Talk:Finasteride/Archive 7

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Failure to Maintain a Neutral Point of View

"All encyclopedic content on Wikipedia must be written from a neutral point of view (NPOV), which means representing fairly, proportionately, and, as far as possible, without editorial bias, all of the significant views that have been published by reliable sources on a topic."

Under this definition, the Finasteride article does not currently present a neutral point of view and is rife with errors. When I (and others) attempt to correct the errors and add additional information to achieve a neutral point-of-view, these edits are summarily deleted without any sort of rational explanation. I have gone back through all of my edits to this page and found that nearly all of them were deleted by editors who apparently did not read the citations, apparently do not understand the pharmacology of this drug, and who appear to have a strong and consistent bias against fairly presenting all significant views published by reliable sources about finasteride.

The current version of the wikipedia entry for finasteride reads like an advertisement for the drug. In some cases, there is almost no connection between the text in the article and the citations which are claimed to support that text. Toxicities and risks are minimized. Editors make assertions about wikipedia standards of practice, and provide links to these practices, but these assertions appear nowhere in the guidance materials for wikipedia editors.

The culture in this particular niche of wikipedia is characterized by ad hominem attacks, ignorance, failure to conduct due diligence before responding to an edit or a comment, extreme bias against data about drug toxicity, extreme bias toward claims about drug efficacy, and a mean-spiritedness that is quite astonishing. Somebody attempted to log into my wikipedia account. I received a threatening phone call. This is outrageous. Some action needs to be taken to curb the behavior of those who attack well-meaning and well-informed editors. Also, some action needs to be taken to reduce what appears to be the anti-science bias of editors on this page.

Some specific complaints:

• The finasteride article asserts that "side effects are mild" and cites an 8 year old meta-analysis that did not evaluate the adequacy of adverse event evaluation and reporting in the primary literature and that has been deprecated by later literature. Specifically w/r/t treatment of androgenic alopecia, this assertion that "side effects are mild" is contradicted by a meta-analysis that found that 0 of 34 published articles on this topic adequately assessed or reported adverse events.

• Finasteride is only modestly effective for cosmesis of androgenic alopecia. The 30% improvement claim in the current version of the article is inaccurate. I would refer interested editors to the most recent FDA-approved package label, which provides information derived from 3 pivotal randomized controlled trials. "At 12 months there was a 107-hair difference from placebo (p<0.001, PROPECIA [n=679] vs placebo [n=672]) within a 1-inch diameter circle (5.1 cm ). Hair count was maintained in those men taking PROPECIA for up to 2 years, resulting in a 138-hair difference between treatment groups (p<0.001, PROPECIA [n=433] vs placebo [n=47]) within the same area. In men treated with PROPECIA, the maximum improvement in hair count compared to baseline was achieved during the first 2 years." For any reasonable estimate of baseline hair density, this corresponds to about a 10% greater hair count at 5 years compared to placebo, and about a 2% greater hair count at 5 years compared to baseline.

• There is a significant and growing literature about the risks of finasteride. This includes high-quality secondary sources. This literature is not reflected in the current version of the finasteride wikipedia article. The more time that goes by, the further and further the science gets from wikipedia.

• Something as simple as drug class is not listed. Why is this done routinely for other drugs but not for finasteride or dutasteride. I could certainly understand how somebody selling hair implant treatments might not want to emphasize that finasteride is an antiandrogen, and that it reduces plasma DHT levels to a level similar to that of castrated men. (finasteride is often used as part of hair implant surgery to "support" the engrafted hair)

• Information about toxicity in the finasteride article is presented in a confusing obscurant manner, with lots of irrelevant surrounding text.

What is to be done, folks? I'm not a wikipedia expert, but somebody out there reading this maybe is. How do we fix this corrupt and/or ignorant mess of a wikipedia article? — Preceding unsigned comment added by Sbelknap (talk • contribs) 01:31, 5 May 2018 (UTC)

I asked you exactly a year ago if you would propose a rewrite of the whole adverse effects section, trying to give appropriate WEIGHT to all the adverse effects relative to one another, and to the rest of the medical content, following what the best MEDRS refs do that cover the drug. You never replied. (someone else did, who is very experienced here, and you should read that). Instead. you have been relentless at banging precisely one drum, and now you have posted this tl/dr rant

Please consider responding to the request to show that you care about more than one very narrow issue. Jytdog (talk) 02:18, 5 May 2018 (UTC)

Jytdog refers to my comment as a "tl/dr rant." We certainly don't want to offend Jytdog with proposed edits that are too long and that he won't read. Here's a counter proposal. Both Jytdog and Doc James deleted the hyperlink antiandrogen from the lead for the finasteride article. Yet, the pharmacology textbooks, the literature, Merck's origininal composition-of-matter patent, and the actual category on the bottom of the finasteride article all classify finasteride as an antiandrogen. There are strong commercial interests that seek to obscure this information, as this might dissuade men from having a hair transplant. (finasteride is often used to "support" the engrafted hair after a hair transplant.) If there is a single fact that is more important and less uncertain than the fact that finasteride is an antiandrogen, I don't know what it is. I propose that we include antiandrogen in the lead for the finasteride article. Here is my proposal for the first sentence of the article:

Finasteride is an antiandrogen medication that is sometimes used to treat an enlarged prostate in men.[2][3][4] — Preceding unsigned comment added by Sbelknap (talk • contribs) 13:43, 5 May 2018 (UTC)

Wow, I'm honestly shocked that somebody tried to hack your account and gave you a threatening call. I'm sorry that happened to you. I'm not sure what to do about this article, Jytdog has apparently taken ownership of this article, instilled a bias that conceals or counteracts any negative information about the risks involved with this drug, the most recent text attempting to boisterously malign a patient advocacy group is just one example. A prime example of a WP:Bully if one has ever existed. Are any neutral parties here willing to step up and mediate or moderate this? — Preceding unsigned comment added by 2604:2000:E0CF:5100:71DB:1933:7B4:DA2B (talk) 15:44, 5 May 2018 (UTC)

I missed the sentence about the harassing phone call; that is terrible and i am sorry that happened. See WP:DWH about what you can do.

On the password issue, there has been a slew of that so it may be unrelated -- see this. I have gotten a bunch of such notices recently and in the past.

With regard to putting the drug class in the first sentence. If you look across many articles about drugs, you will see that the order of things in the LEAD generally follows the order of the sections in the body, which follows section order described in MEDMOS. So the medical uses come first (1st paragraph); 2nd paragraph is often adverse effects and pharmacology; third paragraph is history and society and culture.

if you look at the lead of this article, you will find The lead currently has, in the 2nd paragraph, "Finasteride is a 5α-reductase inhibitor, and hence an antiandrogen", immediately following adverse effects and kicking off the summary of pharmacology. This is entirely normal.

Still no response on the request to present a whole adverse effects section, showing what WEIGHT Sbelknap would give to the sexual side effects in a NPOV adverse effects section that in turn has appropriate WEIGHT in the whole page. Jytdog (talk) 16:06, 5 May 2018 (UTC)

Jytdog describes a good goal for an adverse effects section. Lets work toward that. I will focus on the lead at this time, as that is what the average wikipedia reader will see first on their iphone. Lets get our users up to speed as quickly as possible. I have reviewed the various style guidlines and also looked at 100+ wikipedia articles about other drugs (e.g., chlortalidone, lisinopril candesartan, etc.) These wikipedia articles put the drug class and/or mechanism of action in the first sentence. That seems like good practice to me. The current lead seems deliberately confusing and obfuscatory. I recommend we work hard on the lead to clarify it as much as possible and to get it as close as possible to where the medical science is. Let us remember that nobody owns the finasteride article and that wikipedia is a collaborative enterprise. Personal attacks, precipitous deletes, threats to block other editors etc are inconsistent with the wikipedia philosophy. So knock it off! — Preceding unsigned comment added by 2602:30A:C07E:B630:5164:B91C:B88E:D2E2 (talk) 18:47, 5 May 2018 (UTC)

Nope, the lead just summarizes the body. If you make changes to the lead that are not summarizing the body they will be reverted and if you continue we will end up needing to protect this page. Jytdog (talk) 19:06, 5 May 2018 (UTC)

Seems reasonable. The lead summarizes the body of the article. Given jytdog's interest in improving the adverse effects section, I would ask him to incorporate the latest high qulaity secondary source into our finasteride article. Here is the citation: When you have a draft of that, please post, and we will critique. Thanks. — Preceding unsigned comment added by 2602:30A:C07E:B630:5164:B91C:B88E:D2E2 (talk) 19:21, 5 May 2018 (UTC)

The issue here is Sbelknap's obsession with one kind of adverse effect and not dealing with issues of WEIGHT in that section or the article overall. There are hundreds of pages in Wikipedia that need urgent attention. Men and their penises is way down on my list of urgent needs to address in WP. This page currently discusses these issues and does a decent job of it - not perfect, but nobody reading this now would fail to understand there is some issue here. I am utterly uninterested in wasting any further time on this specific issue which is trivial in the big picture of medicine and of medicine in Wikipedia. This is approaching the disruption that the anti-circumcision activists cause as they push and PUSH and PUSH. Men and their god damn penises. I am willing to consider an edit by Sbelknap that shows that he cares about this article overall, and the policies and guidelines that govern what we all do here. I will post a request to have him indefinitely blocked if he posts anything, anywhere in WP, focused on this specific issue again. I am fed up with this narrow minded drain on volunteer resources. Jytdog (talk) 20:37, 5 May 2018 (UTC)

