Should DayQuil Be Legal?
theargumentmag.com
theargumentmag.com
Scientists often talk about the "therapeutic index" or "safety ratio" of a drug. It's the LD50 (dose at which 50% of recipients die) divided by the effective dose. Common hard drugs like heroin or methamphetamine have a safety ratio of about 6-10 [1]. "Soft" drugs like marijuana or LSD often have safety ratios of about 1000.
The safety ratio of acetaminophen is under 4. A typical dosing schedule for an adult is 4-6 500mg tablets within a 24 hour period [2], for a total of no more than 3g. 7g of acetaminophen can kill you, and 12g is likely to [3]. Acetaminophen is the leading cause of liver failure in the U.S, causing 50% of cases and 20% of transplants.
When they tell you "don't exceed 6 doses daily", they really mean it, and it's across all acetaminophen-containing products. The margin for error is narrower than heroin.
[1] http://politicsofsin.50megs.com/risk/Toxicity.Comparison_Add...
This is why you have to be very, very careful. If you're doing 8 500mg Tylenol pills and then you also do 6 doses of DayQuil or Mucinex without realizing it's also acetaminophen, you can end up needing a liver transplant.
>end up needing a liver transplant
You won't get one nor should you get one if the reason is this.
Acetaminophen poisoning actually featured on two episodes of House, and one of them had the suicide plotline. In S05E11, "Joy to the World" they suspected an overweight teen OD'd on acetaminophen trying to kill herself, but the actual diagnosis was eclampsia from an undisclosed pregnancy. In S06E10, "Wilson", a friend of Wilson's suffers acetaminophen poisoning while trying to manage his back pain.
Intentionally overdosing on Tylenol gives you a day or so afterwards to panic and seek medical attention and probably live instead of dying a horrible death. More violent means do not give you any time to retroactively back out of it.
And, yes, in America at least, some lucky people do get liver transplants after acetaminophen overdoses, occasionally even intentional ones.
It'd be like intentionally eating death cap mushrooms.
I like beer quite a lot and have for a very long time, so acetaminophen is banned from my medicine cabinet.
I am on a medication that's contraindicated with NSAIDs, but I made sure that a low dose of Ibuprofen was acceptable.
Sooo ya :)
Better just stay off the beer hubby.
Remember, beer makes you fat also.
The narwal bacons!!
But thanks for the input, sweetlips!
Even in the absence of beer, I'm not choosing acetaminophen. The juice isn't worth the squeeze.
Maybe your package needs to be clearer but here in Sweden it says to avoid taking with alcohol.
Or people cannot read anymore?
Saying this to encourage label reading and to refute those who might try to characterize your wife's experience as anecdotal. And for those who stop reading a page like this one, after the first paragraph that touts "no evidence": https://www.tylenolprofessional.com/safety-and-efficacy/safe... when at the bottom it reveals the Liver Warning.
That said, everyone's physical ability to metabolise drugs is different. I might worry something else was wrong, or at least get a followup test done later, if her liver tox screen showed that, just to rule out another cause.
This part is what a lot of people miss IME
Alcohol use acutely reduces the levels of these enzymes which convert paracetamol into it's toxic byproduct as ethanol preferentially binds to the same enzyme for it's own metabolism. Therefore, acute alcohol consumption can reduce the harmful effects of paracetamol.
The reverse is true for overdose in the context of chronic alcohol use, when the liver adapts to long-term alcohol exposure by increasing the levels of enzymes, therefore rapidly metabolising paracetamol into it's toxic byproduct and worsening harm.
Source: doctor
As a side comment, the lack of medical knowledge displayed in HN threads paired with the absolute confidence some verdicts are delivered with is worrying, and something I thought this forum would be better at than other sites (looking at you, reddit). Paracetamol and NSAIDs (including ibuprofens) are safe drugs if taken to the package directions. Some of the ideas shared in this thread about taking one over the other, or not taking one ever etc, are not rational. Please consult your doctor if you are worried about your particular situation, but generally OTC medicines are not dangerous if taken to the package instructions.
Accidental overdoses of paracetamol are exceeding rare, but intentional ones are common.
OTOH Ibuprofein, doesn't have anything like that deadly profile, but enough gut and other issues.
Paracetamol/acetaminophen has a therapeutic dose that is uncomfortably close to the fatal dose, but is otherwise as safe as any drug can possibly be. So long as you don’t take too much.
Ibuprofen is also relatively safe, but it has a number of ways that it can do damage even at the therapeutic dose, if you are taking it all the time.
The main one is that it depletes your mucus lining in your stomach, which can lead to bleeding and death (used to be a big problem here in Aus when codeine combined pills were available without prescription). It’s also harder on your kidneys and liver.
Completely fine at therapeutic doses taken as per instructions and not mixed with alcohol. But having it every day is going to be much worse for you than the paracetamol and almost certainly lead to health problems.
The main issue with ibuprofen is that it can have fairly annoying (but non-life-threatening) side effects like stomach upset and GI bleeds even with normal dosing.
Those side effects are more problematic when used chronically. This is when acetaminophen shines, because it has virtually no side effects at all when used as directed.
On top of that daily use brings it down to 3-5, preferably 4 or less of those a day. And they last less than 6 hours.
The 8h extended release is 650mg a tablet, and you can have 3-4 a day daily. And if you have any experience taking them you can feel the first half of the extended dose wear off before the extended one kicks in, which leads to basically NEEDING 4 a day, and staggered start times.
The people you know may be obtaining it from less reliable apothecaries; that can be a real issue.
Anyway much of the discussion was on how hard it is to make suitable drugs, and someone said "We actually have some fairly inexpensive, reliable, and well-characterised ACE inhibitors with a nice long half-life and known efficacy, but the therapeutic window of nerve gas is pretty narrow..."
When your measurement is "that looks about right" when purity is entirely unknown, not much really is all that safe.
They treated me with an antibiotic, a potassium-rich saline drip and acetaminophen. Yeah that's all they put in my orders.
The thing that pissed me off so much, firstly they insisted on calling it "Tylenol" when it was not, in fact, brand-name Tylenol but generic acetaminophen (even if they could charge $$$ per pill on it) and also that they basically refused to administer it at a rate that would keep my exquisite headache pain at bay. I was literally screaming and moaning through the entire night and day. (Actually, I was wearing one of those radio-transmitting heart monitors, and mostly the screams happened when I moved suddenly, and the electrodes tore at my chest hair...) But my head was also constantly throbbing, and that's how I knew to go to the hospital in the first place.
The nurses could tell me how long to wait between doses, but they couldn't explain to me how to know that interval, given no clocks and no written-down time of dosing. So basically I had to keep guessing throughout my sleepless nights. And they didn't really inform me of a way to just put it on automatic dosing like a normal hospital would have a schedule for.
