Why has a useless cold medication been allowed on shelves for years? | Hacker News Reader

Why has a useless cold medication been allowed on shelves for years?

theatlantic.com

73 pointsfortran7794 comments

Previously:

https://news.ycombinator.com/item?id=37499106 – The Uselessness of Phenylephrine (2022)/ 226 points/21 hours ago/323 comments

https://news.ycombinator.com/item?id=37485940 – Phenylephrine for colds and allergies don’t work, FDA panel says/57 points/1 day ago/37 comments

Not sure how the conversation went from the drug they want to remove Phenylephrine (as being ineffective,) to pseudoephedrine, (the one used as an ingredient for making meth.) But, I know for a fact that Benadryl does work for allergies. I did an online search at Walmart for the drugs they sell that have the ingredient they say doesn’t work—Phenylephrine.

https://www.walmart.com/search?q=phenylephrine&page=3&affini...

It's time to put Pseudoephedrine back on store shelves and end the silly behind the counter failed war on drugs experiment. This result forces everyone to confront that reality which damages egos and pride so it will be resisted but I'm glad science is finally winning out over hysteria.

You can still get it in the United States if you ask the pharmacist. But otherwise, yeah, it should just be on the shelf instead of behind the counter.

You can get it in the USA if you show ID and ask the pharmacist.

You're limited in the amount you can purchase at any given time, and it's (for me at least) often not available in the form I want it in, making it a real pain in the ass to rely on.

There's a very good reason it's behind the counter. I'm not talking about the people who need it as cold medicine, it's the people who buy it to make drugs and get high.

Before it was placed behind the counter you couldn't even find it on shelves due to the amount of theft.

with the chemists selling useless cold medicine but the streets EVEN MORE full of meth-heads than before, obviously this particular "war on (some) drugs" measure is a pathetic failure.

That’s not how logic works. It could be that it saved us from an even worse epidemic.

That's also not how logic works, if you want to claim that this measure was successful you need to offer convincing evidence in favor of that. The benefit of the doubt doesn't go to failed war on drugs policies.

I'd imagine you'd still need a cost benefit analysis if this inquiry were done in good faith. Which in politics, especially when it comes to controlling drugs, it never is. The exception possibly being prohibition itself—but prohibition actually worked, in the sense that the rate of binge drinking dropped drastically. No such efficacy is obvious here and it seems like a really useful medicine.

The problem there is that alcohol is relatively high-volume, I mean a barrel of pure ethanol is still a barrel of pure ethanol. By contrast fentanyl for example can be effectively shipped, in commercial quantities, in the back of a sedan or human-portable luggage.

Stopping binge drinking meant reducing the amount of available alcohol, a substance requiring large scale shipping and production, storage and so on. Modern drugs really don't have that problem, and for the ones that do, synthetic alternatives would just take over.

What is your suggested solution?

There's no solution to drug use. There's only acceptance of this unwavering human reality.

Now all the junkies on the street corner? Lock them up

Improving folks economic reality tends to lower drug use. We could try not further ruining lives by putting them into the "justice" system and instead close the gaps they fell through while helping them up.

That’s the whole point of this discussion—that the reason it’s behind the counter (which everyone already knows is because of meth) is NOT actually a good reason to have it there.

Rationing it so people who need it can have access to it is a bad reason?

As someone who has bought it twice in the last decade, I'm glad it was available the day I went to the store looking for it. The price however is bananas, but I feel that way about all non generic brand name pills.

It wasn't put behind the counter because meth makers were buying out the entire supply and leaving people with colds with none. It was put behind the counter to attempt to minimize meth makers buying it at all.

If the reasoning was to prevent theft, why can I only buy one box at a time, and why does my license get scanned, preventing me from buying twice in the same week (or whatever) from different stores?

I was between 18-25 years of age and the Idaho pharmacist wouldn't sell to me with an out of state ID. Luckily my dad was perusing the magazines and they let an Idaho adult buy me my medicine.

I just wanted a single box of Mucinex with pseudoephedrine for my cold.

Not to mention every time they scan your license it goes on a list. XKCD made light of this very fact.

https://imgs.xkcd.com/comics/cold_medicine.png

Always post xkcd with the full link so that people can see the alt-text.