Unbelievable... even for you JYTDog, this is the most uncivil behavior I've seen on Wikipedia. This will be dealt with appropriately shortly. Sbelknap is a highly respected scientist and you are not only driving away valued expertise from wikipedia but you are threatening to have them blocked with no standing. — Preceding unsigned comment added by 2604:2000:E0CF:5100:A18C:7ACC:FD14:9E33 (talk) 02:42, 6 May 2018 (UTC)

Hmm. The article by Traish is a high-quality secondary source about the current state of the science of finasteride-associated adverse drug effects, not just on sexual adverse effects. Perhaps if jytdog would read the Traish article, he would come to understand just how deficient this article on finasteride is. Also, jytdog appears to be threatening me with wikilawyering. Is that jytdog's intent? Sbelknap (talk) 22:06, 5 May 2018 (UTC)

metabolism of non-androgen steroids

5alpha reductases have many steroid substrates that are not androgens. This is relevant to some adverse effects of finasteride. I recommend adding discussion of this to the pharmacodynamics section. OK? — Preceding unsigned comment added by Sbelknap (talk • contribs) 04:25, 6 May 2018 (UTC)

Consensus on adverse effects of finasteride

There is currently an effort to TBAN me because I am accused of having COI, of disruptive editing, and because I dissent from what is said to be the consensus on adverse effects of finasteride. I note that very few wikipedia editors have participated in the discussion about finasteride adverse effects. This effort to TBAN me has been supported by Doc James and jytdog.

Are there any other wikipedia editors who care to opine on whether the current version of the finasteride article has a NPOV for discussion of adverse effects?

I am reminded of this: https://newrepublic.com/minutes/126871/wikipedia-dying — Preceding unsigned comment added by Sbelknap (talk • contribs) 14:50, 6 May 2018 (UTC)

finasteride is an antiandrogen

As per discussion above, I will add back antiandrogen to the lead. It is fairly standard to indicate the drug class and/or mechanism of action with a brief mention in the lead. — Preceding unsigned comment added by Sbelknap (talk • contribs) 22:42, 3 May 2018 (UTC)

The description of finasteride and dutasteride is in the antiandrogens section on page 839 to 840 of Goodman & Gilman's "The Pharmacological Basis of Therapeutics 13th Edition"Sbelknap (talk) 22:55, 6 May 2018 (UTC)

Society and Culture Section

@Jojomuju: there doesn't seem to be a good reason to take this information out of the article. If you look at WP:MEDMOS you will see there is a section under society and culture that includes legal issues. Beyond just that many people would be interested in seeing this information from an encyclopedic standpoint whether it may be doctors, scientists, consumers, or journalists. You only state that unresolved lawsuits don't belong here but that is neither supported by WP:MEDMOS nor pertinent because the US cases have been resolved.98.7.48.66 (talk) 23:10, 21 October 2018 (UTC)

The issue is there wasn't good reason to put it in. The liability lawsuits are in the controversy section. Listing new on-going litigation, which is meaningless trivia in the content of pharmacology articles, especially in its own section, is giving undue weight to that section which already summarizes those issue. A similar situation has arisen in this article before as per the archives. The new edit by an IP editor doesn't add any new information and could be considered, like I noted in my edit, borderline advocacy. Also, conflicts of interests need to be disclosed, and I notice only reverts to this finasteride article from your IP; if you don't have one, my bad. Other editors are free to take a look here at the diff. I'll tag some folks in WikiMedicine, and see if they can shine some light on this also. Jojomuju (talk) 07:43, 22 October 2018 (UTC)

I think it is appropriate for the article to note that there have been some lawsuits, but until the matter is settled, I agree with Jojomuju that it should be presented in a minimal fashion. WhatamIdoing (talk) 19:31, 22 October 2018 (UTC)

I don't have any conflicts of interest. https://anewmerckreviewed.files.wordpress.com/2018/04/life-propecia-settle-agr-04-09-18.pdf You will see that Merck resolved about 600 of the cases on confidential terms. Many other articles for things facing product liability have their own sections on the topic. Glyphosate is just one example and that has many references to the controversy and those cases aren't close to being resolved. I don't think a huge amount needs to be said, but given this is an encyclopedia it is very reasonable to mention the existence and settlement of cases in the US and the approval of a class action in Canada. The article wouldn't seem balanced to me without a proper summary of what is a culturally significant issue. 2604:2000:E0CF:5100:853D:2E38:28BB:754 (talk) 01:32, 23 October 2018 (UTC)

@Doc James: @Jytdog: My recent, good faith edits were reverted by Jojomuju even after they were reviewed and slightly edited by Doc James immediately following my edit. These points were a neutral stating of the facts supported via third-party sources after news events about the cases and settlements this year. I'm a bit surprised they were reverted, especially after I used several other pharma Wikipedia pages as a template for unbiased and encyclopedic creation of this type of content. Now, after further review, I notice that this user, https://en.wikipedia.org/wiki/Special:Contributions/Jojomuju, has only 185 edits and the bulk of them deal with this page. Their initial edits were on this page and were immediately questioned by Jytdog as being a potential Conflict of Interest. It appears the account was created in April and has attempted to become the gate-keeper for this page, even as Jytdog and Doc James were monitoring the page very closely. Then, the user entered into a COI discussion against @Sbelknap:. Warranted or not, I'm curious if this was just to mask a potential COI of their own. Diving into this user's edits even more, I continue to question a potential relationship between them and the pharmaceutical company behind this product. Please advise. 23.118.36.69 (talk) 19:21, 24 October 2018 (UTC)

You are a SPA account yourself, editing solely about ongoing litigation, yet are accusing others of vested interest. This page is a nightmare of advocacy. Jytdog (talk) 19:40, 24 October 2018 (UTC)

Settlements are not ongoing litigation. 23.118.36.69 (talk) 19:48, 24 October 2018 (UTC)

That is true; they do of course inform the ongoing litigation and weigh into how people consider starting new ones. And your edit included ongoing litigation. I think I have nothing more to say to you. I have no time for bullshit and misdirection.Jytdog (talk) 19:51, 24 October 2018 (UTC)

I intend to keep the neutrality of this article and combat advocacy. Instead of accusing people of COI when you are clearly a SPA account, it's better to make informed, thoughtful edits to controversial pages like this one. I mentioned the issue you had on the WikiMedicine page, and am awaiting more responses, but in the meantime it's best not to hammer your edits down everyone's throats and collaborate. Jojomuju (talk) 02:25, 25 October 2018 (UTC)

@Doc James: Can you please come add a sense of reason in this discussion? Jytdog has just reverted a sentence that was on this page from May 2016 (added per Talk page discussion https://en.wikipedia.org/w/index.php?title=Finasteride&diff=prev&oldid=721492661) until I edit it last week. Until consensus can be reached on the updated wording and references, I was simply trying to revert back to the wording that has appeared on the page for 1.5 years. Then, suddenly, they aren't appropriate? Please advise. 23.118.36.69 (talk) 20:08, 24 October 2018 (UTC)

What sort of source is this http://s21.q4cdn.com/755037021/files/doc_financials/quarterly/2016/Q1/1Q16-Form-10-Q.pdf#page=19

Doc James (talk · contribs · email) 22:36, 24 October 2018 (UTC)

I was curious of that, too. It was on the page you both patrolled for 1.5 years. 23.118.36.69 (talk) 17:31, 31 October 2018 (UTC)

It appears to be a dead link for Merck's 10-Q filing, which is submitted by US public companies to the SEC. It is used to inform the public about the business operations. A working link can be found at http://d1lge852tjjqow.cloudfront.net/CIK-0000310158/4090aa36-4d97-4244-ad16-e50143954bfe.pdf 98.7.48.66 (talk) 00:23, 1 November 2018 (UTC)

Proposed new section

Settlements

On April 9, 2018, Merck agreed to settle with a plaintiff committee of 562 cases who were suing for damages caused by taking finasteride.