I really didn't want acetaminophen at all; I don't like it much, and it really hasn't ever relieved any pain I've ever taken it for. My parents chomped so much of it, made me sick just watching them. I lived through the cyanide adulteration episodes and though unsolved, that guy wasn't wrong.
When I finally got to visit a sane PCP after all this madness, I told him I was taking big doses of Bayer Aspirin, and he said that's fine; just follow instructions and heed warnings, and he also warned me: for Heaven's sake don't ever take any acetaminophen, because it would seriously harm my liver!!!
On the plus side you can still buy psuedo OTC.
Can't read or follow simple instructions? Well maybe modern society is not for you anymore.
Untreated acetaminophen overdose is an extremely unpleasant way to die.
Anyone can buy this stuff, no need to make it sound like it's some controlled substance. I will say if I take to much Acetaminophen I'll just head to the hospital instead of winging it!
The vast majority of so-called drug overdoses are due to polydrug intoxication. It's much harder to die by consuming a single substance. This is clear from the statistics of the few jurisdictions that report all substances in the blood in coroner's reports. See, for example, the Scottish data from 2020 (https://www.drugsandalcohol.ie/34642/7/ndrdd_report.pdf ): "In 2020, almost all (96%) [drug-related deaths] occurred after the consumption of multiple substances."
There has been some suggestions that acetaminophen products should contain NAC to offset some of the toxic effects, but I dunno where they've gone-- there probably isn't any money in it to study it formally.
I try to make an effort to know what the treatment/antidote is for any hazardous substance in my home... things you hope you never need to know but are glad if you do.
Also works wonders for COVID spike protein detox.
I agree that people should be cautious, but I think you are significantly misunderstanding [3].
"Toxicity" != death -- toxicity is merely "some evidence of a toxic effect" -- possibly as simple as a transiently abnormal blood test with no symptoms or sequelae, ever.
Single (accidental) doses of up to 200 mg / kg are routinely recommended to be managed at home [0], i.e. "you don't really need to go to the emergency department for this." For me, a fairly average 79kg male, this would be about 16g.
Please consult with your local poison control if you have concerns or questions!
There are other studies where Dextromethorphan improves both objective and subjective measures of coughing: https://pubmed.ncbi.nlm.nih.gov/37232330/
They also picked a study that shows honey outperforming Dextromethorphan but ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.
There are so many studies and papers published now that you can find both positive and negative results for just about anything. When someone starts pulling up singular random links to papers you should be suspicious. Be even more suspicious when someone is calling for bans or regulations based on those individually selected papers
Doesn’t that suggest that the effect overall is neutral?
If that implies the effect is neutral, then by extension that means nothing works at all.
Also, the very claim that there are positive and negative studies for everything is handwavy nonsense. There might 100 studies, all of which agree except for one outlier ... what does that "suggest" to you?
To be fair, you're doing pretty much the same by claiming these studies exist without proof.
Auvelity is interesting, but the exact mechanism of action is not very clear.
Auvelity is a combination of two drugs: Dextromethorphan and Bupropion. Bupropion, aka Wellbutrin, is an antidepressant by itself. In Auvelity it helps alter how Dextromethorphan is processed by the body, but we can't rule out that it contributes to the antidpressant effect. I mean it's literally an antidepressant.
Dextromethorphan has a lot of interactions and gets a lot of comparisons to ketamine because it has NMDA affinity, but if you look at the table of receptors it interacts with the serotonin receptor is one of the strongest interactions. It is a potent serotonin reuptake inhibitor, which is also known to have antidepressant effects. It also has some sigma receptor interactions which might be doing something significant.
The NMDA interactions get all of the attention because if you put "ketamine" in the headline you get a lot more attention, but NMDA may be much lower on the list or even negligible for this combo.
N=1, I've had very positive experiences with DIY Auvelity, using 150mg Buproprion XR that I'm RX'ed with 60mg OTC DXM-only tablets.
Should read “NMDA receptor antagonists _may_ give rise to treatments that _may help prevent or ameliorate the symptoms_ of Alzheimer’s.
Nobody even knows how Alzheimer’s works at all — like most diseases it’s a description of some detectable symptoms, some of which could even turn out to be the body defending itself.
Thus compounds that may have a mechanism of action that affects some concomitant, visible symptoms might potentially be useful.
The use of definitive sentences about unknown results is how we end up with wellness and some “biohacking” nonsense.
The only cold and cough medicine that really truly works is the over-the-counter stuff, pseudoephedrine, works amazing for me. I usually pick up a box of the stuff when school starts in the fall and I go through half a box of it by the following summer.
If it helps with your coughing, it’s because it’s stopping the postnasal drip, not suppressing the cough as DXM would by shutting down the cough reflex.
Two different, but very similar use cases. DXM is a god-send in the appropriate time.
I think it's perfectly reasonable to contest the research summary this article is providing. All science-based articles on interesting topics are going to be like that. But you're writing your comment as if they took a flyer on DXM, and the research consensus is in fact that DXM is not effective. It's not as bad as phenylephrine (it has detectable, if immaterial, impact in adults), but it's pretty bad.
The point of the article, of course, isn't that Dayquil should be illegal because it's dangerous; it's that it doesn't work. Having spent an unreasonable amount of time in HN pseudoephedrine threads, I think the broad consensus of this site is that phenylephrine should be taken off the shelves.
From what I remember it was actually quite effective topically but not through pill form. Could be wrong.
Also makes me wonder if there's an alternative function to DXM for people with colds (maybe it makes them feel better in other ways). Or it's just good marketing and associated with NyQuil having other drugs and people assuming DayQuil works
The case against DXM is nowhere nearly as good as the case against phenylephrine; phenylephrine is a scam, and DXM is a drug everyone thought was the gold standard cough suppressant, but then serious studies knocked down its effectiveness.
"Using objective and subject assessment tools validated in pediatric populations, this study provided evidence of the antitussive efficacy of DXM in children, aged 6–11 years, at the current OTC monograph dose and labeled indication. Compared with placebo, DXM treatment reduced cough rates 21.0% over 24 h (primary endpoint) and 25.5% during daytime/awake hours. In addition, children treated with DXM reported greater reductions in cough severity and frequency in the mornings and afternoons over 3 days than children treated with placebo. These treatment effects were statistically significant despite the study not reaching its planned sample size and are medically relevant."
Also as I mentioned in another comment, the author of original article misrepresents the findings of their own citation. DXM was found to be effective in adults, just not children.
