Two pharmacists figured out that oral phenylephrine doesn't work
scientificamerican.com
scientificamerican.com
Off the top of my head, https://pubmed.ncbi.nlm.nih.gov/19230461 from 2009 but there are many earlier studies as I recall.
As someone who suffered chronic congestion, and had experienced the effectiveness of pseudoephederine, it was immediately obvious that phenylephrine did nothing. It's just surprising that this "open secret" has taken 20+ years to be publicly confronted.
But it's not homeopathic -- the defining property of "homeopathic" remedies is that they have been progressively diluted until they consist of only pure water.
The second part, why they are getting away with it, is that naturalistic and pseudoscientific healing BS has a long, long history in Germany. Schulmedizin, at least somewhat, had the image of being perverted by Jewish influences. "Völkische Medizin" the OG Heilpraktiker in some sense, started most of the Quack stuff you see today. The same circles are also still infested with nationalist and anti-jewish sentiments á la "the globalists" to this very day. It’s a crazy, crazy world if you take a closer look.
The only problem is that the pharmacy always seems to be closed when you need it.
IME, guafenesin can be helpful for making coughs more productive, hydration helps with that too, and again IME, so do spicy foods. Mixing cough suppresants and expectorants together makes no sense, but is common --- if I'm trying to clear the junk in my lungs with an expectorant, why am I supressing the coughs that are needed?
Because you need sleep too. And if a cough isn’t productive, having more of them doesn’t help, it only hurts.
The ideal case is to have a minimal number of coughs that are productive.
For suppression of 'ticklish' coughing (i.e. where any form of very minor irritant in the air will set off a coughing fit): Dextromethorphan, which is an antitussive (and which is psychoactive and depending on genetics WILL make you trip even at therapeutic non-abuse doses)
For 'sticky' coughs where the mucus refuses to depart: Ambroxol, which functions as a Mucolytic, i.e. it makes the mucus/phlegm thinner by causing partial breakdown of them, i.e. it fucks with phlegm composition which in turn fucks with the phlegm's rheological parameters
For 'dry' coughs, where there isn't enough mucus: Guaifenesin, which functions as an expectorant (albeit as explained below, "Secretolytic" seems like the better term by far), ramping up mucus production/bronchial secretions/hydration. (avoid confabulating with Guanfacine.)
And then of course for ticklish coughs/antitussive action, there's two other, much better solutions, but ones with it's own issues: Codeine & Dihydrocodeine. Works wonders — as long as your CYP2D6 doesn't function in an atypical manner, in which case it'll either not work at all or get you way too high.
Part of the problem is that a lot of the literature uses the word "expectorant" in the same way I used it above, but really, the more appropriate word to describe guaifenesin is "Secretolytic".
Obligatory disclaimer:
this comment isn't medical advice, I'm neither a medical professional nor a medical paraprofessional, in case of concerns, contact/consult an appropriate medical professional and/or appropriate medical paraprofessional.
I wish I knew why no combination of Guaifenesin & Ambroxol seems to exist on the market, but there probably exists SOME reason.
To any professionals reading this:
Sorry for the low quality content, I know it's very flawed
1: https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
That does appear to be frowned on today.
Certain individuals are prolific bullshitters too. I’d read a questionable comment and notice it’s the same person.
(My observation is general, not specific to this topic)
I guess the generics could be using cheap corn starch…
Same with pesticides - the brand name products often include things like better surfactants that make them much more effective. At least based on the papers I’ve read.
Not always of course.
I came to the conclusion about these drugs on my own years ago.
If they did read the ingredient list, people would realize that all those products in the pharmacy are mostly remixes of the same handful of chemicals sold at different prices.
I guess I only buy decongestants like once a year at most though, I would probably pay more attention if I needed them more often.
This is one of the major problems with putting pseudoephedrine behind the counter. It had been an ingredient in many of these combination products -- after all, if you have a cold, you have the combination of symptoms that come with a cold and want to take the corresponding combination of drugs.
But the combination products are convenience products. You could just as well buy the ingredients individually and take them together. People buy the combination product to be saved the trouble, which isn't compatible with the trouble of getting something from behind the counter.
So there generally isn't a combination product available with the decongestant that actually works in them. And phenylephrine, in addition to not working, has more dangerous side effects (e.g. larger increase in blood pressure) than pseudoephedrine. But now it's the thing in the bottle grandma gets when she has a cold.
You missed the step where cartel super-producers (that didn’t depend on small qtys of feedstock from pharmacies) just started producing 5% more to make up for it.
The organized producers appreciated the government shutting down their nibbling competitors.
Sucks for the public though, paying the price for an ineffective measure.
The policy doesn't have to cut off the meth supply to be successful on its own terms.
Moreover we already have the most draconian and well funded drug agency of any OECD democracy, surely they could cope with some trailer park meth labs without having to hassle everyone with allergies or a cold.