References

--— Preceding unsigned comment added by 23.118.36.69 (talk • contribs) 19:50, 24 October 2018 (UTC)

The 2nd ref doesn't mention the settlements. And sign your posts. Jytdog (talk) 19:55, 24 October 2018 (UTC)

Then let's just use the first reference only. Can you please add this new section? Thanks. 23.118.36.69 (talk) 20:03, 24 October 2018 (UTC)

Looks like a unsuitable/sensational source. For discussion about what might "kill" we need WP:MEDRS. Alexbrn (talk) 05:04, 25 October 2018 (UTC)

WP:MEDRS only applies to medical claims which isn't relevant to the discussion here. The article is suitable for referencing a verifiable fact. Per Wiki, Vice is a "print magazine that is focused on arts, culture, and news topics" making it particularly suitable for a reference in the society and culture section of this page. Nobody is using it to source a medical claim. At the very least, nobody seems to be objecting to including a mention of the legal cases if they are settled. Maybe people here only said that because they didn't realize the cases had been settled. While this article suffices for stating a fact, you can also use the original court filing which can be found at the following link - https://anewmerckreviewed.files.wordpress.com/2018/04/life-propecia-settle-agr-04-09-18.pdf 2604:2000:E0CF:5100:DCED:F73B:9B4D:F96E (talk) 14:24, 27 October 2018 (UTC)

It appears that WP:MEDRS only applies to biomedical information and, per Wikipedia:Biomedical information § What is not biomedical information?, legal issues are not considered biomedical information. This suggested addition using the first reference is appropriate. WestWorld42018 (talk) 18:29, 27 October 2018 (UTC)

That is true, if it is proposed only to use the source to support the legal issue. But asserting that damages were "caused by taking finasteride" in Wikipedia's voice is a biomedical assertion. This source is also a rather fringey/sensational first-person feature - so just not good. If there are decent secondary sources discussing the legal issue there might be a case for saying inclusion was WP:DUE. Alexbrn (talk) 04:27, 28 October 2018 (UTC)

The text you want taken out doesn't "assert damages were caused by taking finasteride" so your point is off-topic. You are moving the benchmark by which you say the edit should be included which suggests you have a clear POV on the matter. Nobody else seems to agree with you so it doesn't appear you are on the side of consensus here.98.7.48.66 (talk) 17:25, 28 October 2018 (UTC)

That is the text proposed at the head of this section. Alexbrn (talk) 18:12, 28 October 2018 (UTC)

The reference appears adequate for this section of the article as it has a byline from a regular contributor to the publication. I suggest we omit the phrase that troubles you in order to reach consensus. WestWorld42018 (talk) 18:01, 29 October 2018 (UTC)

I suggest we omit this entirely unless a serious source can be found. It is undue. Alexbrn (talk) 19:16, 29 October 2018 (UTC)

Maybe that's helpful: https://www.lexislegalnews.com/articles/25761 M9c (talk) 19:58, 29 October 2018 (UTC)

A recycled press release? Not helpful. Alexbrn (talk) 18:10, 31 October 2018 (UTC)

It's an article from a respected publisher of legal news. M9c (talk) 19:31, 31 October 2018 (UTC)

Lexis Nexis is a big legal publisher, but this is just relaying Mealey's press release. If there were some secondary source providing analysis, then there could be an argument for inclusion. Is there such a source? Alexbrn (talk) 19:54, 31 October 2018 (UTC)

Would an article about the case from a reliable newspaper (say, the guardian) be such a source? Apologies for the question, I'm rather new here and not yet familiar with the conventions. I don't know of any such newspaper article, however, it's also not clear to me what that would add in terms of reliability. In fact, newspaper articles about findings in science and medicine for example are often much less reliable than the original sources.M9c (talk) 23:55, 31 October 2018 (UTC)

I agree with Alexbrn; where is a legitimate reliable source that analyzes this information? Also, is there any other primary source of this settlement information that reinforces the information in the press release? Jojomuju (talk) 21:11, 31 October 2018 (UTC)

Mealey's isn't a "recycled press release". LexisNexis is one of the world's leading organizations for legal research and Mealey's is one of the news services it provides. I already posted the primary source that shows the establishment of a confidential settlement. The court document is originally linked from a blog that covers all kinds of topics related to the drug's manufacturer. https://anewmerckreviewed.files.wordpress.com/2018/04/life-propecia-settle-agr-04-09-18.pdf 98.7.48.66 (talk) 00:30, 1 November 2018 (UTC)

• 2 notes. I just searched both google and a university library for sources about this. Nothing other than what was found above; nobody cared. Second note, and this is just a "personal knowledge" thing - settling 562 cases for $5M is indeed not worth talking about; its a nuisance payment for Merck and that the plaintiffs accepted it can only mean they thought their case was very weak. Jytdog (talk) 01:32, 1 November 2018 (UTC) (strike Jytdog (talk) 15:52, 1 November 2018 (UTC))
  • The settlement, per the primary and secondary sources, was confidential so you can't say how much it was for unless you know something that we don't. There were several sources that reference the settlement so it was a matter of interest. With the currently available sources, people are only suggesting two sentences about it.98.7.48.66 (talk) 02:15, 1 November 2018 (UTC)
    • Hm. I am not sure where I got the notion it was ~$5M and I cannot find the source for that now (I looked at boatloads). I've struck. Jytdog (talk) 15:52, 1 November 2018 (UTC)

"Several sources"? - the question has not been answered: is there a reliable secondary source giving some analysis of this so it rises to the level of due accepted knowledge? If not, it's not worthy of inclusion - and the push to do so savours of WP:ADVOCACY. In lieu of decent sources I suggest we're done here. Alexbrn (talk) 09:22, 1 November 2018 (UTC)

But that's exactly the article on vice.com referenced above. M9c (talk) 09:41, 1 November 2018 (UTC)

Sorry, but sensational claptrap like an amateurish op-ed entitled "I Need to Quit Hair Loss Drugs Before They Kill Me" is exactly the sort of thing we need to avoid. Alexbrn (talk) 09:46, 1 November 2018 (UTC)

Ok, I agree. Still don't see how a newspaper article would add much in terms of reliability though, most newspaper articles would also just be based on the sources we discussed above. M9c (talk) 10:03, 1 November 2018 (UTC)

Vice is a fully reliable source and it is backed up by the primary source document. In fact, the primary source is all that is needed as it is not a medical statement. You are the only one making the argument that it isn't a valid source and the consensus of multiple editors disagrees with you. The suggestion is to put in a couple sentences of factual statements. We are willing to work with you but you don't seem open to compromise and are advocating for your own POV. If you are unwilling to work with consensus then consensus stands. 98.7.48.66 (talk) 01:33, 2 November 2018 (UTC)

It is really UNDUE. The fact that all we have is the tossed off line in Vice and a legal newsletter report is not really sufficient. Compare with the Vioxx settlements for example - when I went looking I found those discussed in the NYT, the WSJ, etc. The world didn't care and so neither does WP. Jytdog (talk) 01:55, 2 November 2018 (UTC)

Due and undue weight refer to different viewpoints, rather than statements of fact. You are twisting guidelines here. As a separate issue, the Vioxx litigation receives its own section on the Vioxx page, a mention in the lede, and ten full paragraphs. What is suggested here is two sentences so your comparison is completely a false equivalence. You have a history of wikilawyering to whitewash this entire page.2604:2000:E0CF:5100:21D6:C9A8:ACF7:C3A7 (talk) 13:17, 3 November 2018 (UTC)

I agree. The simple statement about the resolution of a legal matter is a fact, not a debatable viewpoint. It is more than DUE. To deny it is whitewashing per NPOV means neutral editors, not neutral content. Also, when stating facts, even primary sources are acceptable. A primary source may only be used on Wikipedia to make straightforward, descriptive statements of facts that can be verified by any educated person with access to the primary source but without further, specialized knowledge. via WP:PRIMARY. I would suggest this primary source of an SEC filing from Merck disclosing the settlement and amount. It reads "On April 9, 2018, Merck and the Plaintiffs’ Executive Committee in the MDL and the Plaintiffs’ Liaison Counsel in the NJ Coordinated Proceedings entered into an agreement to resolve the above mentioned Propecia/Proscar lawsuits for an aggregate amount of $4.3 million."[1] WestWorld42018 (talk) 22:32, 3 November 2018 (UTC)

This is a much better source, in my opinion; although, I wonder if the details of the next sentence should be summarized as well. Maybe something like "On April 9, 2018, Merck and the Plaintiffs’ Executive Committee in the MDL and the Plaintiffs’ Liaison Counsel in the NJ Coordinated Proceedings entered into an agreement to resolve the above mentioned Propecia/Proscar lawsuits for an aggregate amount of $4.3 million. The settlement is subject to contingencies including a clawback provision based on plaintiff participation." In other words, Merck could potentially recoup a portion of that money depending on participation, which impacts how much the final settlement amount is. Jojomuju (talk) 00:23, 4 November 2018 (UTC)

I don't really feel that level of detail is necessary. However, we should also explore the paragraph above that in the filing regarding ongoing lawsuits. In this NPOV tutorial, it states that adding content about ongoing legal matters is acceptable. From the above section of this Talk page, I notice reverted edits mentioning cases from Canada that also appear adequately sourced. I'll look at those further and report back. WestWorld42018 (talk) 22:48, 5 November 2018 (UTC)

Yay there is the source. I remembered it as 4.9 so rounded to 5. It is even less. This is trivia not worth mentioning, as demonstrated by no serious secondary sources giving discussion to this - all we have is the tossed off line in the Vice piece and the trade magazine churnalism piece. It is UNDUE. Jytdog (talk) 16:12, 10 November 2018 (UTC)

It is obviously not the source you used to get to the settlement amount. Do you even know where to access or find SEC filings? I think it is currently worthy of inclusion and will wait on other editors to see where consensus lies. 2604:2000:E0CF:5100:65FB:CB44:D9A7:62AF (talk) 16:51, 10 November 2018 (UTC)

