[HN Gopher] The Uselessness of Phenylephrine ___________________________________________________________________ The Uselessness of Phenylephrine Author : hprotagonist Score : 427 points Date : 2022-03-30 17:26 UTC (5 hours ago) (HTM) web link (www.science.org) (TXT) w3m dump (www.science.org) | christkv wrote: | I remember somebody calculated the cost of making meth from over | the counter pseudoephedrine tablets and it would be the single | most expensive drug available. | hilbert42 wrote: | Derek Lowe makes a good point that we're wasting everyone's time | and money with useless phenylephrine and the fact that | pseudoephedrine is so much better as a decongestant. | | The fact is that pseudoephedrine is not only banned in the US but | it is also banned in many other counties for the same reason that | it's a precursor for meth. | | The trouble is that banning pseudoephedrine seems to have only | made matters considerably worse as I learned from this HN story a | few months back: https://news.ycombinator.com/item?id=29027284 | | Banning pseudoephedrine has led drug cartels to ramp up | production of the precursor P2P, phenylacetone, which, it seems, | is a better precursor anyway. It's worth reading this story in | conjunction with this one. As Lowe hints, given the | circumstances, we'd be better off going back to a decongestant | that actually works. | | Quote from the earlier HN story: | | _" Meth in the US shifted to P2P synthesis between 2009 and | 2012. | | In the before times, meth was made with ephedrine or | pseudoephedrine. However, in 2006, the US banned over-the-counter | sales of pseudoephedrine, and in 2008 Mexico banned almost all | sales. In response to this, meth makers switched to a synthesis | based on P2P, which can be made from many different, widely | available, source chemicals."_ | [deleted] | pwned1 wrote: | Pseudoephedrine isn't banned, you just have to ask the | pharmacist for it. | hilbert42 wrote: | Right, 'banned' is a blut word here, I suppose I should have | used 'restricted schedule' as per officialdom but the earlier | HN article used 'banned'. Incidentally, many countries have | banned it or made it only available on script (i.e.: where I | live). | | Never tried to get it myself since it went on script. | Personally, I find it repulsive stuff - makes me feel sicker | than the cold or flu alone so I no longer use it (makes me | feel queasy on the stomach). | blakesterz wrote: | The Wikipedia article they link to [0] has a pretty long list of | brandnames. Many of them are the "-D" version of whatever the | thing is. Claritin-D, Zyrtec-D and so on. I think the version | without the "-D" doesn't have Pseudoephedrine? | | [0] https://en.wikipedia.org/wiki/Pseudoephedrine#Brand_names | bvinc wrote: | In those cases, Claritin and Zyrtec are allergy medicines. The | -D indicates that this allergy medicine comes along with a | decongestant. The version without the -D will just be the | allergy medicine. | hammock wrote: | Specifically, drugs with -D indicate that they come with | pseudoephedrine. In the US, they (like the non-PE version of | Sudafed) are only available behind the pharmacy counter. | sp332 wrote: | It might not do much if taken orally, but a phenylephrine nasal | spray can be pretty powerful. | NoPie wrote: | This. Derek has missed that spray is rather effective. Also | other agents, such as oxymetazoline is used. They all have a | rebound effect, so their use should be limited to 7 days at | most. | | Also, this is mostly for comfort. There is no really reason to | go back to pseudo-effedrive and risk side-effect (high-blood | pressure etc.). Also people value their comfort a lot, they are | not so good with assessing risks. Apparently that is the | reasoning to continue selling phenylephrine because people want | to get something even if it is not distinguishable from | placebo. | djrogers wrote: | > Also, this is mostly for comfort. | | Spoken like someone who has never had _severe_ nasal | congestion. A week or two of not being able to sleep, taste, | or speak with your normal voice would change your view of the | importance of good decongestants. | genewitch wrote: | When i lived in california, this was a yearly ordeal. I | also found out that when a bottle says "do not use for more | than 4 days" they mean that. I very nearly choked on my | tongue because i couldn't move it in my mouth due to the | insane dryness, i