Here in Australia we had project STOP in Queensland which started about 20 years ago, and there's an analysis of the outcomes here - https://www.aic.gov.au/publications/tandi/tandi509
tl;dr it did stop pseudoephedrine going to meth labs BUT it has had no long term impact on the number of labs being detected nor seemingly on the availability of crystal meth.
To me that's an abject failure of a policy, but some people look at it like "we restricted a precursor successfully!" and count it as a win.
If you live in the US or several other places, you probably know that the "good" Sudafed is kept behind the counter, and you have to sign for it. You may have also noticed that there is another version, called "Sudafed PE", that you can just pick up off the shelf.
A lot of people have done that and concluded for themselves that the PE version didn't work. That's why there are so many people commenting that they already knew the thing the article is about.
So... a lot of people were familiar with "PE", and apparently a lot of them knew that it stood for "phenylephrine". And it all touches on a bunch of existing controversy about why the effective medication is locked up.
It wasn't always. People knew that Sudafed was an pretty effective drug. (It was even used, under a different brand, on Apollo missions -- there was a TV ad with an astronaut endorsing it.) A lot of people are grumpy that a well-known effective medicine was made hard to get, and something else sneakily substituted.
The point being, it's not entirely a surprise that people are aware of the phenylephrine -- especially if they're older than, say, 40, and live in the United States. They remember, sniffily, when cold medicine started to suck.
It’s like drinking 15 cups of espresso all at once for me. Jittery; quick tempered; but a clear head and nose. Good with the bad when you’re ill but holy fuck would it be brutal without the head cold + alcohol + caffeine.
In my state, that's not how it works. You have to have a doctor's prescription to get it, which means you have to have a doctor -- and getting a doctor is incredibly difficult.
There's really no reason this shouldn't be OTC.
For years, I had friends in other countries buy it and mail it to me, but that's no longer an option at all.
It was Drixoral, which is a combination of pseudoephedrine and dexbrompheniramine. You can get dexbrompheniramine OTC and combine it with pseudoephedrine and it's OK -- but not quite the same because Drixoral was a time release thing.
I usually pick these cough syrups with codeine when traveling overseas, and has worked extraordinary well, including for my then young children. They are recovering by the 2nd or 3rd day after sleeping though the night without coughing. Obviously children dosage. I think sleep was the medicine.
I've found with most medications looking for an active ingredient and an amount is helpful. You can search for effectiveness or side-effects. The brand I got last time isn't always available and they'll have 3-hour or 12-hour versions with warnings about exceeding recommended dosages (or mixing medications). Or company annoyingly package similarly-branded things that just aren't the same.
Is this not common practice? I would be uncomfortable taking an ambiguously labeled “cold medicine” pill, personally. I know which medicines are effective for me and which are a waste of time and money.
They buy a brand that promises to fix what they don’t like, and if it works, they buy more next time.
https://www.cvs.com/search?searchTerm=acetomeniphen https://www.cvs.com/search?searchTerm=ibuprofin
But there's also one bottle of pills labeled as Arthritis Pain Relief. And one labeled as Muscle Pain relief. Which both have exactly the same medicine and the same time release capsules.
There's a Migraine variant label, a Tension Headache variant label. Just "Headache" relief. There's Back and Body pain relief (though that one is Apsirin, it's just showing up in the acetomeniphen search).
Some years back, Reckitt (British-Dutch multinational) got in trouble with the ACCC (Australia's competition and consumer protection regulator) for doing this. Selling "Headache Pain", "Back Pain", "Period Pain", etc all next to each other, despite all having identical active ingredients. The ACCC took them to court for misleading consumers, and won.
https://www.accc.gov.au/media-release/full-federal-court-ord...
"We can charge twice as much if we put it in a pink packet and say it's for period pain".
Very deceptive.
Zyrtec and Flonase together is probably the best normal combo and is generally accepted to be ok.
Disclaimers: I'm not a doctor. Combining a nose spray and a pill is generally accepted practice and studied in several peer review studies I've seen. Stacking claritin and zyrtec pills together is not generally accepted practice, so don't do it.
Direct decongestants like pseudoephedrine are of limited use because you quickly develop a tolerance and they become ineffective. With corticosteroid nasal sprays, they work best after consistent use over several days and keep working more or less forever.
But in general for any HN topic the people who have something to say get attracted to the article.
I've found that conservative and non-continuous use of Afrin is a better option for me.
So I have a sore spot about this whole issue. I get made to suffer in order for lawmakers to have an empty gesture toward addressing the meth problem.
I hadn't really thought about it until now, but these pharmacists did not directly work with each other, so it must have been obvious that phenylephrine was ineffective.
The real change is to add the mandate of efficacy to FDA for OTC medications.