Is this section still open? If there are no decent sources then this tittle-tattle is undue/advocacy-directed. Alexbrn (talk) 17:16, 10 November 2018 (UTC)

anybody who works on business topics is aware of edgar. for pete's sake. Jytdog (talk) 20:09, 10 November 2018 (UTC)

This section, actually more expanded than this proposed statement, is DUE. The primary reference is adequate for this factual statement as I've stated above. To not include this statement and brief content about the other cases is whitewashing. WestWorld42018 (talk) 01:25, 11 November 2018 (UTC)

WEIGHT (which "DUE" is about) is driven by independent, secondary sources, of which there are zero. The argument you are making is that the source is verified (a different policy, WP:V), which is not the same as the WP:NPOV policy in which the concepts of due and undue weight are found. "DUE" doesn't mean "I like it" and "UNDUE" doesn't mean "I don't like it". Again compare with the Vioxx settlements - boatloads of independent sources about them, because they were seen as a big deal out there in the real world. Jytdog (talk) 01:38, 11 November 2018 (UTC)

Again, I point to NPOV means neutral editors, not neutral content which states "A lack of such content may be an indication that editors have exercised whitewashing and censorship. It is a serious violation of NPOV to use censorship and whitewashing to remove any non-neutral opinions, facts, biases, or sources." I am not saying this needs some huge section similar to other articles, however, to give it no mention would be whitewashing. I edit a lot of sports articles and using primary sourcing is commonplace when presenting facts. WestWorld42018 (talk) 02:43, 11 November 2018 (UTC)

To me, it comes down to whether this info is DUE or not. Like Jytdog said, just because it's verified doesn't make it worth including. Since the controversy section already mentions that Merck is a defendant in x number of product liability lawsuits, what value does adding this settlement amount they've allocated, derived from this SEC filing, add to the article—or does it simply amount to trivia and undue weight to that section? Perhaps we can finalize this section, though? It seems like editors members are going around in circles with this. Jojomuju (talk) 19:26, 11 November 2018 (UTC)

It seems even you are going around in circles. You were ready to add the content with the primary source just last week. See above. WestWorld42018 (talk) 19:58, 11 November 2018 (UTC)

I disagree; I was being collaborative and agreed that the source you provided was better if consensus was reached to keep that info in the article. I don't personally think it should be, though, and initially edited it out of the article. Jojomuju (talk) 22:38, 11 November 2018 (UTC)

Again WEIGHT is driven by independent secondary sources. You can continue WP:BLUDGEONing this talk page with incorrect descriptions of the [{WP:WEIGHT]] policy if you like, but you are not going to get consensus here and continuing will likely lead to community action. You can pursue one of the steps in WP:DR for content, but the community is very likely to reject it because of the lack of secondary sources needed per WEIGHT. You will do as you will. Jytdog (talk) 20:34, 11 November 2018 (UTC)

Thanks for your response. I just have experienced this same issue with primary sources on a page about college football recently. I'm still learning. WestWorld42018 (talk) 20:47, 11 November 2018 (UTC)

I hear you about working on sports pages. In all pop culture topics the boundary between WP and the blogosphere is very thin because there are so many crappy sources and people use them freely. On the health and medicine the literature is very well defined and the boundary between WP and the blogosphere is very clear and very bright for the most part. We use only high quality sources on these topics; trying to drive content into pages based on crappy refs will waste everyone's time. Jytdog (talk) 20:52, 11 November 2018 (UTC)

Jytdog, you are the one WP:Bludgeoning the talk page with your incorrect application of due and undue weight. [WP:DUE] very specifically refers to subjective viewpoints and does not pertain to facts which are verifiable. I agree with WestWorld that your advocacy amounts to whitewashing, especially when the suggestion is to include two sentences. The proposal is not to include a full ten paragraph summary with currently available sources, but more detail will be warranted as the issue is further investigated.2604:2000:E0CF:5100:65A5:C781:5029:BE44 (talk) 23:44, 11 November 2018 (UTC)

Changes to Controversy section

I made a change yesterday to the reference of the Health News Review op-ed to better reflect the general purpose of the piece and it was reverted by @Alexbrn: without an explanation as to why. The prior edit was focused on one example to further Hoffman's general argument in the op-ed but was not clearly translated well to the Wiki article. I additionally fixed reference about the lawsuits where the underlying reference notes there are "approximately 1,370" while the wiki article says "about one thousand". Alexbrn later argued this was a non neutral edit but I honestly don't see how making something measurably more accurate is the non neutral edit. 2604:2000:E0CF:5100:30AD:4F76:672F:DB6F (talk) 12:55, 7 December 2018 (UTC)

The principal topic of the source is the dishonesty of the advocacy group. Your edit removed that with a weird shift of focus. If you want to limit the edit to, trivially, changing "about one thousand" to "approximately 1,370", I won't object. But I do object to what is effectively whitewashing. Alexbrn (talk) 13:07, 7 December 2018 (UTC)

@Alexbrn: This has gotten off to a little bit of a rocky start and I hope you will be willing to engage with me on this in a constructive way. This is a controversial subject which makes it a challenge to edit so I hope you will assume my good faith as I am doing for you. You have suggested that I am whitewashing the page and I have extended you the courtesy of not using emotional language which makes it more difficult to cooperate.

I see a couple issues with the current reference to the Health News Review blog post. It isn't a very high quality source for several reasons but the blog makes a fair point which I think could be worth including to provide balance to the controversy. Right now the reference doesn't make much sense in the current state of the article. It says "A 2015 post in Health News Review noted that the foundation put out a press release timed to the publication of a review it had funded claiming that the NIH had recognized "post-finasteride syndrome"; in response to an inquiry, an NIH spokeswoman said the statement released by the foundation was inaccurate and not determined by the NIH." It is confusing because it doesn't say why the foundation supposedly put out a press release saying the NIH had recognized the condition and it creates the impression that this was a completely made up statement. The press release was sent after the NIH created a webpage (https://rarediseases.info.nih.gov/diseases/12407/post-finasteride-syndrome) for PFS on their Genetic and Rare Disease website. I think you could see how that could create the impression that the NIH recognized the condition, until the NIH further clarified that the NIH does not use the database to issue endorsements about rare diseases. To fully explain the inclusion in the GARD, which is absent in the article, and why that does not reflect an opinion by the NIH would require too much text in my opinion.

That being said, I think the conclusion of the blog reasonably expresses the opinion that public discussion of the condition has become dramatized, focuses on worst-case scenarios, and emphasizes personal stories. I hope you'll been collaborative and open to working with me to improve this. 2604:2000:E0CF:5100:1D5B:8B9A:2973:1F84 (talk) 20:22, 8 December 2018 (UTC)

What we have is fine. Your WP:WALLOFTEXT is just special pleading. Alexbrn (talk) 20:25, 8 December 2018 (UTC)

@Alexbrn: I respectfully ask that you respond to my attempt to discuss with you. If you prefer not to, that will be your choice and I will pursue a different avenue. My discussion was not a "special pleading" and I showing why the current text does not accurately summarize the blog it references. 2604:2000:E0CF:5100:1D5B:8B9A:2973:1F84 (talk) 20:35, 8 December 2018 (UTC)

@Alexbrn: if you can show anywhere in that source that you just reverted that it explicitly says it is 'unclear whether finasteride causes permanent side effects' that is fine but please see WP:SYN. You cannot conduct original research and apply your own conclusions to the body unless the article says it explicitly. Also please review WP:OWNBEHAVIOR. Thanks. 2604:2000:E0CF:5100:D0AA:320B:E01D:DE22 (talk) 15:58, 15 December 2018 (UTC)

Long-settled consensus (see e.g.[2]). If you continue disrupting the page you will be blocked or the page protected. Your choice. Also, are you a WP:SOCK? Alexbrn (talk) 16:18, 15 December 2018 (UTC)

@Alexbrn: I have a dynamic IP address that changes from time to time. You just violated 3RR for the 2nd time in recent weeks without fully having a discussion on the talk page. There is no such thing as "long-settled consensus" as it is subject to change WP:CCC. This is especially the case when you showed me an archived discussion from 2.5 years ago. Will you please respond to my direct point why that reference is not a violation of WP:SYN because that is the most important issue here? Please focus on the content. 2604:2000:E0CF:5100:D0AA:320B:E01D:DE22 (talk) 16:44, 15 December 2018 (UTC)

@Alexbrn: I agree with Alexbrn on this—why is this an issue? I also suspect this could be a sock for Doors22; the way they speak and the wall of text/ overselling their point of view seems very similar. I recommend some kind of sock investigation. A lot of tomfoolery and disruptive behavior has gone on lately from IPs that act and speak fairly similarly and leans towards advocacy. Jojomuju (talk) 07:12, 17 December 2018 (UTC)

If you think I've broken 3RR take it to WP:AN3 (hint: you're wrong). The source is properly represented - see that previous discussion to see how. Alexbrn (talk) 16:47, 15 December 2018 (UTC)

You've clearly broken the bright line 3RR twice but it is not a major focus of mine as mine as a 24-hour block isn't going to resolve this dispute. I reviewed what you showed me in the archive and I see this was somewhat addressed. I'll see if anybody else offers an opinion. 2604:2000:E0CF:5100:D0AA:320B:E01D:DE22 (talk) 17:47, 15 December 2018 (UTC)

Text

• Some

finasteride users have reported developing what is known as "Post Finasteride Syndrome" after cessation. Little is known about this syndrome other than it can be a serious and life-altering disorder involving long-term mental, physical and sexual dysfunction

The first source is from a journal with no impact factor and which is not pubmed indexed.