didn't think it was even possible to | accomplish that level of dry. | | I discovered "neti pots" because in a bout of panicked rage | i snorted nearly an entire can of saline nasal wash, had | immediate relief, and went and bought my first plastic neti | pot. I never use deionized or whatever water, the chances | of toxins in my water is extremely low, and i usually just | do it in the shower anyhow, where there's hot water right | there. Sodium Bicarb + NaCl just works. | | More recently for the sort of dry allergy nasal stuff i | started putting mentholated petrolatum jelly directly in | and around my nose. I'm sure in 10 years i'll find out that | i'll get nostril cancer or something, but whatever, i can | breathe, thank you very much. | r2_pilot wrote: | Please use boiled water at least(and definitely not just | hot shower water) due to the possibility of Legionnaires' | Disease: | https://en.wikipedia.org/wiki/Legionnaires%27_disease | gojomo wrote: | So perhaps they should sell the sprays, for their topical | effectiveness, but stop the wasteful sales/promotion of pills. | ketchupdog wrote: | True, but they have a significant rebound effect. | mh- wrote: | Only relevant if you ever let it wear off. (/s) | selimnairb wrote: | First, I find that Phenylephrine works well enough as a | decongestant for me, without the jitters and heart palpitations. | Of course, others' mileage may vary. | | Second, how did this sentence: | | "There are a number of synthetic procedures for doing this, some | of them quite alarming, and several of which can indeed be | performed in the barn, garage, basement, or trailer park of your | choice..." | | make it through editing. This reeks of insensitivity and | classism. | tptacek wrote: | No, not really. Meth manufacturing is famously a scourge of | trailer park communities, where the manufacture itself poses | risk to residents that probably outstrip the risks of the drug. | Trailers and barns just happen to be an efficient place to | stand up makeshift meth labs. | sydthrowaway wrote: | I am suffering with a bad/cold flu right now and this has made me | mad as hell! What if someone is so sick they can't fathom to walk | into a pharmacy? | | Fuck senators. | djrogers wrote: | Thank God I have about 100 different people I could call and | ask to pick up medicine for me were I in that situation. | sydthrowaway wrote: | Lucky you. | stjohnswarts wrote: | Nothing works as well for allergies for me as zyrtec-d. I get the | 12 hour variety and just use benadryl at night. Luckily I only | need it a month or two out of the year. Don't know about taking | that stuff year round :) (pseudoephedrine) | perardi wrote: | I'm skeptical the regulations will ever get rolled back, because | it's just so trivially easy to get spooked by the idea of making | meth, but as mentioned in this article, I don't think | pseudoephedrine would become a _significant_ source of | methamphetamine again if it was made easily available over the | counter. | | Because the cartels have gotten really, _really_ good at making | meth. Extremely pure and extremely cheap, and the proper | psychoactive isomer. There's a massive supply of cheap and "good" | crank out there, so I doubt deregulation of Sudafed would really | make a blip in the total supply. | cmrdporcupine wrote: | Pseudoephedrine is a stimulant and not a particularly pleasant | one at that. Here in Canada there's still cold medicines with it | in them, and to be honest, when I see it, I avoid it. | | It may not be as good of a decongestant but phenylephrine won't | keep me up at night. And when I'm sick with a cold what I really | need is a good sleep. | jonhohle wrote: | I have the same feeling. I'm very sensitive to pseudoephedrine | jitters and do my best to avoid it. It may be placebo, but | phenylephrine "works" for me and can "tell" days that I forget | to take one in the morning when I have post nasal drip. Knowing | it should have no clinical effect, I'd be interested in | blinding myself to a placebo to convince myself it really has | no effect. | jfengel wrote: | I've certainly found it useless, and when I need a decongestant I | make certain I'm getting actual pseudoephedrine. The 12 and 24 | hour slow-release versions are fantastic. I've never done a | proper blind trial on myself, but I feel quite certain that I | could tell the difference. | | I suppose people must be buying it, and given how