One of my favorite slides is when we compiled dozens of trials on something that’s basically a nitrogen fertilizer, which as much of a guaranteed positive effect as you can get in agriculture. When compared in a graph most of the trials show an overwhelming effect on increasing yield over an untreated check, however there’s always a portion of the trials where the yield decreases compared to the (untreated) check.
Real life is extremely noisy for a multitude of circumstantial reasons that are either not practical or possible to control for, so a single trial is generally worth fuckall. It takes a lot of testing to see a consistent trend across them.
I wonder if the cost benefit analysis would show that this is still the best policy - I.e. are more people dying because of overdose of acetaminophen than would have from “behind the counter” + controlled acquisition of codeine products.
I would also imagine that the compliance / nationwide tracking is now much easier than when the legislation was initially conceived.
There should be a class of drug where the pharmacist gets to decide, based on some registry, whether you get to have something.
They should take all the ineffective phenylephrine products off the market and educate the consumer about asking for pseudoephedrine versions. But I think the ship has sailed and meth is being made with industrial chemicals now, so the restriction isn't as useful as it was.
I think it's not a bad idea to have a registry to prevent over-dispensing of opiate cough syrup. It's really an important drug. There are a lot of conditions that cause chronic, lifelong, unproductive coughing. Doctors end up prescribing things that are either more habit-forming or more dangerous.
That said, dextromethorphan works just fine on its own (if you take enough -- 2 tsp is nonsense). Why they feel the need to mix in a bunch of other actives is beyond me.
It's even worse than that, they appear not to have actually read the analysis they cited because two of the three studies on DXM found it was effective in adults. The same efficacy was not found in children but there are other very plausible explanations for this (difference in dosage and measurement techniques).
You used to be able to get Nyquil with real sudafed in it. That was the gold standard. It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos.
As an aside:
> In January 2011, the FDA set a maximum amount of acetaminophen that could be packaged in combination opioids like Vicodin or Percocet. The odds of hospitalization due to opioid-related acetaminophen toxicity plummeted.
Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.
which is a much, much worse way to go, apparently
User takes a large dose and gets high -> "why does big pharma condone drug abuse???"
But then drug makers realize they can get more sales by selling a placebo that won’t have the friction.
What do you mean "morons"? Say I'm a normal person who doesn't habitually read magazine articles about drug effectiveness. How am I supposed to know that phenylephrine doesn't work? It's in the drug store and they're selling it as a decongestant; I have good reason to believe it will decongest my nose.
After using it and you experience zero relief, unfortunately. Sniffle. It’s infuriating when you’re ill.
I wonder how anyone learns of the good stuff if they didn’t grow up prior to Sudafed being moved behind the counter.
When I’m sick and standing in that isle I long for the day when there were just two on the market: Sudafed during the day, and Actifed at night.
Or am I just suppose to try the dozen different gobbledegook ingredients on the shelf before figuring which one isn't bullshit while wasting my time on half of them?
> "...suppose to try the dozen different gobbledegook ingredients on the shelf before figuring which one isn't bullshit..."
When you say "on the shelf" i presume you're specifically referring to OTC medication and not prescription medication, right? A common sense question deserves a common sense answer. Yes. Companies will happily take your money and sell you snake oil (nominally, so long as the consequences are near zero). Caveat emptor. Phenylephrine as the non-regulated version of pseudoephedrine is the perfect example.
IMHO the only way to buy OTC medication (or food for that matter) is to read the labels and understand the ingredients. (I hate palm oil and sugar. yuck)
Reality is in fact a given. If you mean that the author is just fine with that reality, that's patently false.
> presumably because they can make more money from morons buying the placebos.
If that's your evaluation of everyone who lacks perfect information then you need to look in the mirror.
> You used to be able to get Sudafed; it worked. It was moved behind the counter for $REASONS. You've got enough to guess that the new stuff is some kind of inferior substitute and that you're only going to be able to get the real thing during pharmacy hours.
Grossly intellectually dishonest and downright unintelligent nonsense. Here's a fact that is inconvenient for this moronic argument: acetaminephen is readily available on the aisle. Things not being locked away does not imply that they have no effect. The more complex reality is actually discussed in TFA.
> Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.
The misspelling of "its" is the least egregious part of this nonsense.
I am convinced that many people ask LLM's "give me a citation URL" and don't bother to read it.
> The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. [...] There is no good evidence for or against the effectiveness of OTC medicines in acute cough.
This is obvious, but thank you for putting it so succinctly. One has to wonder how much support for "do your own research" is driven by people who want to remain proudly-in-denial about their own inabilities.
When I want to get irrationally angry about something in a department store, I'll walk over to the shampoos, which for some reason always have a whole entire aisle dedicated to a single product, when they all do literally the same exact thing, just with different scents and advertising budgets baked into the sticker price.
It's similar to the shampoo example (a huge selection of borderline useless products that make money purely because of marketing) but with a minor safety consideration, too.
You ask what is new about this, and the answer is, in 2026 context: nothing, but compared to the year 2000: plenty. Regulators used to issue fines for this behavior, and for worst offenders, regulators used to shut them down. Lying to customers is illegal in most jurisdiction, it used to have consequences, and it should do so again.
i don't need to smell like grandma
Sulfate-containing shampoos give you a deeper clean, but can dry out your scalp and make the color in color-treated hair fade. They're ideal for most people, especially if you don't wash your hair every day.
Sulfate-free shampoos are more gentle, but if you're supremely oily and/or don't wash your hair every day, you might not feel like they clean your hair well enough. Almost all "color-safe" shampoos are sulfate-free. They're ideal if you wash your hair daily and/or have a dry scalp... and they're a must if you dye your hair and want to keep the color looking nice!
But I don't have time to do that. I would rather have a retailer do that curation for me and provide me with effective high value products, and stand behind returns when they miss the mark. Then as a customer I can reward them for that value added work.
That's why Costco is great most of the time. Although they sometimes miss the mark with certain products they stock.
That ignores over a century of law regarding drug safety and efficacy, and false advertising.
So - why again does the FDA exist?
Is the argument that because the FDA may not be perfect, the public would be better off if it didn’t exist?
The FDA handles many thousands of product categories, tens of thousands of prescription drugs, etc. Which items (and how many total) are you referring to? For many of them might there be a reason available as to why they didn’t end up as you recommended?
Is there any country on earth without an FDA where you think the result is better than the US’s FDA?
Yes, that (roughly) happened because the FDA regulates sunscreen like a drug and RoW mostly treats it as a cosmetic. And FDA drug approval is expensive, so nobody was bothering.
Regardless, for those of us with pasty white skin, it kinda blows not being able to get a good daily sunscreen that doesn't make us look even more ghostly.
EDIT - Yes, the FDA needs to exist, it's WAY better than nothing. But, it's probably due for some reform.