People want to buy them and they won’t get hurt, let em, I guess.
I would qualify that as, if people know what they're buying and want to buy them.
They will try to shiv you though if you keep trying.
This has long been a thing already.
https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...
> Many OTC medicines, including phenylephrine, are sold because they have an ingredient that FDA generally recognizes as safe and effective (GRASE) when used as recommended on the product labeling, which is documented in an “OTC monograph.” If FDA determined that oral phenylephrine is not effective, the agency would first issue a proposed order removing phenylephrine from this monograph.
https://en.wikipedia.org/wiki/Generally_recognized_as_safe_a...
So it is an effective drug, overall. Just not when used this way.
So good luck nailing whichever bureaucrat approved this.
Their defense to the FDA in being allowed to continue to market despite being proven even before they began their cynical ploy was consumers want convenience, which sadly is clearly true, that despite knowing if you walked five feet further and got the pseudoephedrine they would get relief they grabbed the drug conveniently placed. Fortunately lobbying money only went so far this time.
Some people I know are essentially nocturnal, and have to significantly disrupt their lives whenever they have to do an irregular medication pickup rather than having it shipped ahead of time.
So it can be beyond just "slightly more work" for many people to get it.
Personally, I try to remember to get some whenever I refill meds at the pharmacy, not because I go through it that often, but because if I'm feeling poorly enough that I'm taking it, I probably am not in a state where I want to wait an hour in line just to ask for it.
0) generally recognized as safe and free of containments - it won't kill you and you get what is on the label. This should be applied and enforced through some kind of mandatory batch testing. Supplements desperately need this because you really have no idea about what you're getting.
1) Plausible Efficacy - this is 0 plus a plausible efficacy for the marketing claim. I.e there is some mechanism of action or reasonable amount of evidence this could work. Marketing would have to make this clear. Most OTC medications should be under this standard.
2) FDA proven efficacy - this is the highest standard of proof, basically the current standard. Prescription medications should be held to this standard.
maybe 3) YOLO/Emergency/Terminal illness authorization - can't be marketed, only listed in a government index and you need a DR co-sign and acknowledge that it may kill you, is unproven and the outcome is recorded for the purposes of later study.
The best case scenario is that there is enough market will to allow a lab to monopolize the market, leaving you with the same problems as today but with even less standing in the way of fraud, like companies just paying for good reviews. The realistic case is that no such testing would happen, just like it was before the FDA.
Consumer Reports already exists. https://www.consumerlab.com/ exists.
And the FDA is part of why there is no market for it. Note, for instance, tat the above-mentioned site reviews supplements, which don't have as many restrictions (and which do very much need these kinds of reviews).
> like companies just paying for good reviews
That would conflict with "respected review company", and leave an opportunity for a company that doesn't accept any kind of payment.
Maybe it's reasonable for us to agree that some kinds of oversight are worth funding as a society without waiting for incentives to sprout up out of the ground.
Question: how do you know that this third party is both well-regarded and neutral?
Answer: Read a detailed review from a well-regarded neutral party that conducts laboratory reviews.
Just a small example of why the entire mentality behind "being responsible for our own outcomes" is utter bullshit. You want to be responsible for all your own outcomes, go live on an island by yourself. The rest of us live in a complex society where everyone is interdependent, and where strong governance over the things we depend on for survival is extremely important.
Each of us are responsible for holding others accountable too, as we all currently do with other products.
Someone's pill makes someone grow a third arm, they'll be on John Oliver in no time. And without being able to hide behind "FDA said it's OK" (a la opioid epidemic) they'll feel the full brunt of the consequences.
Soviet-style dumping the power and responsiblity on government bureaus is lazy & stupid vice masquerading as virtue.
Self-responsibility is just a phrase. When elaborated into the idea you have suggested it crumbles. By the time the market corrects industrial causes of human suffering, far too much preventable suffering will have occurred.
Unless you are philosophically indifferent to human suffering your ideas about self-responsibility are empty nonsense. You have no grounds to criticize others for childish sentiments.
That's simply not true, and we have the entire experience of the eastern bloc that's conclusively proven it's not true.
You're simply pretending organisations like the FDA are something they're not, and that they're nothing but good, and all ills must be blamed on private actors. That's picking your conclusion first based on an emotional need to have a warm cozy paternalistic fantasy of a protector government.
Whereas in reality it's the opposite. The rapid innovation of the private sector, driven by consumers who want their suffering alleviated in the fastest and most effective way, is the suffering alleviator. And the slow, obstructive, and competition-free corrupted public sector, the FDA, is the one causing drug innovation costs to be sky high, thereby causing excess deaths and suffering that the private sector would otherwise have been preventing.
You're siding with the baddy and blaming the goodies for his wrongdoing.