strong placebo | effects are in general I guess it's doing something for them. | tcherasaro wrote: | Same, Sudafed is a silver bullet for me. The 12 hour release | absolutely works to clear my sinuses and relieves the sinus | pressure headache (almost completely when combined with | ibuprofen). | | My wife insists Phenylephrine works for her and thats all she | will take. She has offered it to me a couple times when we | didn't have any Sudafed and Phenylephrine had 0 noticeable | effects for me. | | Edit: I forgot to add that Alavert-D 12 also has | Pseudoephedrine and works for me too and is what I take when my | congestion is allergy related. | mh- wrote: | One of many such studies: | https://pubmed.ncbi.nlm.nih.gov/19230461/ | | Keep in mind this doesn't say that it's not effective. It's | just not more so than the placebo effect, which is quite real | even on physiological matters. | thehappypm wrote: | The article suggests the uptake is widely variable person to | person so perhaps she's just a lucky one. | nvahalik wrote: | Same here. Actual Sudafed works for me and anything else I | think generally only tends to work with whatever NSAID they | bundle with it. | angry_octet wrote: | If there were a darknet way to buy medical grade Sudafed that | would be fine by me. | bigbillheck wrote: | I haven't really been able to take pseudoephedrine for a number | of years now due to getting heart palpitations with even a small | dose. Luckily fluticasone is available without a prescription and | I've had success with that. | 14 wrote: | It is sad that society has gone into such a protectionist stance. | In our great grandfathers day you could buy opiums and cocaine | you name it. Now everything is so locked up heaven forbid someone | abuses drugs. The problem with a useless drug like this is people | won't get the desired effect and start compounding more drugs | into their system. Like what I had to do with an abscesses tooth. | I don't abuse drugs, I no longer drink and don't smoke marijuana | I don't even drink coffee anymore. But when my tooth went bad all | I was allowed was Acetaminophen and ibuprofen which didn't even | come close to touching the pain. So I took extra acetaminophen | and ibuprofen anyways despite the risks out of desperation. Then | I started using copious amounts of oral gel tooth numbing | medicine which has benzocaine I believe which can also increase | heart rate I believe. I was so desperate for any form of relief | while I waited to get to the dentist that I was forced to abuse | anything I could get for relief that one narcotic medication | would have easily treated. I have often wished I could return | unused narcotics I have been given to show the doctors "look I'm | returning drugs I don't have an abuse problem I only use them for | pain control please continue being generous with them in the | future". | The_rationalist wrote: | Levo-methamphetamine is a legal decongestant BTW | ncmncm wrote: | Where does one obtain that? From the waste stream of the | methamphetamine producers? | somebodynew wrote: | It is sold over the counter in most US pharmacies under the | Vicks inhaler brand. The active ingredient label conveniently | uses a spelling that most people will not recognize which is | probably effective in preventing alarm from customers who | aren't familiar with the dramatic difference in the effects | of the two enantiomers. | The_rationalist wrote: | btw racemic meth is legally prescribed for ADHD under the | brand desoxyn, although it's probably hard to find doctors | prescribing it over regular amph | pkaye wrote: | Used to get Vicks inhalers with it. I don't know if its still | available. | starwind wrote: | A1 headline right there. Not clickbait, but right to the point | jrnichols wrote: | phenylephrine is a great drug in hospital for sepsis patients, | but as a nasal decongestant, it really is useless. | | the "war on drugs" push to restrict pseudoephedrine created more | problems than it's worth. "the new meth" has been even worse. | | https://crimeandjusticenews.asu.edu/news/chemically-differen... | | There's a really good Atlantic article about it as well (google | "the new meth" Atlantic) but it's behind a paywall. | caturopath wrote: | To quote the alt text from https://xkcd.com/971/ | | > Telling someone who trusts you that you're giving them | medicine, when you know you're not, because you want their money, | isn't just