Posting mobile version because mobile people dont't have alt-text on hover: https://m.xkcd.com/1618/

https://imgs.xkcd.com/comics/duty_calls.png

Always post xkcd with the full link so that people can see the alt-text.

Posting mobile version because mobile people don't have alt-text on hover: https://m.xkcd.com/386/

In places with low rates of shoplifting (i.e. most places), this never seemed to be an issue.

In any event, the restrictions on pseudoephedrine had huge societal costs (as a proxy, apparently at least $1.7B/yr is spent on useless “decongestants” [0] as a result), and I would hope it at least had corresponding benefits. But it doesn’t seem that meth has gotten any less available.

[0] Presumably more. After all, if people have trouble buying a decongestant that works, might as well buy a homeopathic “decongestant” instead, which is probably safer than phenylephrine while being no less effective.

It's more available and cheaper than ever, can be made in bulk cheaply, resulting in a more harmful product.

Meth is now insanely cheap because it’s manufactured in industrial size Mexican labs with precursors from China and smuggled into the US, there’s no real incentive to manufacture it yourself when high purity meth is available for dirt cheap prices.

How do you know meth is cheap? Nothing is cheap anymore.

Except it doesn't stop that at all. That's the whole point. Modern meth is just made in Mexico using industrial chemicals.

Alarms have been raised that this could be even more harmful for the users.

It is far worse in my country (Greece). I am unemployed, and thus uninsured; this means that my psychiatrist cannot prescribe my medicine (Concerta in my case, a slow-acting version of Ritalin) because they are just so tightly controlled. Pseudoephedrine is similar.

We the uninsured need to procure it from a public mental hospital, but the appointments are months away, so I cannot get any. So this medicine, which my psychiatrist considers essential, is just... denied to me; I have not taken it in 8 months, resulting in my barely being able to function, much less find the employment that would make me, you know, insured.

That’s terrible. You may consider trying Yerba Mate. Anecdotally it’s helped a lot of people I know with ADHD. Perhaps something to try in the meantime. I hope the situation in your country gets better.

> I am unemployed, and thus uninsured

What the hell have we done to ourselves letting corporations be the gatekeepers of our health!?

Having a job with benefits isn't a badge of honor, but corporations have convinced so many it is that I am unsure if this will ever change.

I agree, but, the way things are set up for the population, it is a badge of honor if you need dental work done and not have to pay out of pocket. It’s all been designed to control what we’re allowed and not allowed.

Getting a large amount of our medications imported from China is completely absurd. Last year, China accounted for 95 percent of U.S. imports of ibuprofen, 91 percent of U.S. imports of hydrocortisone, 70 percent of U.S. imports of acetaminophen, 40 to 45 percent of U.S. imports of penicillin and 40 percent of U.S. imports of heparin, according to Commerce Department data. Dec 20, 2019

Someone I know smuggled some psuedofed to their friend in Colombia. They quipped "How many people have you heard getting busted for taking drugs into Colombia?"

Meth is really bad. Having to ask the pharmacist for Sudafed is not that big of a deal.

The prior situation where the cold medicine that's out in the middle of the store is ineffective was worse IMO because people reasonably assume that if they're selling it then it should work. If you tell them that they have to ask the pharmacist, they'll just do that and get something that works.

This does nothing to stop meth.

Pseudoephedrine is one of many precursors to making meth. Putting it behind the counter and requiring an ID, AND limiting how much could be bought, was all a heavy handed way of trying to stop meth production. Instead the tweakers found new ways. I could not agree more, it's become asinine.

And with that ban all the homeopathic stuff.

Pseudoephedrine is another victim of the "war on drugs." It works really well as a decongestant, but purchases are tracked, pills are expensive, and you can't keep a stockpile like you might for some other medicine.

I get the expense and tracking argument but not the stockpiling one. You can buy 3.6 grams in a day and 9 grams per month. Are there stricter state level laws or pharmacy policies that I’m unaware of? 9 grams is like 75 120mg 12-hour pills. How much pseudoephedrine are people using?

If you are purchasing for a family of 6 that all get colds within a short timeframe the limit can get annoying. Well actually it's the per-visit limit. You can only buy like two boxes at one time even though you can come back the next day and buy some more.

Yeah, I don't quite get the outrage at this particular useless thing being on store shelves, among so many other useless things.