Bunch of the rest was based on primary sources. Doc James (talk · contribs · email) 03:04, 23 December 2018 (UTC)

Reference #77 not available anymore

The article was written by Jill Margo and is titled "Looking at care with a critical eye". It was published on The Australian Financial Review on 26 September 2012. It apparently has been removed from the website. Fortunately, there's a at least one cached version on The Internet Archive. Should we update the references, and how? — Preceding unsigned comment added by 37.162.80.211 (talk) 22:41, 10 January 2019 (UTC)

Thanks for that. I've updated the reference with this edit. I added

|archiveurl=https://web.archive.org/web/20121114220945/http://www.afr.com/p/lifestyle/mens_health/looking_at_care_with_critical_eye_ZRbAzUV4cRxZhspW7YRwBJ |archivedate=11 November 2012

to the citation template, and the template magic handled the rest. Adrian J. Hunter^{(talk•contribs)} 03:04, 11 January 2019 (UTC)

Request edit on 31 August 2019

While looking up Finasteride through Google I found the following text in the Google Preview of the page:

"It can also be used to treat excessive hair growth in women and as a part of hormone therapy for men who are pretending to be women."

This wording does not seem to appear in the page itself. Only in the Google Preview. I am unsure how to edit the text in the preview or if that is even possible. If someone is able to take a look at this it would be greatly appreciated. — Preceding unsigned comment added by ClairVoyantt (talk • contribs) 04:39, 2 September 2019 (UTC)

That text appeared here briefly and would have been captured by Google equally briefly. It is no longer here nor on the Google preview. Captainllama (talk) 09:28, 2 September 2019 (UTC)

Major update to article

This article had a number of issues including:

• Out of date citations. Dozens of studies involving finasteride and its effects have been published in the last few years.
• Somewhat disorganized. Some material was in the wrong section, or redundant.
• Structure not consistent with organization of other drug pages.
• Vague/incomplete treatment of adverse effects.

I've rewritten and reorganized parts of the article, which is a draft here: https://en.wikipedia.org/wiki/User:Mariedegournay/sandbox/Finasteride-revision_(DRAFT)

I asked a couple of editors how to make updates to the article and didn't hear back. I will start with an update to the Overview now, and consider updates to individual sections later. Mariedegournay (talk) 15:29, 6 February 2020 (UTC)

It is mainly not only used to treat a large prostate.

I do not believe my version stated it was "mainly" used to treat a large prostate so I'm not sure what gave you that impression.

A second point regarding your revision: how do we know it is "mainly" used to treat BPH and hair loss? I believe these are the only FDA-approved uses and other uses in the U.S. are off-label; however do you have a source for "mainly"? Another use is to reduce risk of prostate cancer, and I'd be interested in how you know that it's used more for BPH and hair loss than prostate cancer. It could be true, I'm just not sure. Also, "mainly" is vague. Mariedegournay (talk) 16:35, 7 February 2020 (UTC)

Have restored the year it was patented. Which indication was approved when is in the body of the article. First approval is most important as it is often simple used off label after that in the US.

I moved information about patent expiration to a History section which I did not update yet; it is still in my Sandbox. This seems like deeper information that makes the overview bulky. You have reinstated a bunch of material that seems like too much for the Overview. I did make an effort to keep valuable information and put it in the right places (sometimes in other sections). Mariedegournay (talk) 16:35, 7 February 2020 (UTC)

Simplified the first sentence

Type of medication is in the second paragraph, infobox and body of the article Doc James (talk · contribs · email) 03:38, 7 February 2020 (UTC)

Prostate cancer

This "It has been shown to reduce the risk of prostate cancer in men over 55."

Is overly simple. Source says: "finasteride (Proscar®) for up to 7 years decreased the risk of low-grade prostate cancer in men age 55 and older compared with that in men who received a placebo. Although high-grade cancers were more common in the finasteride group, the finasteride and placebo groups had similar 15-year overall survival rates."

It is best to deal with this pluses and minuses in the body which we do. Doc James (talk · contribs · email) 03:45, 7 February 2020 (UTC)

The claim of reduced risk of prostate cancer is supported by high-quality evidence which is not limited by the long-term survival study you mention. The NCI research summary states: "In the updated analysis, men taking finasteride had a 30 percent decrease in the relative risk of developing prostate cancer compared with men who took a placebo..."

The "updated analysis" is: Thompson et al, Long-term survival of participants in the prostate cancer prevention trial, NEJM 2013. This retrospective study of survival rates examined a population from a prior, prospective study of prevention of prostate cancer lasting 7 years, called PCPT, reported in NEJM (2003). PCPT participants were determined not to have prostate cancer when enrolling. The full conclusion of PCPT: "Finasteride prevents or delays the appearance of prostate cancer, but this possible benefit and a reduced risk of urinary problems must be weighed against sexual side effects and the increased risk of high-grade prostate cancer." (Side clarification: this last point, on a difference in high-grade cancer risk, does not alter PCPT's overall finding of reduced prostate cancer risk in the finasteride group.)

Thompson et al (2013) provides further support for PCPT's main finding: "Finasteride reduced the risk of prostate cancer by about one third." Importantly: "The cause of death for the majority of men was not available, and as a result prostate-cancer–specific mortality cannot be determined."

The 2013 study (NEJM, 2013) is retrospective, does not examine the effect of finasteride on prostate cancer risk, and does not dispute the PCPT claim of finasteride reducing prostate cancer risk over a 7-year period; rather, it takes up a different question: survival rates over a 15-18 year period. In a retrospective study, having the same long-term survival rates does not say anything about the prospective risk of these populations getting prostate cancer. We might look back and see that the two groups got cancer at different rates, but that doesn't tell us about their prospective cancer risk. So the two studies are investigating different questions even though the study population is overlapping.

A crude but accessible way to describe the issue:

1. One might be at high risk of cancer and live 15 more years

2. One might be at high risk of cancer and die in 2 years (for any cause, cancer or not)

3. One might remain cancer-free and live 15 more years

4. One might remain cancer-free but die in 2 years

The 2013 study did not correlate "cancer risk" with survival, because prospective risk data is not available for surviving individuals (the difference in risk was established at the group level). We only know whether an individual is alive or dead, and we might know whether they had prostate cancer at death. To summarize, a finding of similar survival rates between groups does not limit the original claim about reduced prospective cancer risk. (If you have a citation to the contrary, do share it.)

The title of the NCI's research summary is clear: "Finasteride Reduces the Risk of Low-Grade Prostate Cancer in Men 55 and Older". The issues you raised are not "pluses and minuses"; they are other findings that did not speak to cancer risk. I believe the claim you deleted is accurate as well as relevant, and will reinstate it. Mariedegournay (talk) 20:29, 7 February 2020 (UTC)

This would be a fair summary "It decreases the risk of low grade prostate cancer but may increase the risk of high grade prostate cancer and has no effect on overall survival." The discussion does not belongs in the lead.

High grade prostate cancer is significantly more concerning than low grade prostate cancer. Doc James (talk · contribs · email) 01:23, 8 February 2020 (UTC)

Adverse effects

You reinstated this sentence:

Side effects are generally mild.

The term Adverse effects (or adverse events) is preferred per these articles: Side effect and Adverse effect. See also article in the Journal of the National Cancer Institute: "The most common adverse events observed in the finasteride arm during the PCPT study period were sexual dysfunction and gynecomastia." The Cochrane Review article you refer to does not use the term "side effects" in the summary, and instead uses the term "Drug-related adverse effects."

Regarding the reinstated claim that "side effects are generally mild", here is the Cochrane review (emphasis added): "Drug‐related adverse effects for finasteride are rare; nevertheless, men taking finasteride are at increased risk for impotence, erectile dysfunction, decreased libido, and ejaculation disorder, versus placebo."

Is there something else in the text that you're getting "mild" from? I trust we can agree that "mild" and "rare" have different meanings. Imagine if .00001% of people die from taking drug X (and we can definitely attribute the death to drug X). That is not a mild adverse event, although it is very rare. Mild and rare are essentially orthogonal.