lying--it's like an example you'd make up if you had | to illustrate for a child why lying is wrong. | PaulHoule wrote: | It is even easier to make | | https://en.wikipedia.org/wiki/Methcathinone | | from pseudoephedrine. You can just oxidize PE with potassium | permanganate and purify the product... No need to risk blowing | yourself up the way you would making methamphetamine. | Reason077 wrote: | At least in the US and UK, you can actually still get | pseudoephedrine-containing products from a pharmacist. In some | countries (New Zealand!), it is prescription-only. Same with | anything containing codeine. | [deleted] | cwkoss wrote: | I had a friend who would keep pseudoephedrine in his glovebox to | be used for alertness in case he became drowsy driving. He was a | chem nerd, so was not particularly remarkable to me. | | I have to wonder if the restrictions on pseudoephedrine have | driven anyone to purchase meth. The safety profile of | pseudoephedrine is pretty good - I think it could be argued its a | good legal stimulant to offer to the public. | | Could increasing it's availability be a legitimate harm reduction | measure that would displace/prevent meth use among some | populations? | scythe wrote: | Doubtful. Caffeine is already a legal recreational stimulant. | What distinguishes methamphetamine/cocaine is that they are, | for want of a better word, prosocial. People don't just do | meth, they seek out other people who are also doing meth. | Pseudo will not fill that niche. | | There may be other "safe(r)" substitutes, such as HDMP-28 or | amfonelic acid or something, but they have to reproduce the | social function of recreational stimulants to _culturally_ | substitute. | cwkoss wrote: | Ah, yeah the social aspect probably can't be replaced by | pseudoephedrine. | | However, meth can be functional enough that I would guess | it's used for wakefulness/focus among a significant | proportion of users (especially in early stages of | addiction): truckers using it to drive longer, students using | it to study, graveyard shift workers using it to stay alert | while operating dangerous equipment, etc. These use cases | seem like they could potentially substitute pseudoephedrine, | and in doing so, could function as an "anti-gateway-drug": | users who solve their use case without the euphoria are less | likely to get addicted or transition into social usage. | tyingq wrote: | It's interesting how many younger people in the US aren't even | aware that the only useful decongestants are behind the counter. | I assume they just think there isn't a useful treatment for the | symptoms. | taeric wrote: | I remember when the over the counter stuff just seemed to stop | working. I just assumed that something about my body changed. | Took me a year or so to find that the ones behind the counter | still worked very well. | | I think I'm lucky, in that I don't really need too much help | that often. I can only imagine if my sinuses were as bad as | they were back in the day, though. | AaronM wrote: | If you get the chance, go read all of his (Derek Lowe) blog posts | about things he refuses to work with. Highly entertaining read. | genewitch wrote: | FOOF (or FOOOOOOF) | samatman wrote: | Thanks for pointing out the author, the headline is not news to | me and I would have passed on reading it. | oh_sigh wrote: | Strange that you were reading all the comments about the | article you weren't interested in... | samatman wrote: | I didn't say I wasn't interested in the [headline] I said | it wasn't news to me. It's a topic I find interesting, and | as it turns out, by an author I already enjoy. | | The article was not informative [to me], but it was fun | reading. _Since_ it was not informative to me (as I deduced | correctly from the headline) I could have easily read the | comments and not the article. | | Hope that helps! | astrange wrote: | The problem with this advice (which gets posted to all of his | articles) is those posts aren't meant to all be read at once. | They're basically all the same thing, which is why he hasn't | written any new ones recently. | | I still want to know what isocyanide smells like. | floren wrote: | My assumption has always been: people know pseudoephedrine works, | so that's what they want to buy, but you can no longer sell | pseudoephedrine over the counter. However, you can offer | phenylephrine, which still lets you reasonably name the