The outrage should be that anyone who wants the safe and effective option is treated as a potential meth manufacturer.

The problem is that the names are very similar and most consumers are confused about which is which. Most consumers don't know to go to the pharmacy and ask, because there's something claiming to be effective on the shelf.

Basically, it's snake oil. These companies are taking people's money by selling drugs that do not work using false promises. The FDA is was established to combat this sort of scam, but somehow FDA seems to have allowed these companies to legally market this useless crap without actually confirming effectiveness.

Sure, there were reasons to make it more difficult to obtain a certain type of drug. Fine. There are obviously economic effects of these regulations on the manufacturers. Somehow these companies found a loophole to fill the gap by making it easy to buy useless bullshit.

This is massive egg on the FDA's face and I'm really curious how this happened and what's going to be done to prevent it happening again.

And as soon as the laws making it a pain to buy were passed, cartels in Mexico were almost immediately able to provide instead. The restrictions were passed into law in the US in 2006, and Mexico implemented similar restrictions in 2005. According to the DOJ themselves meth production dipped briefly but stabilized or even increased by 2008:

https://www.justice.gov/archive/ndic/pubs31/31379/meth.htm

They're expensive?

I've bought pseudo for years, and to this day a box is around 5 bucks. Maybe that would get expensive if one were to use them frequently, but they're not meant to be a replacement for allergy medication or whatever.

This. Sudafed is ~$12, but most pharmacists will ask if you're fine with the generic, which is about half the cost.

And that's for 2 sheets of 12 hour.

No, I flat out don't believe this. Maybe you got a good source. I've never seen it for less than $10 for the small box.

Probably depends on the locality, yeah. In the LA area, I never end up paying more than 4 or 5 bucks for a small box of immediate release pseudo. The name-brand boxes might be over $6, but I can't imagine paying $10.

To be fair deoxyephedrine and the other amphetamines also work really well as decongestants.

Pseudoephedrine doesn't produce as pronounced a "high," but it definitely is noticeably psychoactive. It doesn't just clear up your congestion, it also makes you feel better and boosts your energy. It really is a fine drug for masking cold and flu symptoms.

Other commenters seem to disagree, but you're right: if, instead of an entire aisle of useless junk, your local pharmacy just had generic extended-release pseudoephedrine, the world would be better off.

It's absurd how pseudoephedrine gets put behind the counter, and then Sudafed launches a new brand, "Sudafed PE".

Obviously meant to confuse people, because that looks an awful lot like it would contain pseudoephedrine.

But the "PE" now stands for the useless "phenylephrine".

I always thought the "PE" was for Placebo Effect which would explain why it never does anything.

Why is this a surprise? CBD creams, copper bracelets, Kinesio tape, and thousands of "reinvigorating, youth restoring" cosmetic products are sold in American pharmacies (hypermarts). There is no meaningful difference between products regulated as drugs and those considered supplements or health/wellness when they make false claims.

Cough medicines don't work either. Expectorants don't expectorate, suppressants don't suppress. (Why they're both sometimes in the same bottle is beyond me, but they don't do anything, anyway)

Serious question: What is the point of banning ephedrine at this point? There's a good chance it's WORSE for public health... I guess it does push the meth labs to mexico?

That's not really how it was sold: Have mexico make more dangerous meth in bulk using industrial chemicals, while shutting down small labs in the US, and causing plummeting prices.

It may be controversial whether ephedrine based meth is any less harmful, but I think there's enough to suspect it. It's just theater.

In the best case they're equally bad, but it's still pointless.

Have prices actually plummeted, or are we just funneling thatthe much more money to the cartels? Because I don't remember prices falling at the super market, I can't imagine the black market is any different.

At some point it did. I'm not saying currently, but when mega labs came on the scene, I guess it did.

Of course, as a non-meth user and non-expert (although I wouldn't trust "experts" on drugs) I'm not sure, but somewhere in the 90s to early 2000s, they really figured out how to flood the market.

Oxymetazoline works great for short-term relief (like 2-3 days), so I'm honestly not sure why people are so bent on wanting to use controlled substances for very common ailments.

When I moved to France I was very surprised to know that oxymetazoline is prescription drug here. It is routinely prescribed to children and available over the counter where I am from.

