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Without knowing the exact approval history in the US, I doubt that it is a lax approval process as much as it is an absence of better alternatives.

There are not really any known effective clinical interventions (be they in the form of medicine, therapy, or things like more exercise), and a 10% improvement is better than nothing (clinical therapy (notably Cognitive Behavioral Therapy) is generally believed to be more effective but not by that much and it is financially out of reach for many people who are able to afford medication).

I'm not sure how universal this is, but for me, phenylephrine is literally just side effects. It still makes my anxiety worse, but does nothing for my congestion.

More on this from Derek Lowe of Things I Won’t Work With fame:

https://www.science.org/content/blog-post/uselessness-phenyl...