The quality of the clinical trials examined by Cochrane, whose review is now 10 years old, has been called into question in a meta-analysis by Belknap et al (2015). This is in a reputable and relevant journal, JAMA Dermatology. The balance of the research published in the last decade since the Cochrane review provides further evidence for side effects. In chronological order:

• Review: Traish et al (2015)
• Comprehensive review and meta-analysis: Corona et al (2017): "Overall, 5ARIs [finasteride and dutasteride] determined an increased risk of hypoactive sexual desire [OR = 1.54 (1.29; 1.82); p < 0.0001] and erectile dysfunction [OR = 1.47 (1.29; 1.68); p < 0.0001]."
• Systematic review: Zakhem et al (2019): "We identified level 1 evidence for sexual adverse effects as a primary outcome in patients taking finasteride." Level 1 is the highest standard of clinical evidence. See Hierarchy of evidence
• View/Review: Traish (2020): "One of the most prominent observations on the safety of these drugs is the increased incidence and persistence of sexual dysfunction (decreased or loss of libido, ED and orgasmic dysfunction), irrespective of duration of study, drug or dose used." (quote in body of article which is gated)

I have not seen the adverse effects described as "mild" anywhere in the literature. Recent research cited above has amply established the existence of these adverse effects. There are three questions in the background: is there evidence for these adverse effects; how severe are they; and how common are they. The change I made refers only to the evidence for the effects, not severity or rarity. Severity is at least somewhat subjective, and frequency is a complex question, too in-depth for an Overview (see Kiguradze et al (2017)).

I believe this argument is a sound basis for deleting your change and reinstating the prior description of adverse effects, so I will do so. Mariedegournay (talk) 17:44, 7 February 2020 (UTC)

Sure will change to rare per "Drug-related adverse effects for finasteride are rare; nevertheless, men taking finasteride are at increased risk for impotence, erectile dysfunction, decreased libido, and ejaculation disorder, versus placebo."[3] Doc James (talk · contribs · email) 01:27, 8 February 2020 (UTC)

References

Cochrane Review

I am eliminating your reinstated reference to the Cochrane Review because 1) it is now ten years old and a fair number of reviews and meta-analyses have been published since then; and 2) The review itself did not evaluate the quality of how the clinical trials assessed adverse events. Here is a quote from an interview with Steven Belknap who did a meta-analysis of the original clinical trials of finasteride for Androgenetic Alopecia. The quoted portion comes from time point -7:25 or so (time from end, not beginning). Emphasis added. This quote would not suffice for a Wikipedia article, but provides useful context on the Cochrane Review as a source.

"...there were actually several meta-analyses that had been done so I started with one of those which is by the Cochrane Collaborative which is a very excellent group of investigators that take as their raw material the clinical trials themselves and then make an assessment by synthesizing the information of the trials. They didn’t really mention in the meta-analysis very much information about the quality of the assessment of adverse events in these studies. So we decided this was worth bringing to people’s attention, just the lack of information about an essential issue."

The Belknap meta-analysis (2015) in JAMA Dermatology concluded: "Available toxicity information from clinical trials of finasteride in men with AGA is very limited, is of poor quality, and seems to be systematically biased. In a cohort of men prescribed finasteride for routine treatment of AGA, most would have been excluded from the pivotal studies that supported US Food and Drug Administration approval for AGA. Published reports of clinical trials provide insufficient information to establish the safety profile for finasteride in the treatment of AGA."

See also Zakhem et al (2019) cited above which "identified level 1 evidence for sexual adverse effects", the highest standard of clinical evidence. It is from last year, and incorporates more evidence than the decade-old Cochrane Review. Mariedegournay (talk) 17:44, 7 February 2020 (UTC)

Yes we say sexual side effects may occur.[4]

That ref says "Among men taking 1 mg finasteride for androgenic alopecia, the evidence for sexual adverse effects is less conclusive. We identified 5 studies that did not support the increased rates of sexual dysfunction in men taking 1 mg finasteride for androgenic alopecia.9,61-64 However, we feel that the evidence describing increased rates of sexual dysfunction is more compelling. We identified 10 studies demonstrating sexual adverse effects, including ED and decreased libido, in patients taking 1 mg finasteride.10-15,17,19-21 In studies addressing reversibility, most of these patients have resolution of sexual adverse effects after discontinuation of finasteride, and many have improvement of adverse effects over time with continued finasteride use."

The Cochrane review says sexual side effects may occur. This does not invalidate the Cochrane review. Doc James (talk · contribs · email) 01:39, 8 February 2020 (UTC)

Adverse effect in BPH

We also need to keep in mind "Although drug therapy usually is not as effective as surgical therapy, it may provide adequate symptomatic relief with fewer and less serious adverse effects compared with surgery."[5] Doc James (talk · contribs · email) 01:48, 8 February 2020 (UTC)

We could change this to "relatively rare" based on this source if you wish... Doc James (talk · contribs · email) 01:53, 8 February 2020 (UTC)

Changing Citation for Risk of Depression and Suicidal Ideation?

The page rightly notes that there have been reports of depression and suicidality in patients taking finasteride.

However, the source that is cited right now doesn't really speak about it. It is an article on the effects that hormonal medications can have on GABAa receptors. It does mention this risk with finasteride, but only briefly, and provides citations of sources that have investigated this. In short, the article is investigating something other than the risk of developing these symptoms while taking finasteride, and only discusses it in relation to a larger, neuroscientific argument.

Perhaps one of those articles would be a better citation than the current one. — Preceding unsigned comment added by BornOn8thOfJuly (talk • contribs) 00:22, 27 February 2020 (UTC)

Post-Finasteride Syndrome Merge

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.

---

NikosGouliaros, Alexbrn unilaterally shifted this over and merged while we were discussing. This newly section is very messy and overlaps with a lot of content that already exists in the main page. Would you support removing it since it is as times inconsistent but also redundant with what already exists in here. Part of what has been mentioned regarding the Reuters investigation has been overly diluted and needs to be addressed as well. 2603:7000:2400:1E91:F919:CC35:8852:825F (talk) 15:31, 11 April 2021 (UTC)

The merge discussion ended and the content copied across in accordance with the consensus reached. The content may need fettling. Alexbrn (talk) 15:51, 11 April 2021 (UTC)

Alexbrn, please don't interact with me. I was in the middle of discussing when you chose to merge without approval by an admin and I will finish up my discussion with Nikos. I will discuss civilly with other editors that will work constructively and not obstructively, as I mentioned before, and you have simply not shown a willingness to cooperate. I'm here to improve the quality of this article under wiki guidelines and I don't feel we are even close to the same wavelength. The question about editorials is a big one here. The general impression is that they were not allowed bc they aren't mentioned on MEDRS but they contain a lot of useful information that has been omitted from this article. I don't have a problem either way, but as you have consistently shifted goal posts to meet what seems like your agenda, a clear standard needs to be agreed upon. As I mentioned, this page would look extremely different over the years if editorials were incorporated into the page. But you have been nitpicking all the sources to remove whatever you can and now you puzzlingly incorporate a source completely excluded from MEDRS to build a story you want. Again, pls do not respond because I'm working this out with cooperative editors. 2603:7000:2400:1E91:F919:CC35:8852:825F (talk) 20:28, 11 April 2021 (UTC)

If you don't want Alexbrn to interact with you, you should avoid discussing him or his actions. He has every right to respond when you do. MrOllie (talk) 20:31, 11 April 2021 (UTC)

That's fine. I'd like to leave it at that and pick up the conversation with Nikos that was interrupted if possible. I think the separate PFS section should be deleted but some of the material can be put into the LT effects section.

"Preclinical evidence demonstrates interference by 5alpha-reductase inhibitors in sexual, cognitive and physical domains relevant to reported persistent symptoms.[53] The existence of the condition is often considered controversial, owing to both the underlying biological mechanism and the incidence of the condition being unclear.[55] A lack of clear diagnostic criteria and the variable reporting fraction in different health-care settings make the problem challenging to evaluate.[56]"

"Case-control study of symptomatic post-finasteride syndrome patients has revealed significantly higher expression of the androgen receptor in penile skin, markers of neuropathy of the pudendal nerve, and persistent alterations in levels of neuroactive steroids.[57]"

I think it makes sense to discuss the controversy and difficulty diagnosing PFS. The main section is also lacking ref to neuroactive steroids. Everything else seems to be redundant or overweighted. 2603:7000:2400:1E91:F919:CC35:8852:825F (talk) 01:42, 12 April 2021 (UTC)

Anonymous IP - you don't own this page, or this topic, and Wikipedia functions on consensus. The solution if you want to avoid me here is to go away as a form of self-imposed WP:IBAN. The merge was performed properly: if you think there was something improper about it raise it at an appropriate noticeboard. Also note there is nothing to stop you continuing any "conversation" you were having at Talk:Post-finasteride syndrome, as the page was not deleted. Personal conversations though would be better hld at the user's Talk page. Your understanding of WP:MEDRS is wrong and your personal attacks are likely to get you removed from the Project if they continue. Alexbrn (talk) 03:26, 12 April 2021 (UTC)

OK, thanks for that. Now I turn my comments back over to constructive editors here.2603:7000:2400:1E91:F919:CC35:8852:825F (talk) 04:10, 12 April 2021 (UTC)

Another personal attack. If you have some actual proposal to improve the article, then make it and the consensus process will roll. This is not a WP:BATTLEGROUND. Alexbrn (talk) 04:17, 12 April 2021 (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.

Undoing POV

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.