drug | "Sudafed PE" or whatever. Customer browses the shelves, sees "PE" | in the drug name, this triggers a vague impression that it | contains pseudoephedrine and thus will actually work well. | denimnerd42 wrote: | or maybe like sudafed pe is an advertisement, a reminder to | check behind the counter for the real thing | floren wrote: | The "PE" stands for "placebo, essentially" | dkryptr wrote: | That's essentially the selling point behind Zicam and other | homeopathic drugs. | smm11 wrote: | I'd be crippled without Bronkaid. | | And weed. | djrogers wrote: | I'm not sure mixing uppers and downers like that is a great | idea, but Bronkaid has been a life saver for me. | HL33tibCe7 wrote: | Reminds me of docusate, a very commonly prescribed "Laxative". | The problem? There's seemingly barely any evidence that it | actually works. And plenty to suggest it has no effect over that | of a placebo. Yet there's a culture of prescribing it, so on | prescribed it goes. | insickness wrote: | Wow. I've purchased more than a few bottles of ducosate. But it | looks like you're right: | | Reevaluating the Use of Docusate in the Management of | Constipation https://www.drugtopics.com/view/reevaluating-the- | use-of-docu... | munificent wrote: | My drug of choice for colds is NyQuil. It's always been great for | opening up my nasal passages enough to let me breathe easily and | then knocking me the fuck out so I could sleep off most of the | cold. | | I remember several years ago when all of a sudden NyQuil stopped | doing anything useful. I had no idea why but I directly observed | that it was like it had been replaced with a non-functioning | placebo. | | Only a couple years later did I make the connection that this was | right when they passed the law restricting pseudoephedrine. I got | my hands on some NyQuil D and everything was back to normal and I | had a functioning cold remedy again. | | Phenylephrine is completely useless. | lkxijlewlf wrote: | Probably would be better to take two shots of whisky, a | teaspoon of honey and a shot of Afrin in each nostril[0]. | NyQuil isn't what it used to be. | | [0] Careful, you can easily form an "addiction" to this med. | 542458 wrote: | In Canada you can find cough & cold medications in both the | Phenylephrine and Pseudoephedrine formulation, often under | near-identical labels (IIRC one can buy "Tylenol Cough and | Cold" with either active ingredient, for example - carefully | checking the label is the only way to tell). I didn't realize | there was a difference until one day after running out of | Phenylephrine-based medication I bought the Pseudoephedrine- | based one - it was a night and day difference! Now I tell | everybody with a cold to check the labels and buy the good | stuff. | | Interesting case study in being able to sell a low-quality | product (one of the most important active ingredients doesn't | work!) side-by-side with a much better product and most people | won't ever notice that one is better. | JPKab wrote: | In US, same deal, but you have to show your ID at the counter | to obtain the pseudophedrine version. Phenylephrine is so | useless. Nothing worse than getting to a store after pharmacy | hours and being forced to only get the useless garbage. | joezydeco wrote: | Original NyQuil also had a healthy shot of ethyl alcohol in it. | Exactly the thing you weren't supposed to mix with | pseudoephedrine. | sva_ wrote: | I believe you're just not supposed to drink alcohol on | Pseudoephedrine because you'd be combining an upper with a | downer, and it's very easy to go overboard with the downers | when you're on an upper (tolerance to alcohol increases | dramatically and increases overdose risk along with all the | other side effects and risks.) | | So a small amount of alcohol won't really have much of an | effect, I'd claim. | joezydeco wrote: | In my experiences with old NyQuil it was enough to make you | drowsier. And getting to sleep was the primary objective of | NyQuil. | | Back in my college days you could replicate it with one | 30mg Sudafed and a shot of Jagermeister. =) | sva_ wrote: | > NyQuil | | I don't know about this medication in particular (since I | don't live in the US), but I see it contains DXM | (dextromethorphan), which is a dissociative (such as ex. | ketamine), which probably causes the effects you | described. I'm seeing it also contains acetaminophen, | which probably makes it hard on