I wish the industry, our health organizations, and most people in general acted as though this were true.
The environment we live in in general is increasingly hostile to people who ask those questions, do their own research, and take responsibility for their health in this way. I have first hand experience having reversed chronic health conditions myself by doing my own research. What have and do others say about it? Everything: every person on the sidelines watching who have formed opinions about how things are supposed to be, and how doctors and nurses and pharmacists are supposed to know better, attack and ridicule me and others like me and when we "look at what is effective and what the active ingredients are" we are gaslit and told we can't possible understand and know that and to leave it to the experts. Of course the definition of expert is only ever tribal and is a moving trojan horse for whatever best allows the agenda of an industry to establish its control over you.
Do you agree on this definition?
Assuming so, I hear you asking how can asking particular questions get you this? I'll assume you have good will and are willing to engage with friendliness.
Simply asking specific questions about health, about diseases, about diet, about social media addiction, about controversial topics like politics, etc release hostility from a handful of people. These people engage with ill will and not friendliness. And it is assumed by them that the asker (me usually) meant unwell - this hostility represents my intentions and assumptions as ill will assumptions. Oddly enough this usually is strongest from people with strong identity attachment to a particular belief or set of beliefs that when questioned releases so much dissonance their nervous system gets hijacked and without the emotional intellgience or mindfulness skills to pause before they engage what comes out is a slop of hostility and aggression most commonly being Ad Hominem or Straw Man attacks as I've mentioned. All when all I did was asked questions.
When someone demonstrates this without actually inquiring into ones assumptions or why they asked, thats a clear demonstration of hostility.
Do you need more examples?
Hopefully I don't come off as hostile but there were no examples in your post.
What were your questions? Did you also show an open mind and willingness to engage?
> Simply asking specific questions about health, about diseases, about diet, about social media addiction, about controversial topics like politics, etc release hostility from a handful of people. These people engage with ill will and not friendliness. And it is assumed by them that the asker (me usually) meant unwell
Specific instantiation: during COVID after vaccines had rolled out, I asked my social network on Facebook who had experience with Ivermectin. I have used it successfully myself, and even my vaccinated parents used it successfully when their recommended treatments and advice was not successful for managing pain and symptoms. I got a lot of hostile and ridicule and mockery along with being called a murderer, by people I knew, simply by asking questions. I wasn't recommending to take it. I received people making lots of assumptions about my vaccine status simply because I was asking questions, people lumping me in with conspiracy theorists and being anti-science and more.
Edit: I showed lots of curiosity and inquiry into what was said, though there wasn't an opportunity to engage in what was an agenda of prejudice and hostility that wasn't open in return and not willing to deviate from what the engager believes to be true.
To de-worm yourself? Awesome, always good to be worm free.
> I got a lot of hostile and ridicule and mockery
I don't condone hostility. But if you were a friend of mine and you claimed you cured Covid using ivermectin I would definitely mock you. Sorry bro.
> what was an agenda of prejudice [against ivermectin for Covid]
Why do you think it was prejudice and not, y'know, post-judice? https://www.astralcodexten.com/p/ivermectin-much-more-than-y...
What's a simpler explanation?
"Ivermectin is really effective against Covid but the drug companies just want to make money so they're suppressing the truth"
OR
"Ivermectin is really effective against worms. Being worm-free is helpful in fighting Covid. If you don't already have worms it won't help you with Covid"
Did you have an open mind to both these explanations? Do they both seem plausible to you?
If you reject explanation 2 outright, maybe you're the one who's close-minded and hostile to new ideas?
If you agree both are plausible explanations, what was your framework to decide which one was true?
Somewhere on a shampoo forum people are complaining that all computers do the same damn thing. I guess they probably just don't know what they're talking about.
They're all Turing machines
I think the phenylephrine stuff is absolutely messed up. I personally had no idea it was ineffective, and I've bought medicine with that included, believing it would do what it says it does in the active ingredients list. To me, this is criminal, and these companies should be taken to court for outright lying about their products. (And the FDA should be slapped, hard, for not having done something about this by now.)
But when it comes to the CVS brand of acetaminophen costing $5 and the NyQuil brand costing $10, that's just... the result of normal market forces. I'm not a big "free markets" guy (because we don't, and can't, have truly free markets, and if we could and did, it would be a disaster), but it's pretty normal and common for people to pay more for something just because some company did a better job advertising it than their competitor did. That's just life.
It's funny, because when I go to a pharmacy, the store brand is usually shelved right next to the big-name brand, and there's even often a little card next to the store brand (or even printing directly on its packaging) that says "Compare ingredients to $BIG_NAME_BRAND!" And yet, people still buy the big name brand. ::shrug::, that's life.
Downvoting you isn't enough. How about we stop trying to take advantage of people and extra every dollar from them in every possible way?
In the past, a lot of people unknowingly ended up addicted to morphine, as it turned out both companies and individual doctors were happy to mislead them about the contents of medication.
If anything, you need honesty from healthcare companies in the first place if you're even going to begin making an informed decision. You're putting the cart before the horse here: people absolutely should be doing their own research before medicating themselves, but it is the OTC companies that obstruct that.
And, secondary to all of this, your analogy about shampoo is misinformed. Still, it is fitting for this scenario, but not in the way you intended. There are lots of different hair types, including ethnic hairstyles that require specific treatments. There are also a number of lifestyle choices that can change your hair treatment needs. As a result, the shampoo aisle actually is stocked with a wildly varying assortment of haircare choices, but actually figuring out what product works best for your needs can be challenging because it is walled behind layers of marketing nonsense that don't inform the consumer adequately on what makes each product different. This isn't much different than the problems in the medicine aisle.
It took a lot of secondhand research to find the ideal hair care product for my thick, curly hair that would mitigate the damage of thrice-weekly swimming in a chlorinated pool. I can assure you, not everything in the shampoo aisle is exactly the same. It was especially hard figuring this out as a man, when so many products are arbitrarily marketed to specific genders.
this argument makes very little sense. Plenty of very potent drugs are in the single digit mg range in a tablet that weights hundreds of mg.
More importantly, as always, it is a problem of incentives. There is no strong, commercial entity focused on removing ineffective drugs from the market, but plenty of commercial pressure to keep them. The FDA has zero incentive to clean house. The magic hand of the market is supposed to be consumers choosing not to buy these drugs because they are ineffective, but for many reasons (choice, placebo effect, basic scientific literacy) this does not happen.
I don't know what the most effective entity is. I cannot personally imagine a commercial structure to support this, but perhaps one could be built.