Your arguments come from a hypercapitalist fantasy that systemically fails to protect vulnerable populations. Letting market forces satisfy the need of alleviating human suffering is terribly naive nonsense. When the corporations get around to policing themselves, if they do at all, the human toll will be far greater than if we as a society continue to vote for representatives who will reign them in.
You see and comprehend flaws in the current system, but you for some reason cannot see or comprehend that the dumb things you are writing here are much worse.
Bringing up paternalism in this conversation is especially puerile nonsense.
A vote is simply an abdication of responsiblity to people far away, who you don't even know, who don't even have liability if they fail to do as they promised.
I guess you're quite young. You'll learn how the world is eventually. You think you're fighting your own little independent fight, but you're actually just an ant serving a nest you've never seen.
Additionally, we're now under a caveat venditor regime regarding product liability, whereas back then it was caveat emptor. Them being able to say "FDA approved it" lets them dump responsibility too (see opioid epidemic).
Dumping the responsibility on a government bureau, while knowing full well those are on the opposite ends of the spectrums of reliability and innovation versus startups, is completely adsurd.
It's strange that this got such downvoting in such a tech savvy community. You'd think they'd know better.
In what world does Googling for reviews result in accurate, unbiased, independent product information? Can I have some of what you're smoking? (I'll be sure to Google it first.)
The idea is getting a negative response because this is a tech savvy community, everyone here is well aware that Google is an abusive monopoly that's far more concerned with leveraging its market power to line its pockets than it is with delivering accurate information.
I can maybe buy that a free market solution could work for this, but citing Google as an example of a free market... nah, actually, I can't buy it at all. Are we really floating the idea that we don't need an FDA because Consumer Reports could do all the research we need to determine whether drugs are safe after they hit the market?
FDA approves you? Your product gets an FDA sticker. Otherwise, you sell it without one.
Then people could choose how much they care what the FDA thinks. After all, the FDA rubber stamped the opioids. Your friendly local heroin dealer can gives you the same stamp of approval for his poppy based products.
Also prevents the FDA actively killing people by raising the barriers to getting new drugs to them in time. Win win for all (except the FDA I suppose).
Yes, how much of an hassle it is to wade through 90% of crap and fake reviews when shopping for an insignificant mechanical widget or software app in some unfamiliar topic.
Do not want.
If a drug company on the other side of the planet is adulterating the drugs in a way that makes people sick 20 years from now, your bad reviews will show up 20 years too late.
If fly-by-night retailers on Amazon can game the reviews for USB flash drives, you sure as bet that an unregulated pharmaceutical company could.
If you buy from the internet from a fly-by-night based in India because someone on an internet forum said it was good, you can.
If instead you only take what your doctor provides, and pick a doctor who checks independent tests of drugs before prescribing them, you can.
How do you propose that someone who purchases an ibuprofen at a convenience store verify that it is safe, if independent audits are no longer legally required? Where would someone find independent test results? How would they know where it was made?
UL is a better example but it is defacto required by the US legal environment for any serious retailer. And UL/ETL stamps are notoriously faked on imported items. If that was the standard my drugs were made to, I’d avoid imports altogether, and trust only drugs made by a company that can be sued in my local court jurisdiction.
On one hand you have patients either a certain death diagnosis. They'll take anything, they have nothing to lose.
From the drug trial point of view its more complex. Your death and side-effects are recorded. It's not great if half the people in a study die. What if 90% die? Adding lots of one type of patient yo one side of a study, without adding similar to the control group, invalidates the whole study.
And people who are already "hopeless" may end up masking the good outcomes for people earlier in treatment.
Currently there's no mechanism for random unproven drugs to be disseminated outside of a study, but equally its a rare study that wants to add "certain death" candidates to the roster.
If we want "hail mary" options in drug administration then we need that to exist outside of nedical studies. And formalising this would be difficult because one senses that moves in this direction would open the door to massive exploitation and profiteering by both snake-oil salesmen and big pharma.
For all the hate that politicians get on public forums like hn, this is one of the few cases where they actually made a difference.
Decongestants work.
Oral phenylephrine does not.
Pseudoephedrine works just fine but it was moved behind the counter long ago and now you have to ask the pharmacist for it, because besides the fact that it's a great decongestant it can also be used for making meth. TIWWCHNT (this is why we cannot have nice things).
The over-the-counter replacement for pseudoephedrine is phenylephrine and it's basically a placebo when ingested orally. (It works well in nose drops and nasal spray.)
Because of asshole governments that wage beyond-insane wars on drugs?
I don't think restricting sale of medicine that is often used to make methamphetamine is one of them. Back when it was over the counter, how much of the profit from selling pseudoephedrine decongestants was really profit from selling a meth precursor?
Private profits from legal meth seems like a problem any society has to deal with.
Had this same conversation with someone missing a number of teeth, they reported that chicken feed contains pseudoephedrine and is able to be collected by using a piece of wood as a capillary sieve.