---

This has gotten to be ridiculous. Your history on here is pushing a very clear POV and you have reverted so many edits, not just today but over a long period of time, that try to accurately reflect the underlying sources to provide NPOV and due weight. Your editing history and obstructionist approach to resolving disagreements both in the articles and on the talk pages has gotten to a point where this needs to be addressed with third parties unfortunately. If you would like to modify or adjust certain edits that would be completely reasonable, but you are unwilling to do this. You said yourself that this section needed to be cleaned up and you blanket delete any changes made to the article. I will not be responding to you on here because any attempt to resolve any conflict is met with hostility. When I get a chance, I'll address this in the proper forum. 2603:7000:2400:1E91:49BD:1F3:B4AD:311C (talk) 15:04, 1 May 2021 (UTC)

Using editorials for hard biomedical claim and deleting text that disagrees with the activist line (and which has been agreed by consensus) is not a good idea. You might also be interested in WP:BRD. As above, any sensible proposals are welcome. Alexbrn (talk) 15:42, 1 May 2021 (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.

Reorganization of adverse effects section

A persistent point of debate and misunderstandings has been the different indications, patient populations and adverse effect profiles of finasteride for BPH vs. androgenetic alopecia (AGA), or hair loss.

Finasteride for BPH: Branded name Proscar, 5mg/day, mean age over 60 (see Cochrane 2010)

Finasteride for AGA: Branded name Propecia, 1mg/day, taken by men 18 and above, including many who are 18-45

The sexual adverse effects listed on the FDA labels for Proscar (for BPH) and Propecia (for AGA) are different. Accordingly, I will be making edits today which will break out the sexual adverse effects section into subsections for these two indications. Mariedegournay (talk) 20:05, 28 March 2021 (UTC)

Reuters Investigation

The article has the following sentence:

"A 2019 Reuters investigation showed that Merck found evidence of persistent side effects in their original clinical trials and did not disclose it in their warning label. They uncovered court filings which demonstrated that Merck misrepresented Propecia's safety record following clinical trials in the mid-late 1990s."

I struggle finding this information in the cited reuters source. Particularly that they found evidence of PED in their original trial. It is a very long article and it does not directly show any such document. Scisne (talk) 08:06, 28 March 2021 (UTC)

The information is all in there and the corresponding unsealed filings. The article is long, but you should take your time to read through the whole article before asking people to cite every last line for you otherwise it seems like you're just trying to nitpick. 2603:7000:2400:1E91:5C58:B309:C960:6145 (talk) 01:56, 29 March 2021 (UTC)

Adverse Effects

I believe some of the statements in the Adverse Effects Section are not correct or misleading:

Post-finasteride syndrome may also have reduced levels of neurosteroids such as allopregnanolone in their cerebrospinal fluid. One study found that 1.4% developed persistent sexual dysfunction.[13]

Citing the review by Zakhem https://pubmed.ncbi.nlm.nih.gov/30905792/

But the review does not include any information on allopregnanolone or neurosteroids. Since these two sentences make up their own paragraph, this is misleading and there is no source for this claim. Also the review states, that there is only level 2b evidence (Very low) that persistent sexual effects are real. The 1.4% refers to any sexual adverse effect, therefore it does not belong in the section on Persistent Effects.

This isn't true. The article says "These findings were most convincing in a retrospective study of 11,909 patients that identified 167 with PERSISTENT ED (1.4% of the cohort vs. 31.5% of patients with treatment related ED). I'm sure there's a secondary source somewhere that mentions the persistently low levels of allopregnanolone in PFS patients as there are certainly primary sources that have arrived at such findings but its not worth it for me to dig around for it right now.2603:7000:2402:7100:4FA:DDC4:6534:A75B (talk) 20:01, 10 March 2021 (UTC)

You have a point about the 1.4%, it is in fact the percentage of people with PED in one study and i made a mistake. But I don't think that this disproves the core of my point: that there is no good evidence. The study that you are citing(https://peerj.com/articles/3020/) is not placebo controlled but just a retrospective analysis. Therefore it doesn't prove a relationship. the data in the stusy showed a large correlation between the use of SSRIs and finasteride, which is also responsible for sexual side effects. The review by Zakhem still states that there is just level 2b evidence for PED. — Preceding unsigned comment added by Scisne (talk • contribs) 17:54, 16 March 2021 (UTC)

The original study was highly powered and controlled in that it compared patients who had taken finasteride and developed long term side effects vs. age controls for those who didn't take finasteride. Your criticism still is of a primary source, and the Wikipedia powers that be have determined that medical articles need to rely on secondary sources, which the reference does. If you still feel uncomfortable with this claim, I suggest you check out the Reuters investigation which showed unsealed court evidence that patients developed persistent side effects in the original clinical trials, yet this was never disclosed to the public. The two sources independently showed evidence of LT side effects.2603:7000:2400:93E3:641C:CD30:64B8:872C (talk) 17:14, 18 March 2021 (UTC)

It remains, that the study was not placebo controlled and that for example, people also took SSRIs more often when taking finasteride. Maybe Balding causes depression and these sideeffects. Wikipedia recommends secondary sources, because they compare different evidence and different studies. You are not using secondy sources correctly if you pick out whatever lines suit your views. This is an expanded section of the secondary source: "Three studies identified in this review describe complete reversibility of sexual dysfunction in all patients but 11 studies describe patients experiencingirreversible adverse effects. These findings weremost convincing in a retrospective review of 11,909 patients that identified 167 with persistent ED (1.4% of the cohort vs 31.5% of patients with treatment-related ED)." The secondary source also states that there is only level 2b evidence of PED. Scisne (talk) 11:49, 23 March 2021 (UTC)

You're still debating the primary study which doesn't work here per MEDRS. This page would look very different, its specifically prohibited by https://en.wikipedia.org/wiki/Wikipedia:No_original_research. But even if we accept your claims for a moment, which are not appropriate per wiki standards, the blinded and controlled original clinical trials did show persistent sexual dysfunction which is as high quality evidence as you can get. Again, read the Reuters investigation to see what the clinical trials found and what were withheld from the FDA nearly 20 years ago. 2603:7000:2400:1E91:F892:62C:887D:74EE (talk) 20:09, 23 March 2021 (UTC)

These guidelines don't refer to the stuff i write on the talk page. What I am trying to say is that we shouldn't cite single studies that have their own shortcomings. Let's be a bit more productive, I think that the secondary source concludes the following: While some studies show full reversibility of symptoms, others report an increase of persistent sexual side effects. The evidence on persistent sexual side effects is not conclusive. Scisne (talk) 09:37, 24 March 2021 (UTC)

You are allowed to say whatever you like on the talk page, but guidelines govern what can and cannot be included in the article. The way you currently have it in the article is unbalanced and does not give due weight https://en.wikipedia.org/wiki/Wikipedia:Reliable_sources_and_undue_weight to the authors' viewpoints. There were 3 articles vs. 11 articles that showed irreversible side effects. To present the evidence as balanced isn't accurate. Especially since this article was published before the Reuters investigation which shows that Merck found persistent sexual side effects in their original clinical trials (scientific gold standard), yet hid them until Reuters investigated the situation 17 years later. If you balance the evidence accordingly by representing the Zakhem study properly and taking into consideration the stronger and more recent evidence from Reuters, the weighting should be very different than how you are presenting it. 98.7.49.47 (talk) 17:38, 24 March 2021 (UTC)

Fair enough, they found more data supporting PSE. The Reuters article has its own paragraph already and I am not even sure that the section is correctly repeating the content of the reuters article. Scisne (talk) 10:14, 25 March 2021 (UTC)

I have reinstated the line about dysregulated neurosteroid production in post-finasteride syndrome patients. Thank you for pointing the error in my initial citation Sugarhouse90 (talk) 03:27, 25 March 2021 (UTC)

Sorry, but you are citing an entire book "Endocrine Disruptors, Brain, and Behavior" for this claim with no page number or so. Doesn't seem to focus on Fin either. I don't think you can leave it like this. Scisne (talk) 10:23, 25 March 2021 (UTC)

Please refer to the citation again - it specifically cites chapter 5, which discusses the effect blocking 5α-reductase has on the brain, including use of finasteride. Sugarhouse90 (talk) 22:07, 26 March 2021 (UTC)

Can you give me the specific text and page number, not just a chapter? you put it into the long term effects section, are these ireversible long term effects the books is talking about? Scisne (talk) 10:45, 27 March 2021 (UTC)

Can I please ask why you are contesting this textbook citation continuously when it clearly states "As a result, it is evident that finasteride has harmful effects resulting from its ability to dysregulate progesterone and androgen catabolism and metabolism. Emerging evidence suggests that neurosteroid production remains dysregulated, even after finasteride is discontinued, as does risk of sexual dysfunction and anxiety/ depressive disorders." You have contended that this textbook did not have a focus on finasteride, so I do not think you can claim familiarity with this. You also claimed in your editing history that I responded to your most recent comment in talk and refused to provide a page number for the source, which is clearly a false accusation. Sugarhouse90 (talk) 15:34, 28 March 2021 (UTC)

Well i did ask you to add a "page number or so" and you responded with a chapter. The book cites two studies, (both low quality) as emerging evidence. Your wording still sounds like an assertion of a fact. one of the studies is in rats at a very high dose, the other one appears on sci hub as unreviewed (Caruso, Abbiati, et al. 2015; Giatti, Foglio, et al. 2016) Scisne (talk) 15:50, 28 March 2021 (UTC)

Your comment read "Sorry, but you are citing an entire book "Endocrine Disruptors, Brain, and Behavior" for this claim with no page number or so. Doesn't seem to focus on Fin either. I don't think you can leave it like this." That is not a request for a page number. Secondly, your initial dispute with the source was that it doesn't focus on finasteride. Now you are nitpicking the referenced studies. Can you please provide a suitable proposal on how to edit this, given it is plainly stated in a high-quality secondary source? Sugarhouse90 (talk) 05:38, 29 March 2021 (UTC)

Also I believe that this statement is very questionable:

"Finasteride may cause persistent adverse sexual, neurological and physical effects in a subset of men.[13][14] This has been called post-finasteride syndrome, characterized by reported sexual and physical symptoms such as loss of libido, erectile dysfunction, ejaculatory disorders, reduction in penis size, penile curvature, reduced sensation, male breast enlargement, muscular atrophy, fatigue and severely dry skin. People with post-finasteride syndrome may experience depression and anxiety, cognitive impairment and suicidal thoughts.[14]"

Because there is no hard evidence that PFS is real and the list of effects is very long. The Thraish review states, that these effects have all been reported by patients. https://pubmed.ncbi.nlm.nih.gov/32033719/ I think it should be noted that there is no evidence for a causal relationship and that these are just reports.