DXM is fine but oral phenylephrine should be banned. The only reason it's in any of these drugs is because they don't want to lose sales when the real version that works is locked behind the pharmacy counter after hours. It's a scam to keep sales up.
Funny amphetamine used to be an over the counter cold medicine, which the article doesn't mention despite talking about the meth precursor?
Fine article but these two details stuck out to me while reading it.
Ketamine is neurotoxic itself and can cause permanent brain damage. I can't find the info but there was someone in the tech industry who accidentally overdosed and suffered a two year bout of severe debilitating depression culminating in suicide.
If you want to do it the smart way, just consult erowid.org and use a little common sense.
i believe you are referring to Felix Hill.
https://docs.google.com/document/d/1-jBoSEVlryiX1IaSzV4vKuih...
"On mental health, psychedelics and life
This is a story about mental health, psychedelics, psychology and the mind. It is a story about the joy of family, the joy of friends, the joy of being in love, and the joy of doing scientific research. It is a story about life, the world, and how amazing they both are.
After 18 months of intolerable torture, and after many months of consideration I have decided to end my life."
https://www.vumc.org/poison-control/toxicology-question-week...
It definitely works for me. It'd be wild if for all 44 years of my life, it's only worked because of the placebo effect.
The article mentions phenylephrine, and that shit definitely doesn't work. Not even a placebo.
Completely unrelated, I noticed recently that tire detailing spray that makes your tires look black, and the recommended lubricant for my garage door weather stripping, which both cost $15 or more for a little bottle, are just silicon oil that costs pennies for that amount. I have no moral problem with charging higher prices for convenience plus clarity of what the use is. I do think it’s amoral, obviously, to be involved in snake oil sales and unbelievable that the government allows it.
Edit: this is the first result from a Canadian pharmacy searching for cough medicine. Worse it’s for kids: https://well.ca/products/homeocan-kids-0-9-cough-cold-day_88...
It's really worth talking to your pharmacist even if you know what you're buying. There's so many more options behind the counter and they're really knowledgable.
The tire stuff might be the cheap shit that's not so safe just because tires are so thick and robust. Or maybe it's actually designed for tires.
The very "medicine" you linked to in fact displays it right on the cover.
It's much better at clearing congestion than at making crystal meth. And, as the joke goes, it's easier to make an effective decongestant from meth than it is to buy it from a store.
What, to me, should be illegal, is building expensive branding around a group of very basic analgesics - well and other groups like antihistamines.
In the UK I can buy an own-brand 16-pack (8 g) of paracetamol in a supermarket for £0.35 / $0.45. At the same time, I can buy a packet of Panadol (GSK), same substance, same content, same amount, for £2.35, nearly 7 times the price of generics.
How is THAT legal, and how are people so unaware as to actually buy it? "Unaware" may be the key here.
> How is THAT legal
Why shouldn't it be? Companies are free to set prices to whatever the market will bear. In this case it's based on customer ignorance, which makes it feel icky, but I don't think that's a reason to legislate this sort of thing.
> and how are people so unaware as to actually buy it?
Yeah, I don't know. I do remember that, many many years ago, I didn't know about this, and would always go for the big-name-brand version. At some point I learned to look at the active ingredients and just buy the cheapest one that had the same ingredients in the same dose, but I don't recall when or why I learned that, or why I didn't know that before.
I think there's also an implicit quality judgement sometimes, even if it's unfair. When it comes to groceries, say, canned tomatoes, and I see some fancy-looking Italian brand that I've heard of, my brain will automatically rate it much higher than the grocery store's own branded version of it. Maybe that's an effect of marketing/advertising, maybe it's something else, I don't know. And sometimes it's actually true: tomatoes are not all created equal. I think something similar happens with drugs, even if it's an entirely different kind of product.
People also often assume that something that costs more is automatically higher quality. For some types of things, that can be true (because yes, there is such a thing as a better tomato, and sometimes it costs more to cultivate said better tomato), but for drugs in a regulated environment, that doesn't really make sense. But people pattern match on what they know and what they feel.
> Why shouldn't it be? Companies are free to set prices to whatever the market will bear.
Those are the rules of a free market, I'm not contesting this in general, but we're practically talking deceit here. IMO the pricing for a "crucial subset" of WHO's essential medicine list (as if "essential" wasn't atomic enough...) should be capped, plain packaging enforced and no advertising campaigns permitted. Medical professionals being bound by law to inform of the availability of generics in certain jurisdictions is simply not enough. I'm not saying this is realistic or achievable, but it would benefit the society. That same list also includes common antidepressants and antipsychotics for example, even if it's under palliative care management, and those are biiig money makers.
As to the rest, fully agreed. With own brand groceries quality does often follow pricing, but doubting the quality of pharma generics is doubting the whole regulatory system - not unwise - but if we do, that should equally, and especially, apply to the big names for whom more money is at stake, with the good side that this brings (rigorous testing) and the bad side (shady practices).
There can be some arguments made (maybe you think the generic cuts corners and it is only 4.5% vinegar instead of 5%), and the same arguments can be made for the drugs. But IMHO they come nowhere near to justifying the price gap.
The thing that is particularly frustrating in the case of the drugs is how the brand-name is (for many people) the vernacular name. I grew up in a family that called many drugs by their actual name (eg ibuprofen & acetaminophen), but when I go to the doctor, many of them insist on calling them Advil & Tylenol. Sometimes it seems to take them a second to recognize the generic name.
Then, there _are_ arguments about whether generics face adequate testing to ensure the same quality as the originally-approved name brand drug. A lot of this is FUD - I'll happily buy generic acetaminophen in the US - but it's not a totally irrational concern. I doubt any regulator ensures generic equivalence to the same degree of conformity that a big pharma companies' own quality control does.
For example, I personally find real differences in the jankiness of different asthma inhalers, even amongst generics. Maybe that's because I don't shake/use/clean them exactly per the directions, but then that's real-world use for you. My personal experience says brand-name Ventolin has solved a "robustness against user error" problem in a way some alternatives often have not, suggesting the FDA does not enforce equivalence on this dimension. It's not enough of a difference for me to go name-brand, since out-of-pocket price differences can be egregious, but I do distinguish between otherwise-unknown generics.
Finally, you may trust the UK regulator and so do I, but traveling somewhere without good regulatory oversight, I'd probably reach for Panadol - assuming it seemed authentic - over a generic brand I'd never heard of. Brands have value and brand owners have a lot to lose, which is a kind of insurance (see 1982 Tylenol recall).