Porque no los dos?
Poor law with no thought process behind it. I think there is still push to make prescription only as well.
But this is the entire issue, they knew this from the get-go and made billions based on fraud.
How many Nyquil/Dayquil and other decongestant commercials have you seen in your life time... Ive seen thousands. to the point their jingle and tagline are still easy to recall.
The issue here is fraud, most of the marketed products were oral.
So, here is a conspiracy: If they knew that it was useless, but sounded good on the label - then maybe they could get away with putting even less of the substance, if any, in the products to save costs?
I would assume the FDA would require batch testing at some interval?
https://www.fda.gov/drugs/science-and-research-drugs/drug-qu...
It's not something they do for very many drugs or very often.
I feel uncomfortable asking for pseudoephedrine by name, but I do so anyway, because my doctor told me that phenylephrine was hopeless 15 years ago.
Phenylephrine has been available for over a century. It was an unapproved drug. The FDA grandfathered it in (as it did many drugs) by just making sure it wasn't harmful.
Before I started using Flonase for my congestion, real Sudafed was the only thing that would work when I had to fly. If I forgot, take off and landing would be miserable because my ears wouldn’t pop.
Oddly a few days later I overheard pilots in the airport lounge talking about times their eardrum ruptured due to a cold or something. It’s an injury that’s not uncommon for them.
Now I pop one before a fight every time just to be safe. If you’ve never had an eardrum rupture let’s just say it isn’t fun.
Not so much “fun” as “blessed relief”. I picked up some sort of nasty flu in Mexico in about 2005, and my eustachian tubes got blocked for a few weeks, resulting in an ear infection with pressure building up behind the eardrum in one of my ears.
When that drum finally burst I felt so much better. It was a sharp pain, and it was a bit gross, but so much better…
Pseudoephedrine did nothing for me (it usually works great) and it took a a course of co-amoxiclav to finally clear up the infection.
HA! Indeed! I got a three pack from Costco. Should last a while.
Analogy: you wouldn’t eat hemorrhoid cream.
Possibly a digested version of this report from 2015 [2] which found The relative bioavailability of phenylephrine 10 mg was doubled (Fbio 2.11, 95%CI 1.89, 2.31) when combined with acetaminophen 1000 mg, while the absorption half-time was reduced by 50 %. When combined with 500 mg of acetaminophen, bioavailability increased by 64 % (Fbio 1.64). Phenylephrine 5 mg in combination with acetaminophen 1000 mg produced a phenylephrine plasma time-concentration profile similar to that seen with phenylephrine 10 mg administered alone.
Combining information from the first and second reports, the generally available 10 mg dose isn't very effective, but increasing to 25 mg is much more effective --- and you can double the absorption of 10 mg phenylephrine by also taking 1000 mg of acetaminophen the recommended adult dose of 'extra strength' Tylenol in the US). So take double the dose or with something else (tested specifically with acetaminophen, but anecdotally, seems to also work with ibuprofen), and it may work much better than alone. Given that it's been much easier to obtain phenylephrine than more effective decongestants, it's useful to know what you can try to make it work, if that's all you have.
This is a very old, recurrent HN debate.
Were they under the impression you might get younger when you renew your license or was this some kind of automated machine that auto-denies without any recourse?
This describes a lot of bureaucratically-minded humans, fwiw.
The 2d barcodes and magstripes on these cards do have all the info that's printed, though, so I would bet that a "gifted" ID that hasn't expired but which you've replaced or claimed as lost would still work at a retailer who scans IDs.
The correct answer is number 2, and that's the real reason they won't accept expired IDs either.
Incidentally, the TSA does accept expired IDs. I flew with one and TSA didn't say anything to me; they scanned it into their computer then waved me through like normal. Then the bartender at the airport pointed it out and refused to serve me.
Personally, when in a stirring shit mood, it can be fun to ask them what section of the law/code they think says that. I don’t think I’ve ever gotten a straight answer from TSA, and very rarely a straight answer from a police officer.
When I’ve been travelling with things that have specific actual laws that apply to them, I’ve taken to printing out the actual applicable laws (and their policies). It’s rare they actually follow them at first (and multiple times I’ve had them instruct me to do something that would violate them, or had they themselves violate them), but showing them politely usually helps.
I politely declined, not wanting to get shot or arrested, and showed them their policy instead which is that needed to be done before security, outside of the ‘sterile area’ - and I in fact had done so. They insisted a couple more times, I insisted I wasn’t going to violate the law or their policies, they got a supervisor which got angry at them, and they eventually left. And it was transported to my destination, unmolested, as was I.
Still a hassle, and quite concerning - they either legitimately thought it might be loaded and transported it anyway, or were so confused they did that song and dance for awhile until they could figure it out - and thought the answer was to have the passenger handle a potentially loaded gun in the secure area of the airport to demonstrate everything was actually fine? Or wanted to jam me up by creating an actual crime in progress?