Since in a lot of places, meth is easier than pseudoephedrine to obtain, the solution is to simply to go in the other direction and synthesize the latter from the former:

https://improbable.com/airchives/paperair/volume19/v19i3/Pse... [PDF]

I'm just shocked that people kept buying it. Ever since the real thing got moved behind the counter, that's where I go. The sad thing is, they don't even make real Nyquil anymore. Gradually, stores quit selling it; Walgreens was the last to stop carrying their generic Nyquil with pseudoephedrine a couple of years ago. It was to the point where most clerks didn't even know they had it.

Perhaps all the homeopathic cold “remedies” sold right next to the phenylephrine should be removed from the shelves too.

It is simple: the original ingredient pseudoephedrine was put behind counter as it can be used for meth production. The replacement phenylephedrine is just not effective, something I've known for years (so I always go behind the counter).

haha come to france, and weep at the shelves and shelves of homeopathic remedies on offer at every pharmacy

This is the same in the US.

Or Whole Foods in the US where aspirins are hidden somewhere and all you do have is this expensive homeopathic stuff on the shelves…

(As a french) I argue that it's better for physicians to have a way out to not give anything active to the patient who is adament they need a drug for their flu to be over faster. Also, placebo effect do work.

Stuff like this is why people are losing trust in medicine.

Oh, so then you are ok with those companies offering those placebos for immense prices and the insurance (aka the people) paying for that? You could just give some natural products as placebos that are not hurting trust in medicine by legitimizing quackery.

> Oh, so then you are ok with those companies offering those placebos for immense prices and the insurance (aka the people) paying for that?

The price isn't immense though... We're speaking of like 3€ for a month of "treatment". I would definitely rather the state to pocket that money but for the placebo to work you need a bit of marketing, so I don't really know what's the best way.

> You could just give some natural products as placebos that are not hurting trust in medicine by legitimizing quackery.

homeopathics are completely natural products, since it's literally sugar...?

Doctors are just people, they are not gods. It is actually possible self-perscribe if you are well informed.

YES .. Genetic tests can predict when placebos may be the best medicine

https://www.cell.com/trends/molecular-medicine/fulltext/S147...

"Highlights

•Predisposition to respond to placebo treatment may be in part a stable heritable trait.

• Candidate placebo response pathways may interact with drugs to modify outcomes in both the placebo and drug treatment arms of clinical trials.

• Genomic analysis of randomized placebo and no-treatment controlled trials are needed to fully realize the potential of the placebome."

Strongly disagree, especially when they make a profit upselling me some useless placebo, if you can't fix it, don't sell me something that doesn't work, it should be fraud.

Here in the US I got pretty upset the other day when I got an ear infection and went to the pharmacy, and all of the ear drops they had were homeopathic. Even the CVS brand medicines were homeopathic, labeled along the bottom edge of the box where you had to pick it up off the shelf to even see that.

Is there a non prescription ear drop that would help resolve an infection?

Doesn't polysporin have actual antibiotics?

I'm not sure. But I would at least like to trust that, if there is one being sold on the pharmacy shelves as helping an ear infection, that it isn't just water.

Oh, it's even better than that. "Homeopathic", being unregulated, has gotten itself slapped on all sorts of things... some of which work fine! They're labelled homeopathic, but have meaningful quantities of active ingredients. Which makes them bad "homeopathic" remedies, but good remedies overall. And probably contributes further to the confusion that homeopathy makes any sense. Example, I was once given some "homeopathic menthol cough drops". They worked fine, because they contained the same amount of menthol as any other cough drops. Just as labeling something homeopathic doesn't make it work, it doesn't make it not work either.

I imagine there must be message boards out there where "real" homeopaths rant at length about the difficulty of getting homeopathic remedies nowadays because there are so many things falsely labelled as homeopathic.

Why I find the anger about this drug to be a bit overdone.

All sorts of "remedies" that don't pretend to have a scientific basis and have never worked in any context, unlike phenylephrine, which does work when sprayed in the nose, are sold in pharmacies.

I had a pharmacist recommend diluted ground up bees for an eye infection.

Another lovely legacy of fascism in Europe. The popularity of homeopathic remedies is a hangover from Nazis adopting and promoting them as an alternative to the “abstraction” of “Jewish” medicine.

https://www.irishtimes.com/culture/books/standing-up-for-the...

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