The citation linked does not support this claim. In fact it suggests the opposite:
"Dextromethorphan was tested in three of the included studies (Lee 2000; Parvez 1996; Pavesi 2001). One report on a series of three successive studies on a total of 451 adults favoured dextromethorphan 30 mg given in a single dose to placebo in terms of cough counts (measured through cough acoustic signals using a microphone on the nose) and subjective visual analogue scales (Parvez 1996). Differences in mean changes of cough counts between active treatment and placebo varied from 19% to 36% (P value < 0.05) in the three studies (up to a net difference of eight to 10 coughing bouts every 30 minutes). This study did not report on side effects.
A study involving 44 participants tested a single 30 mg dose of dextromethorphan versus placebo (Lee 2000). Both treatment groups showed a decline in cough frequency (from 50 to 19 per 10‐minute period in the active treatment arm compared with 42 to 20.5 in the placebo arm, P value = 0.38 at 180 minutes follow‐up). Mean subjective cough scores showed a decline from 2.0 to 1.0 in the active treatment group compared to a decline from 2.0 to 1.5 in the placebo group (mean difference in decline in cough scores 0.5 at 180 minutes, P value = 0.08).
Pavesi and colleagues also tested a single 30 mg dose of dextromethorphan versus placebo (Pavesi 2001). Outcomes were measured through a three‐hour continuous cough recording, measuring cough bouts, cough components, cough effort, cough intensity and cough latency. Average treatment difference was 12% to 17% in favour of dextromethorphan for cough bouts (P value = 0.004), cough components (P value = 0.003) and cough effort (P value = 0.001), with an increase in cough latency (P value = 0.002)."
Two out of the three studies found DXM was effective in adults. The studies did not find the same efficacy in children but that could be due to differences in dosage (adult dosage is 30mg, child doses vary based on body weight) or in measurement techniques (as far as I can tell the child studies measured results via parental survey as opposed to more objective techniques like cough recordings).
- pseudoephedrine taken orally.
- phenylephrine, but only as nasal spray, not if you take it orally.
- Oxymetazoline (Afrin) nasal spray and others in this broad family
- propylhexedrine, sold OTC as Benzedrex as a vapor inhaler. Unfortunately people crack open the inhaler and swallow the whole thing as a drug of abuse, so often they are out of stock seemingly because of shoplifting, or not sold at all because the pharmacies don't want to deal with the hassle.
Anything that goes directly in your nose has the potential to cause rebound congestion after a couple days which can be pretty bad.
If they sold these chemicals as singular treatments then the abuse would go through the roof. The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this.
I injured my legs, then on top of it, had a minor cold recently, and finally grabbed a bottle of Coricidin HBP out of desperation. I have also been stocking up on 0.0% beers. Between doses of the former and bottles of the latter, I managed to get some great-quality sleep and rest.
The other thing to notice about the Cold and Flu section of your pharmacy is that most all the treatments are supposed to relieve congestion, clear phlegm, and serve as an expectorant, such as all the cough drops with lemon, or menthol. If you are a lifelong smoker with a productive cough, this is great. That includes habitual pharmacy patrons who've always purchased their cigarettes and cigarilloes right there at CVS, next to the candy aisle and the booze aisle.
If you live in a desert and/or suffer from chronic E-N-T dryness and dry coughs, then these treatments will make your life a living hell and must be avoided at all costs. Think about it.
I think we need to do more around accidental overdoses than suggest that everyone should be a "shrewd consumer".
All these overdoses are happening because people do not read the warnings and they do not follow the instructions; and if they cannot understand the warnings and if they cannot follow the instructions, nor even consult a professional, then perhaps they deserve an overdose?
That started me on a quest for a good cough medicine. My research turned up some interesting results.
Different countries have their own go-to medications for decongestants. Actual different drugs, not just the same thing under a different name.
None of them work.
Anything that does work is banned unless the people making it have been doing so for a couple of hundred years, then it seems that they just pretend it's not there.
When challenged the industry defended their sale of ineffective products by saying if they didn't work, people wouldn't buy them.
Anecdotal evidence is taken as gospel in many public health circles. When an attempt to have a substance banned was rejected on the basis of no evidence of abuse, it appears that means 'try again later', not gather evidence. You only have to wait for someone who shares your ideology once and it gets done and getting it undone is too much work for anyone to consider.
It's almost enough to send you off to a music festival to gather your own supplies for home remedies.
>You’ll also find lots of cough medication with guaifenesin, which has similarly thin scientific backing.
He links ( https://pubmed.ncbi.nlm.nih.gov/24003241/ ) which shows that guaifenisin had no measurable effect on sputum volume or consistency (p = 0.12 for volume). But there are other studies with broader outcome measures which show positive effects:
https://link.springer.com/article/10.1186/1465-9921-13-118
>The pilot study was a randomized, double-blind study where patients were dosed with either 1200 mg extended-release guaifenesin (n = 188) or placebo (n = 190), every 12 hours for 7 days [...]
>Subjective measures of efficacy at Day 4 showed the most prominent difference between treatment groups, in favor of guaifenesin.
>The DCPD assessment of symptoms also indicated advantages for ER guaifenesin over placebo for the between-day changes from baseline in response to the questions “Over the last 24 hours how often did your phlegm prevent you from going to public places?” (Day 2; p = 0.0016) and “Over the last 24 hours, how difficult was it for you to bring up phlegm?” (Day 5; p = 0.0070).
G tends to do well in subjective (symptomatic) assessments, even when subjects are blinded, but poorly in objective assessments. However, this isn't enough to condemn it.
For anti aging stuff, the workhorse ingredient is retinol (with a few formulation variations).
However, it is very difficult to buy _just_ retinol - most beauty brands bundle up retinol with a bunch of other ingredients. This has a couple of issues:
1. You won't know your retinol dosage. These creams almost never tell you the retinol proportion and concentration.
2. You're overpaying by _a lot_. The luxury name brand cream will cost maybe 10x more than the similarly sized $9 bottle of retinol from the ordinary, but it will only contain some fraction of retinol.
Tbf this has been slowly changing and I see even La Roche Posay sells retinol bottles for $50. Insane markup, but smaller than what was the case 5 years ago.
This is all compounded with the fact that it's very difficult to tell if your anti aging cream is actually working from your own experience:
- its effect is slow acting
- it's difficult to compare the result with the counterfactual, unless e.g. you only use it on half your face
On DayQuil specifically, the only time I took it I was about as useful as someone stoned. I would have been better off and less dangerous to society if I had just taken rest..
As far as pain management I personally find acetaminophen does nothing for pain and only helps with fever. Similar ibuprofen only helps me with sever muscle pain associated with over exertion or bruising.
Having unfortunately suffered from nerve pain I can say the pain relief opiates provide, even at low levels, is on a whole different level. My experience is that taking them only for pain, when it is unbearable, was not addictive and made pain on the level of I need to go to the hospital bearable.
Just my experience.