your kidneys, if you take | too much, so that is probably why people don't abuse it | more (I guess or hope). | genewitch wrote: | in the US Robitussin DM is the one you get if you aim for | disassociation(?) - NyQuil is explicitly a sleep aid with | some other stuff mixed in, I'd have to go dig a bottle | out but i think the active ingredient is an anti- | histamine (diphenylhydramine i think) - as a sleep aid, | mind you. It is true that NyQuil used to have alcohol, | and didn't have DXM or acetaminophen. If the liquid you | are looking at is Orange, that's the "daytime" stuff, and | that's overpriced garbage. | | One could buy generic "tussin DM" (or pill form of | dextro), mucinex (for guafenasin), and benadryl (or | generic diphenylhydramine) to get the same usefulness | that a bottle of liquid NyQuil has. | Damogran6 wrote: | Didn't they also drop the alcohol percentage? It's 10% now (I | know this because post Covid I seem to be catching EVERYTHING), | I could have sworn it was 14% or higher growing up. | InCityDreams wrote: | Maybe if people wore masks you'd catch less? | | Based on.... How much i respect/ed (mostly) Asian cultures | that wore masks pre-covid. | tptacek wrote: | _Eschew flamebait. Avoid unrelated controversies and | generic tangents._ | | https://news.ycombinator.com/newsguidelines.html | djrogers wrote: | This may be regional, but it's been 10% here for as long as I | can recall - although the alcohol free version is much more | prevalent than it used to be. | fullstop wrote: | This works for one or two nights with me, and then it feels | like I've built up a tolerance to it and I think that it | actually keeps me awake. I'll use it if I have a cough which | keeps me awake, and, if I time it right, I'm pretty good at | recovering within a day or two. | munificent wrote: | Yes, I have the exact same response. If I take it more than a | few days, I'll get a rebound effect. | | My strategy is to take it full strength for a day or two and | then taper it off gradually for the next few days after that. | nostromo wrote: | American law is so disjointed. | | On one hand, we're decriminalizing drugs. Pot is widely legal | now. Other states are allowing mushrooms and LSD. Cocaine and | heroin are not legal, but have all but been decriminalized on | the West Coast. | | Meanwhile it's harder than ever to get pain killers from your | doctor, even when you have a demonstrated need for them. Same | with ephedrine -- a very useful drug -- it's very difficult to | get even when in need. And if you mention enjoying tobacco | products, you're treated as a leper. | | I wish we had a self-consistent view of the issue. | noobermin wrote: | There is probably some truth to this but it is worth noting | the opiod epidemic is largely why it's hard to get pain | killers now. A few of the pharma companies have settled that | they sort of knew people were taking them from pharmacies and | selling them on the black market. | ianai wrote: | "Cocaine and heroin are not legal, but have all but been | decriminalized on the West Coast." | | Citation needed. Never heard this before now. Or is this just | some California thing? | svnt wrote: | In several cities they are now citations. You may get a | fine for possession but you will not be arrested. In | Portland for example the ticket is around $150, which is | about the same as the fee for an expired vehicle | registration. This change in policies has basically stopped | enforcement. As you can imagine it is not a profitable | practice to ticket the unhoused. | munificent wrote: | It's not inconsistent to treat different things differently | and different drugs are _radically_ different in their | individual health and societal effects. | | I live in Seattle where marijuana is legal. Alcohol and | marijuana are widely consumed and I rarely see any large- | scale problems from it. Obviously, there are many people who | can't handle either of those, but their failure to handle it | well seems to not impinge on others as much. And, compared to | them, there are a huge number of people able to consume | alcohol and marijuana in a safe, healthy, non-problematic | way. | | I also live next to a couple of homeless encampments. Many of | the people living there are clearly addicted to opioids | and/or meth. In _just this month_ and _within a mile of my | house_ : | | * I saw a woman, topless, brandishing an umbrella, wandering | between