No actual feel good answers to be found there, unfortunately.
In the US, the reality we live in is that knowledge of the law is explicitly not a requirement for these jobs. A police officer is not required to know what law you are breaking, and can legally arrest you if they genuinely believe you are breaking a law they only imagine exists.
Whether this ought be the case is a separate discussion. But this is the landscape in which a series of court decisions have left us.
In my anecdotal experience, it was extremely effective at drying out my sinuses, which did reduce congestion. So I asked some family and friends and their responses were mixed. Some said it did nothing and others swore it was effective.
I'm not claiming that phenylephrine is in fact generally effective, just wondering out loud if there could be more to the story. I.e., it works for some people and not others.
Anecdotes are not science. But if enough people share an experience, sometimes there is more to the story.
Solely relying on anecdotes as evidence is not science, but they’re absolutely a critical part of it!
Just because the science doesn't exist doesn't mean anecdotes are completely invalid.
> Science is expensive and moves slow.
I don't know if I agree that science is slow. Certainly scientific consensus is slow though. The churn of ideas at the forefronts of fields is rapid. In my field (machine learning/statistics) I'd say too rapid/short term incentive focused.
I really take umbrage at the idea that science is some purely objective, ideal process. It's messy, and scientists are opinionated and stubborn. Some of the most obstinate people I've met are tenured professors... They kind of have to be. It takes time for good ideas to weather the initial criticisms, persist through replication and testing, and to take hold.
It's not even the human parts that are flawed with science either.
Science is fundamentally flawed by nature because in science and therefore reality as you know it you cannot prove anything to be true. You can only falsify things in science. Proof is the domain of mathematics.
Read that again in context to the two people who found the science of why it does not work..
You are defeating your argument...
New theory: Allergy sufferers are likely primarily experiencing sinus inflammation. Pseudoephedrine is the better solution for that. For those of us who are dealing with secretion - phenylephrine is effective.
https://www.jacionline.org/article/S0091-6749(06)00633-6/ful...
This reminds me of the debate around monosodium glutamate (MSG) causing headaches. There were early scientific reports which found no real link and that it was probably psychosomatic nonsense. However more recent studies found that some people have a heightened sensitivity to glutamate, and since it is a literal neurotransmitter there is a promising pathway for the mechanism of action.
Biology is stupendously complex, it's difficult to make hard and fast rules about something being categorically effective or ineffective.
Also the placebo effect is real. So even if the boxes had always been packed with sugar pills, you would expect some people to report that it was effective for them.
Additionally, even if it did have some mild effect, oral pseudoephedrine is better in nearly every way.
Perhaps you have a less active form of the enzyme that degrades it.
I have a similar story. Congestion is not a symptom I typically get. Covid, however, decided to shake things up and introduce me to a new set of symptoms... One of those was congestion such that my head felt like a balloon. Without experience treating this symptom, I went out and ended up with Sudafed PE, oral phenylephrine. It worked _immediately_, it was like a balloon deflating. It worked so well that these headlines regarding phenylephrine's ineffectiveness still cause bemusement...
anddd that's my story.
The effect was not dramatic, and as I understand it, people with allergies need that dramatic effect to be able to breath well.
It seems to me phenylephrine was effective for something different than what the FDA had in mind, but due to their folly, now both phenylephrine and pseudoephedrine are unavailable to the average person.
Refund all instances of the sold chemical, put the company out of business. Is it possible?
If it can't be refunded funnel the money into actually creating an effective regulatory body. One can dream.
It's sold as an anti allergic nasal spray (it definitely helps with my light dust allergy at night) but it also works very well when suffering from Rhinitis.
Also doesn't build dependence, which is a big plus.
I have a few times taken opioids for weeks on end because I had very invasive surgery with quite extraordinary amounts of pain during recovery, and have never felt the desire to take more after the pain stopped being above a very high threshold.
I've known others who have taken opioids for a couple days for something that healed much more rapidly, being very afraid to take them, and had to be sure they disposed of any left because they definitely felt the urge to take more beyond relieving immediate pain.
That sounds like "famous last words". The fact that they don't know of the effects is probably because they carefully avoided looking for them.
I've tried cocaine; didn't like it. I use OTC codeine/paracetamol for pain; I don't need the paracetamol, but you can't buy straight codeine OTC in the UK, so I'm forced to buy a proprietary compound. I'm never tempted to take it if I don't need it.
So it probably sounds as if I'm the type who doesn't fall to addictions; but in fact I've been addicted to alcohol and nicotine for 40 years. I've tried repeatedly to quit both, and failed.
There's just one psychoactive drug I've used that is definitely not addictive: LSD. If you can bear to continue tripping for more than about 3 days, it stops working, no matter how high the dose, and you won't get re-sensitized until several weeks of abstinence.