It would also fix the homeopathic snake oil as well, which has started showing up as options in previously-reputable medicine aisles. So at any rate, be on guard if you don't want to end up accidentally buying a bottle of water plus flavoring in your cold-addled state.
They should probably have to split up large words with dashes or even spaces "phenyl-ephrine" "psuedo-ephedrine". Maybe even "phenyl-eph-rine" "psuedo-eph-edrine". One authoritative list published by the FDA (they already keep a list of what's allowed to be sold OTC in the first place, right?) of how the active ingredient names have to be distinctly stylized to best inform.
I'm advocating something that ideally can sit in the middle of the two philosophical/regulatory regimes with more people on board - being able to buy whatever you want, but regulation aimed at preventing companies "innovating" by simply confusing the market. And while I'm sympathetic to extending the scientific-maximalist approach onto the "supplement" industry that is currently harboring copious amounts of straight up fraud, I would also say that throwing down such a gauntlet doesn't seem like a great idea at the moment!
I am fed up with various "products" that come to my door: mix of vitamins, a-lipoic acid and ashwagada. I can imagine among the billions of physically healthy adults, there are many that choose them. While regulation for drugs is strict, for these products it is less that potato chips. The FDA goes like, as soon as they sell snake oil that doesn't hurt anyone, let the market loose.
It's funny, I never thought about it, but you're right, it does sound backwards.
The ones you have to ask a pharmacist for are “BTC”: behind the counter. e.g. pseudoephedrine.
The desire to nanny-state things to the lowest common denominator is ruining everything, and it's a major driver for various problems all the way to the housing crisis and the cost of healthcare in the first place.
Honestly, combination drugs are out of fucking control. Some people don't know Advil is ibuprofin. Some people think all Advil is ibuprofin. Both are wrong!
It used to be true that doctors could tell people that it was okay to take [X] brand drug with [Y] brand drug but anymore, there are a half dozen formulations of each in varying combinations on the shelf and half of them have some of the same ingredients. Basically every brand has a "fuck it lets just mix everything together, flu" version on the shelf now.
It is not the government's responsibility, nor should it be, to try to solve the fact that someone can do something stupid with medication and harm themselves. Medication, by its very nature, interacts with and changes your body: that's the entire point. There is no way for something to be effective and also impossible to abuse or misuse. Regulating drug safety should always be based on following the instructions for how to use that drug.
That's not to say we can't do more the educate people, but ignorance should not lead to inaccessibility. There are tens of millions of people in this country that are fully capable of reading a box and following instructions and they should not have to live a worse quality of life because some people are not willing or able to do so.
> safe when taken as instructed
Part of that means that instructions and ingredients should be clear.
I am educated and knowledgeable and a trip to the pharmacy is more complicated than it needs to be. You damn near have to pick up every damn box to see what is actually in things, if your pharmacy doesn't have things locked up, and half of the time I ask a pharmacist for pseudoephedrine even they give me combination drugs instead.
I don't think we should take anything off the shelf (except oral phenylephrine). If anything, I think we should make more drugs available OTC.
When asked, they always tell me one of two things:
1. They were trained on these names instead of the ingredient (scary!)
2. They want the "easiest" thing for the patients (i.e. so they don't have to look at the label).
Now I suppose ibuprofen/acetaminophen is common enough that people may be familiar with it, but I could see how in a clinical setting defaulting to brand names is the only reasonable default for accessibility.
I’ve had multiple doctors remark specifically about my use of generic drug name in discussion. “So I presume you’re a little bit familiar already”, etc.
And since I was always more familiar with acetaminophen and ibuprofen, when a doctor would say "Take Tylenol", I would have to ask what the active ingredient is because I didn't know.
They'd actually have to think about it before telling me.
Tylenol is second nature to them. Acetaminophen makes them think.
Oh, and forget about something like dramamine. I'd be told "Non-drowsy dramamine". I'd ask "So you mean meclizine?", and I've literally been told (multiple times) "I actually don't know what the ingredient is."
Ditto for some of the antihistamines (I still don't know what Claritin vs Zyrtec is - are they the same?)
Also meclizine causes drowsiness and you should have been warned that this is a common side effect, I was warned when I was prescribed this (it's also on the drug information sheet that comes from the pharmacy). So it might just be that your doctor isn't that good.
I just checked - Dramamine actually calls it "less drowsy". They have non-drowsy be ginger, which is mostly a placebo (there's a lawsuit about it!).
But this highlights my point: Telling someone "less drowsy" dramamine and there is a good chance they'll buy either the regular or the non-drowsy. Just tell them the ingredient to look for!
Either way, what you describe doesn't sound like a good experience. When I had some issue that necessitated meclizine, the PA wrote a prescription, explained what it was, warned me to be aware of drowsiness until I knew how it affected me, and I picked it up for $1-2 after insurance.
If I had a provider who was anything less than 100% confident and knowledgable about what they wanted me to take, I would be seeing someone else.
Which is why most doctors don't mention them, either.
Look, everything I've been prescribed has a long list of side effects - many quite serious. Just read the pamphlet that comes with it. It's rare that a doctor mentions any, unless the side effect is decently common.
> When I had some issue that necessitated meclizine, the PA wrote a prescription, explained what it was, warned me to be aware of drowsiness until I knew how it affected me, and I picked it up for $1-2 after insurance.
Could it be possible your dose was higher than normal? For me, meclizine is like buying regular ibuprofen - insurance doesn't even enter into the picture. It's not what one normally considers a "prescription medication". Just like being prescribed Tylenol, you typically don't go to the pharmacist with it and say "Give me some" (and if you do, they just tell you to browse the aisles).
> If I had a provider who was anything less than 100% confident and knowledgable about what they wanted me to take, I would be seeing someone else.
I would suggest you re-evaluate your stance. The best doctors (and professionals), are the ones who are always doubting themselves, and the most confident ones are usually the ones who are just faking it - it takes only a few probing questions to expose their facade.
And then there's OTC drugs which are sort of in a weird middle area - and where some of these I feel personally might work best. Make them easily accessible to anyone without a prescription but at least a pharmacist has to hand it to you. They are the experts at dosing and what combinations of drugs are safe after all !
In fact, it’s so effective against pain and fever, it keeps doctors from having to resort to prescribing opioids. Countries that haven’t restricted its use do not have nearly the same problem with opioid abuse.
It makes me wonder if its continued restriction is motivated by profits off the opioid crisis, rather than patient safety.
At least in the States I can still economise.
On the record, I am 100% for making common painkillers, cold and flu remedies completely over the counter. It blows my mind people are making things that used to be prescription (for good reason) OTC, but limiting purchases for things like acetaminophen. I still find it burdensome to deal with the pseudoephedrine controls, and I don't even use it often.
