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Comment by jollyllama | Hacker News Reader

They wouldn't be selling the placebos if the real stuff were accessible. That's the real answer. The article mentions this but just accepts the inaccessiblity of the real thing as a given.

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.

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> It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos.

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.

They also sell homeopathic drugs at that same store. So that at least should tip you off that not everything for sale can be trusted to be effective.

You don't need to know anything about the new stuff. 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.

That was 20 years ago. Plenty of people never experienced the good Sudafed and have no idea it moved.

Then it's also been enough time to think about bringing it back again. That's my whole complaint about this article, is that it fails to reach the correct conclusion.

> “Say I'm a normal person… How am I supposed to know that phenylephrine doesn't work?”

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.

I've bought allergy medication at the drug store before and they don't work for me. Is this the same thing as phenylephrine, which literally doesn't do anything? or is it different because my particular allergies did not respond to this medication? I don't think these two are the same thing, and it makes far more sense that if there is a medication added to a drug, being sold in a drug store, for treating a particular symptom, it should have actual clinical evidence it treats that symptom.

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?

Sorry you're having allergy problems. I only experience mild symptoms, so can't provide any more information than you've prolly found for yourself.

> "...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)

I don't think caveat emptor means that companies should be able to sell products they know do not work.

> you'd overdose on the acetaminophen first

which is a much, much worse way to go, apparently

User takes a large dose and dies -> "they should have used as directed"

User takes a large dose and gets high -> "why does big pharma condone drug abuse???"

I’m not sure. Another explanation is that it is accessible, with a small amount of friction.

But then drug makers realize they can get more sales by selling a placebo that won’t have the friction.

> The article mentions this but just accepts the inaccessiblity of the real thing as a given.

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.

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