016 (UTC)