DXM is also not a placebo, although it might be specifically for cough.
I don't especially want the FDA to ban them, but requiring separating out the acetaminophen might not be the worst idea.
and when its harder to get codeine or real percs/oxys/xans/anything else people get fake street pills laced with fent. thats how they od and die.
all these drugs should be sold with alcohol like rules (free access for adults/over 21, Rx only for minors) and warnings explaining exactly how to take them safely, both for "legit" and recreational use. the harm of drugs is half accidental ods and half organized crime. this defeats both and if cocaine was legal too, cartels would go out of business in a year.
In America? No idea. In the UK it's because they sell codeine+tylenol OTC, and they want it to poison you if you try and get a codeine buzz from it. Incredibly this is true.
It takes it down to just the Tylenol, the DXM (, plus the antihistamine in the NyQuil), and the great slightly tearable taste for the ritual of "time to pretend I'm not sick for a little while".
Something tells me this is because they're using it at the dosages listed.
Because let me tell you, it certainly does NOT do nothing if you take more...
Part of the issue though is that 1 in 10 people have a CYP2D6 enzyme deficiency and if you take the tablespoon or so that would be more effective (that a pharmacist I used to work with advocated for) you REALLY shouldn't be driving (or going to work for that matter).
Phenylephrine of course is absolute garbage -- they just felt like they had to leave people a placebo for when they took away pseudoephedrine from the shelves to stop people making meth out of it.
Beyond that, I do sort of agree that putting all of these actives into a single product entirely prevents you from working the doses for what actually is effective. If you have a product full of acetaminophen you CAN'T then just take more of it to get the effective dose of dextromethorphan (and I'm not even sure there IS an effective dose of phenylephrine, but if there is it's definitely higher than what's on the label).
Not gonna say "there should be a law!" because I don't think anyone needs men with guns coming for them over this, but I do wonder why anyone buys this crap when the individual active ingredients can all be purchased and used in appropriate amounts.
But I guess most people just take what the label tells them to...
https://www.health.harvard.edu/newsletter_article/the-power-...
...
> So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen, which separately would run you about 16 cents at Costco.
Why are they comparing the price of CVS DayQuil to Costco acetaminophen? Either compare CVS DayQuil to CVS acetaminophen or compare Costco DayQuil to Costco acetaminophen.
It's so utterly ridiculous how much space the Cold and Flu section of the medicine aisle takes for no reason at all.
And the whole thing about combining so many medications is just silly, especially the marketing for it. "Why take 3 medications for your cold symptoms when you can take just this one?" then gets countered with "Why take a cold medication that has ingredients for symptoms you don't have?"
IMO, DayQuil should never have existed simply for the reasons the article mentions: It leads to people being unaware of what they're taking. Yeah, the label is right there, but you gotta consider the lowest common denominator when selling things to the general public.
Simple
Drug prohibition has caused magnitudes more harm than decriminalization and legalization.
And part of this article is about claims from what is likely inert or mild effect at best. Remember, we used to have amphetamines, pseudoephedrine, and much more potent drugs to alleviate colds and such. But because of the forever-drug-war , we're stuck with substandard crap, and everything good gatekept by doctors.
I honestly do not trust somebody with a doctor license who I talked to for 7 minutes out of 259200 minutes (6 months).
For example, when I went on a camping trip, I got bit by 15 ticks. After I got back, went to doc for 15 day doxycyclene, gold standard. And its cheap, like $15. NOPE, fucker wanted the ticks in a bag to grind up and waste a $400 Lyme test. And that test is only 60% accurate, tons of false negatives.
If I could have, I would have bought doxy, scaled it to my weight, and did the 15 day run.
But nope. I ended up getting the second recommended, amoxicilian as "fish antibiotics".
If we let antibiotics be over-the-counter, every damn infectious bacteria will be a super-strain in a year.
Antibiotics stop bacteria. Antivirals stop viruses.
Except bacteria can be attacked whenever, the sooner the better.
Antivirals need a rapid and early timeframe to work. Getting a fucking doctor to say yes is almost always too long, and you missed your treatment window. That is unless you go the ER, and lucky to not get shoved aside. Then pay $$$$$
Maybe the better solution is that the government should be paying for the Lyme test as a public health measure. Knowing which areas it is spreading too is extremely important.
And on the flip side I know someone whose father got Lyme but didn't know it for years - he was not very symptomatic at first and ended up with major nerve damage. Not one to mess around with
That's also a problem [0]; and it's one that can't be solved by creating a second, somewhat related problem.
Alpha-gal wasn't prevalent then. It was primarily Lyme and rocky mountain spotted fever. Doxy and amox is the gold/silver standard for both.
I don't need a fucking doctor to tell me I was bitten by 15 ticks. I removed them myself with a tick puller. I don't need to he told that I probably got a disease from at least 1 of them. So yeah, its either going to cure the infection before it starts up, or is a prophylactic to prevent it.
And in more sane countries, I can go in a pharmacy, tell the pharmacist and reasonablely and cheaply treat myself. US? Not so much.
But, I can smoke delta8, tobacco, and drink until my lungs and liver give out. But how dare I take some antibiotics when I need them.
- Alcohol, tobacco & weed are already legal... why them and no other drugs? Check how many deaths do alcohol & tobacco provoke.
- Taxes, lots of taxes, literal mountains of money... a small percentage of which can be redirected to treating addicts.
I got another staph infection previously in the united states. Needed to go to a doc in the box who misdiagnosed it. A few days went by and i needed to go to another doc in the box who gave me topical and trued to give me a steroid shot. Needless to say it progressed and turned into fullblown MRSA which required admitance and a IV antibiotic. Extremely painful. I don't have the ability to add the costs but north of $10k easily.
That's why drugs should be legalized.
I think your maximalist conclusion of "drugs should be legalized" might have some second-order effects that might be net worse for society, though. Addiction, misuse, MRSA, overdoses, etc.
It’s almost like there are other factors at play, and our system is an inadequate band-aid on those issues that has its own side effects.
Also do you see any ironic connection between your two examples: easily accessible antibiotics and a medically resistant infection?
And dead men tell no tales.
Particularly the tales on why they shouldn't be legalized.
Legal status (along with stigma associated with it) does prevent them from getting help before completely crashing out. It has the additional side effect of whatever portion of their lives they come out of it with being completely destroyed by the legal process. You know, because chronic illness obviously deserves punishment.
So I guess the real question is: what is the goal? Help chronic illness, or punish people that do things we don't like?
Also, don't we already have laws for literally all the bad things someone can do while addicted? If not, then why is it bad just because they are suffering from a chronic illness?