• Just as an aside, it seems the "emerging evidence" stuff is a copy/paste (i.e. plagiarism) from p. 127 of the book. 2015 is not really "emerging evidence" any more. In future, book references should be given page numbers, sources used honestly, and copyrights respected. Alexbrn (talk) 12:24, 28 March 2021 (UTC)

• (Add) With this[6] edit things are now even worse: what was merely "emerging" and "suggestive" evidence from years ago is now being asserted as a fact in Wikipedia's voice. I am getting a very strong WP:ADVOCACY vibe from some recent edits to this article. Alexbrn (talk) 14:53, 28 March 2021 (UTC)

The word "emerging" was removed at your contention. Can you clarify what you mean by any implications of dishonesty in use of the source? That doesn't seem to be coherent with the charge of plagiarism if it was previously presumed to be too close to the exact wording. Sugarhouse90 (talk) 15:25, 28 March 2021 (UTC)

Suicidality and psychological adverse events

I added a new section called 'Suicidality and psychological adverse events', citing an article in JAMA Dermatology. Edit was rolled back by @Alexbrn: with the comment: 'Would need WP:MEDRS'. It is not immediately obvious why the cited source does not meet WP:MEDRS. Notes on the source: 1. JAMA Dermatology is the highest-impact journal in the field of dermatology. 2. The study is large-scale, reviewing 3,282 adverse events over 26 years (1993-2019) provided by the World Health Organization. Please provide rationale for excluding this publication under WP:MEDRS guidelines. Mariedegournay (talk) 18:38, 28 March 2021 (UTC)

It's primary research. Alexbrn (talk) 06:16, 29 March 2021 (UTC)

'Post finasteride syndrome'

'reduction in penis size, penile curvature', 'severely dry skin'. Hahaha what kind of shit is this? Someone edit this bitter slaphead nonsense into something remotely sensible please. 82.26.113.110 (talk) 16:29, 24 February 2021 (UTC)

These symptoms are from the cited article, Traish 2020. From the article: "Among the reported sexual and physical adverse effects associated with PFS are: loss of libido; ED; ejaculatory disorders; reduction in penis size; penile curvature; reduced sensation; gynecomastia; muscle atrophy; fatigue; and severely dry skin." See references 50-75 in the article here: https://www.fertstert.org/article/S0015-0282(19)32599-3/fulltext#secsectitle0060

And see several guidelines in WP:TALK including Communicate, Be positive, Stay objective and Make proposals.

Mariedegournay (talk) 21:00, 28 March 2021 (UTC)

"Suicidal Ideation" What? Why are you trying to make a case for something that is extremely debated and controversial. Not only that the studies that this article presents even said that they were poor. Also these studies are really strange. One called "CASE REPORT Finasteride-induced secondary infertility associated with sperm DNA damage" which the report was on a 48 year-old man with a 37-year old wife. There are already too many problems with this. DFI is already associated with age and there are too many variables to conclude that finasteride had a role here. Overall, this article and sources have too many problems. I'm in no mood to see wikipedia turning into another propecia help forum. Tisthefirstletter (talk) 15:50, 6 May 2021 (UTC)

Persistent erectile dysfunction figures

Can somebody include some quantitative information in the section about post-Finasteride syndrome? In particular about persistent erectile dysfunction.

"Among men with 5α-RI exposure, 167 of 11,909 (1.4%) developed PED (persistence median 1,348 days after stopping 5α-RI)". Compare this with men who experienced limited 5α-RI exposure (under 208 days), only 0.44% developed PED. Conclusion "Risk of PED was higher in men with longer exposure to 5α-RIs. Among young men, longer exposure to finasteride posed a greater risk of PED than all other assessed risk factors."

It seems quite important information. Three-four years with erectile dysfunction isn't some minor side effect, and Finasteride increases the likelihood of developing this by a large factor. --Guenonposter (talk) 10:29, 15 May 2021 (UTC)

Would need a reliable source per WP:MEDRS. Alexbrn (talk) 10:46, 15 May 2021 (UTC)

Here is a systematic review in the Journal of the American Academy of Dermatology, one of the top three journals in the field of dermatology:

Zakhem GA, Goldberg JE, Motosko CC, Cohen BE, Ho RS. Sexual dysfunction in men taking systemic dermatologic medication: A systematic review. J Am Acad Dermatol. 2019;81(1):163-172. https://doi.org/10.1016/j.jaad.2019.03.043. https://pubmed.ncbi.nlm.nih.gov/30905792/

From the text: "In studies addressing reversibility, most of these patients have resolution of sexual adverse effects after discontinuation of finasteride, and many have improvement of adverse effects over time with continued finasteride use. However, some studies describe a subset of patients with persistent adverse effects after discontinuation. Three studies identified in this review describe complete reversibility of sexual dysfunction in all patients, but 11 studies describe patients experiencing irreversible adverse effects. These findings were most convincing in a retrospective review of 11,909 patients that identified 167 with persistent ED [erectile dysfunction] (1.4% of the cohort...)." Mariedegournay (talk) 01:43, 21 May 2021 (UTC)

That source is already cited. It's not specific to erectile dysfunction however. We should probably mention the NSAID (etc) suspicions. Alexbrn (talk) 06:06, 21 May 2021 (UTC)

The study they identify as ‘“most convincing” does have a finding specific to erectile dysfunction. Moreover, male sexual dysfunction is a general concept which includes erectile dysfunction. A previous paragraph in the study: “We identified 10 studies demonstrating sexual adverse effects, including ED and decreased libido, in patients taking 1 mg finasteride.”

I’m not sure of the import of the SD/ED distinction here. It seems to me the more important thing is to ensure the Wikipedia article reflects findings of the systematic review.

If you want to get into the risk factors (which are not “suspicions”), it gets complicated — there are 26 significant risk factors in Table 3 of the study by Kiguradze et al. in PeerJ: https://peerj.com/articles/3020.pdf Mariedegournay (talk) 12:39, 21 May 2021 (UTC)

I think we reflect it fairly well. I'd oppose digging around in the underlying sources to effect some kind of fresh view out-of-kilter with what the review actually says. Again, with the NSAID suspicions, it's something the review actually says - so maybe worthy of our covering it. Alexbrn (talk) 12:43, 21 May 2021 (UTC)

I see that this item from Zakhem is included under Sexual adverse effects -> Long Term and I wasn't aware of that (was just looking at the conversation here in Talk).

Text under the heading "Long term" refers to several kinds of adverse effects but only cites the Zakhem systematic review (which is not a "metastudy") focusing on persistence of sexual adverse effects. Consider making the text only about persistent sexual adverse effects and moving it under the Sexual adverse effects => 'Finasteride for androgenetic alopecia' heading.

I am not sure that a dermatology journal is going to be the highest quality source for information on a sexual side effect - while yes, finasteride is used in dermatology, the causal relationship (if one exists) is not something I'd expect to be covered in a dermatology journal. I'm not in a position to access the full text for the next few days at least (at least not with my institutional access as I'm off for a while), but the quote above is also worrisome - it implies that the systematic review is making a claim based on 1.4% of the cohort of one study (without revealing percentages in other drugs/controls/methodologies/studies), as well as using a single retrospective study to make this claim - that's the weakest type of evidence possible other than individual case reports, and it seems odd to me that a statement such as that passed peer review. Perhaps it's just a quote that doesn't include more information that is relevant, but this article is very fishy to me in terms of reliability. -bɜ:ʳkənhɪmez (User/say hi!) 13:14, 21 May 2021 (UTC)

The editorial standards on this page are very inconsistent. If we agree that a dermatology journal isn't the highest quality source for a sexual side effect, the article currently uses a very low quality article in skin appendage disorders to suggest that the sexual side effects are a delusional disorder. The evidence cited in this article is a hair transplant surgeon's experience talking to a single patient. When I read this article, it seems like that reflects medical consensus. 73.95.152.59 (talk) 23:04, 6 June 2021 (UTC)