On the other hand, I tried _one_ cigarette at university, and spend the next day or so with a near constant thought in the back of my head - "I should get some more cigarettes".
Your doctor is right, corticosteroid nasal sprays need to be taken before the onset of symptoms to be most effective. They basally dampen the allergic response and if you already have a bunch of immune signaling molecules bouncing around its too late.
So just take a nasal spray. I get it, all the pills that include it should have it removed, but I don't understand why people just wouldn't use the nasal spray. Personally I don't like decongestant drugs at all because I always feel like I get a stronger "rebound", and a netty pot makes me feel considerably better in any case.
I heard it didn't work! But I haven't exactly gone looking for studies.
Also I know I'm doing it wrong. I read instructions somewhere that say if you spray it in your nose and it dribbles back out again, you didn't get it into your sinuses, where it needs to be. Every. Damn. Time.
Seems like Literally nothing you eat is regulated at all.
Unless it kills you. Then if it kills people the FDA acts only after they see a good amount of people dying.
Almost all of this is universal knowledge now. I wonder why there's no outrage or pressure to change.
> Other nonprescription drugs like guaifenesin (sold in Mucinex and Robitussin), dextromethorphan (sold in Robitussin DM), and antihistamines for a cold like chlorpheniramine likely don't help with coughs and colds.
I knew about phenylephrine, but is there specifically evidence against these other drugs?
That's not very much.
Seriously, this was fascinating and disturbing that it took so long.
Everyone knows phenylephrine is useless.
Easy to say now once it’s proved.
The same is true if corruption rather than incompetence is the explanation.
Weird thing was the pharmacists always want to know why you’re asking (even beyond doing the drivers license check) and I had to say every time that the off the shelf tablets do literally do nothing for me.
It makes me both exhausted and unable to sleep, and although I'm not very good at very many things, I'm generally an exceptional sleeper so this was something I wasn't willing to experiment on dosage experiments to make it work.
https://reason.com/2006/12/21/step-away-from-the-cold-medici...
And 2005 is the year Phenylephrine replaced Pseudoephedrine, so it's not like it took anyone any time at all to figure this out.
[1] https://www.justice.gov/archive/ndic/pubs13/13853/product.ht...
Practically speaking, lots of things are used to make meth. I had to give ID last time I bought acetone. Which is crazy for all sorts of big brother reasons.
I’m not a chemist, but as I understand it, meth isn’t too often made with PE anymore, yet, it sits behind the counter forever now.
Sadly, far too many laws, once on the books, are never considered for removal, even when the original reason for their enactment no longer applies.
Unless enough of us voters badger our congress critters to repeal the "hide the PE" law, it will continue to sit behind the counter.
Its interesting how Americans are so trained to interpret everything as a failure of government we will find a way to think that the law that prevents meth makers from using sudafed is outdated because meth makers are prevented from using sudafed.
They switched methods, and the new method seems to be more cost-effective so it's unlikely they'd switch back even without the restrictions.
You see, it's not about dealing with large-scale operations. It's about keeping that one neighbor you have who always makes poor choices from grabbing 1000 boxes of Sudafed and blowing up their house. They don't care what the industrial process is, they care what they can get away with in their living room.
Throttle access to pseudoephedrine sufficiently and they will look elsewhere. Make it easy to get and they'll DIY. You know, I even admire the DIY spirit involved. I just don't admire the externalities.
There is a cheap process to make meth, and there’s another process that involves Sudafed. Banning Sudafed does not stop meth production. But here you are still supporting a ban on Sudafed - because of what some theoretical person might do with it ignoring that they’re doing it now without it.
I don’t believe this is a logical failure, I believe whatever culture you grew up in imparted this way of thinking.
It's almost like people in fact do base their choices on what's easily available.
https://www.nbcnews.com/id/wbna28802912
"Mexican authorities said they have seized nearly 3 tons of pseudoephedrine from a ship that arrived from South Korea."
Every chemist had piles of phenylephrine tablets but no pseudoephedrine (or even phenylephrine nasal spray, which works quite well). I did not have a fun time explaining to my sniffly girlfriend why these were all trash and there was no point in buying them - she just wanted some relief and couldn't understand how I would somehow know better than all the different drugs on the shelves. It made me feel like some nutty conspiracy theorist, insisting that the medicine was all phony.
Thankfully it didn't derail the trip, and in the end I found some other nasal spray that sort-of worked.
"Sinutab, or own brand, without pain relief" is what you're looking for, for anyone reading.
There is a limit to how many they will supply, but I'm not sure what it is. Generally available now in two forms, with and without paracetamol.
It used to be available off the shelf, but that changed about 15-20 years ago, for the same illicit drug production issues.
