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Comment by sodality2 | Hacker News Reader

I remember complaining to my friends about how frustrating it was to hear that a medicine I frequently used turned out to be placebo, exactly one year ago today. Opened this article up, I'm currently taking the _exact same_ one in the article photo - it's what I had lying around and I had forgotten the name of the "bad" sudafed (it's sudafed PE). They need to take it off the shelves quicker. Every day is tens of thousands of more people who are scammed.

Putting my money where my mouth is and leaving a comment on the FDA proposal...

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I remember when the law first went into place. I bought some meds and the next day was back at the store because the new stuff didn’t work. For me it was even more obvious because pseudoephedrine works so well for me.

PE = Placebo Effect

My grocery store pharmacy has homeopathic stuff next to the Sudafed too. Is literally a placebo.

At least the Sudafed has acetaminophen in it ...

If you're referring to Zicam, there's actually evidence that zinc gluconate helps reduce the length and severity of colds... and it's actually present in more than trace amounts in Zicam. They market it as "homeopathic" in order to get around FDA regulations, and they've gotten in trouble because zinc in your nose can knock out your sense of smell, perhaps permanently. (The lozenges don't appear to have this issue.)

How can you believe you've been taking a placebo for years? Phenylephrine is used for the illicit synthesis of methamphetamine, so there's an inherent bias towards anything that gets it off the shelves. Cherry picking studies that say it's ineffective is more velvet glove than using only the iron fist to ban the stuff. But make no mistake that the iron fist is taking your meds away either way.

I think you're confusing Pseudoephedrine (which works and is used to produce meth) with Phenylephrine (which doesn't work and cannot be used to produce meth).

This article is about removing phenylephrine (sudafed PE) from shelves. Studies have pretty thoroughly showed it is completely ineffective for what it is marketed for

I believe that it doesn’t work wholeheartedly, because every time I try it, it is ineffective - but my sinus problems are rarely bad enough to warrant medication (it’s been one year) and by then I’ve forgotten what works and what doesn’t.

Also, I suspect you’re mixing up your drugs. Phenylephrine (the drug in this article) lacks the methyl structure to be used for the synthesis of methamphetamines. In fact, that’s why it was popularized - pseudoephedrine, the truly effective sibling, was becoming too good for meth production, so they created a less potent alternative, phenylephrine, that lacks the ingredients necessary. They then locked pseudoephedrine behind the counter. Turns out the oral form of phenylephrine is less than “weaker” - it’s largely useless - so they pumped out enough of this crap to the tune of $1.7B that the American public spent every year for 18 years after they knew.

Ah gotcha. So the cynical thing I thought would happen already happened.

Glad to hear we're on a road where peak cynicism is looking behind us.

> so they created a less potent alternative, phenylephrine,

Just to be clear, phenylephrine is not a “creation” or necessarily less potent. It’s an even older drug and a very effective vaso/venoconstrictor. The problem is it has poor oral absorption (bioavailability) as you note, so it doesn’t do much taken by mouth, but anything it does do is mostly deleterious. And thank god for that, because if it had the effect orally that it does via IV it would be killing a lot of people.

Pseudoephedrine is the one that is both proven to be effective and is the precursor to meth. Phenylephrine is the useless placebo that they put in the tablets on the shelf only because it can’t be used to make meth. It should be torn off the shelves because it’s useless.

The only reason the ‘PE’ (marketing term for the ineffective phenylephrine) tablets might be helpful is because they usually also have paracetamol (acetaminophen) in them which is probably the only bit that works. They don’t work as a decongestant for most people like pseudoephedrine does though.

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