It's available as Neo Citran in the EU. Tried a couple of other meds, neither worked, nor the parts of the combo separately (combined with other stuff). Only side effect is that it knocks me out a bit, making me feel tired. At least falling asleep is easier. It's the side effect of pheniramine.
It’s pretty easy to find phenylephrine on the shelves in Canada (I’d say about half the drugs use it vs pseudoephrine) so obviously somebody is buying it. Anecdotally, I always tell people to read the labels and only buy pseudoephrine based medication, and it’s consistently a surprise to people - I don’t think the difference was anywhere near universally known.
The average person has no clue how to evaluate medicines. Stupid laws should not impede those of us who do have said clue.
The first thing that sprung to mind when reading the article was how terrible it was to be treated like a drug abusing criminal whenever we tried to purchase anything containing pseudoephedrine in the United States.
Pharmacist can't figure out how to scan an out of country license, makes you get your passport. Can't figure out how to scan your passport, makes you get additional ID. Can't figure out what to do with additional ID, shrugs and says sorry you can't have this medicine. I'm sorry, what??? Is this a joke? I was turned away at the pharmacy buying cold medication?
Don't even get me started about prescriptions that family members literally depend on for their livelihoods and the continuous monthly battle to keep those prescriptions filled. And I'm not just referring to stimulants.
Insofar as I can tell the prevalence of phenylephrine is due solely to this dumb policy under the umbrella of The dumb War on Drugs.
If this is somehow nationalistic flamebait, or somehow leads to nationalist flamewar, I fail to see how that is my fault. I pay plenty of US taxes, I buy my medicines elsewhere.
Edit: while I have you, can you please review https://news.ycombinator.com/newsguidelines.html and adhere to the guidelines more closely? You broke them in other places recently as well (e.g. https://news.ycombinator.com/item?id=38696491)
On the plus side, https://news.ycombinator.com/item?id=38664857 was great and I am going to send you a repost invite for it!
"Two Hot Pharmacists Figured Out That Decongestants Don't Work"
The only reason I know is because someone's mother hoarded pseudo tablets and had probably 30 years supply.
One year as a teenager I got such bad hayfever that my nose was literally just running constantly and I was losing 2 litres of water an hour in just watery eyes, I could barely see, my skin was inflamed, and I was having trouble breathing.
All the hayfever medicine I took was totally ineffective.
She gave me a single pill, and the effect was actually incredible. I've never seen such an enourmous effect in such a short time from any medicine except maybe morphine. In the space of 15 minutes I was almost completely back to normal. My nose not only stopped running, but became completely unclogged. My eyes stopped watering and subsequently completely lost any irritation, my skin cleared up and my breathing was completely normal.
Not only that, but after suffering like that for days, I was completely normal for the rest of the season. The drug just completely broke some kind of inflammation cycle and the hayfever never returned.
I really think that the gaslighting around this was a kind of crime perpetrated on people. Rarely has there ever been a drug that can improve quality of life so effectively. Hayfever for those who suffer it significantly is truly hell. It's not a scratchy throat or itchy eyes, it's a full body experience. Imagine having a bad flu,but it can last months, and nobody has any sympathy for you whatsoever. And then society takes away a completely effective treatment, substitutes with one that has essentially zero impact, and gaslights you incessantly that you're wrong and it works at least almost as well.
End rant I guess.
This is a problem of knowledge, and a problem of trust. People have been generally ignorant about the ineffectiveness of phenylephrine, because most people have enough trust in their pharmacy that they would not expect the entire "decongestants" section at the store to be 100% snake oil. But our pharmacies sold us snake oil, did it for decades, and FDA backed them up on it. And we ate it up like innocent puppies.
I don't think this means capitalism is broken, and I don't think it means people are so stupid that we're doomed, and I don't think it means we need government intervention at every step.
But we shouldn't let this one slide by. We shouldn't let the pharmacies the ignorance card: they knew they were selling us a placebo. How many other products fall into this pattern? We should all think about taking a take a step back and performing a trust audit on our pharmacies.
Personally, I suspect we won't always have to keep facing this problem of never knowing which suppliers are trustworthy. I suspect there's something missing. I don't know what it is: an app, like a peer review app? A website? A law? A non-profit research group? A revolution? A man can have hope.
Rather than put my name on a state government watchlist that tracked whether or not I bought "too much" Sudafed, I figured out that Zyrtec (cetirizine) worked well enough for me, and could be had cheaply at discount warehouse stores.
EDIT: in Australia you can still buy pseudo you just have to show ID. Everyone knows PE doesn’t work.
So if you don't want a placebo, you have to know that the real one exists, ask for it, and then present ID so they can track how much you're buying.
I've only bought the real one a couple of times. One was to help with a long-lasting post-viral cough in advance of an important meeting. I can't for the life of me recall how I already knew about the distinction.