the sidewalk and into the street screaming at no one. | | * A man was shot in the stomach in front of a food bank. | | * Another man was shot in the neck at an encampment. | | * A drive-by shot up an RV and car. (The people inside | fortunately weren't hit.) | | There's more I'm sure but these are just the ones I know | about in the last few weeks. | | It's entirely consistent to say that we should treat drugs | that lead to the latter behavior differently from drugs that | don't. Opioids and meth are incredibly destructive. I'm not | saying what specific policies I advocate for them, just that | it is reasonable to have _different_ policies for those drugs | compared to others. | afiori wrote: | I believe the parent is referring to policies about how | addiction is defined; a good article on the matter is | | https://slatestarcodex.com/2019/09/16/against-against- | pseudo... | | Essentially by rules a patient asking for higher dosage of | an addictive drug is automatically seen as a sign of | addiction, even if sometime it might just be that the | current dosage is too low. | ray__ wrote: | The fallout from the over-criminalization of opioids, meth, | etc is a big reason that you're observing these behaviors. | Stigmatizing drug use perpetuates the punitive approach to | this problem. If the law treated addiction and the abuse of | hard drugs with compassion rather than the draconian | approach that we have in place currently you'd be seeing a | lot less of this stuff. | | This post could have easily been written about alcohol in | the prohibition era. We've since learned that criminalizing | alcohol makes its impact on society worse rather than | better. We can't strip drug users of their autonomy and | their ability to lead any sort of normal life and then act | surprised when they turn to crime or turn back to drugs | when they have nothing left. | lamontcg wrote: | You don't see anyone who is using opioids in the privacy of | their own home who aren't out on the streets, so your | sampling is massively biased. | | And the way we should look at drug addition with opiates | isn't by looking at the homeless users, but consider the | fact that we're all potentially one bad car accident away | from getting hooked on pain killers, and asking what kind | of support we would need to avoid winding up homeless due | to that. | | Punishment via the criminal justice system is what is | likely to wind up with you losing your job and winding up | out there in that camp with them. So how should you be | treated if it happens to you? | | And the glib answer of "put a bullet in my head" or | whatever isn't an acceptable response. Treat the problem | seriously and propose how society helps you help yourself | to get clean without at trip through a homeless camp. And | the people who refuse to deal with the reality that it | could happen to them or engage with the problem are likely | those most at risk of lacking the self-awareness to | recognize when it starts happening to them. | coward123 wrote: | >all but been decriminalized on the West Coast. | | There's talk that WA is going to introduce a bill in the next | session to completely decriminalize. | rangersanger wrote: | I just finished reading The Urge: Our history of Addiction. | If you're interested in some background on how we got here, | the author does a great job of laying out the historical, | legal, and social constructs that have resulted in the | inconsistent mess. | | https://www.harvard.com/book/the_urge/ | mise_en_place wrote: | From what I've read, d-amphetamine[0] was the decongestant of | choice for much of the 20th century. It's just that the | counterculture weirdos were abusing it and that led to its | restriction. Compared to pseudoephedrine its way more useful | with minimal side effects like drinking a cup of coffee. | | [0]https://www.theatlantic.com/health/archive/2012/04/the- | lost-... | erosenbe0 wrote: | That's dangerous to think it's the same as coffee. You can | have a daily coffee when pregnant but we don't know about a | daily dl-amphetamine. Not even close to the same side-effect | profile. Coffee doesn't dilate your eyes, for starters. It's | just not the same as a dopaminergic | astrange wrote: | Dexedrine is a normal ADHD medicine so this has been | studied and it seems fine. | | eg | https://journals.sagepub.com/doi/10.1177/1087054719896857 | erosenbe0 wrote: | This is really good news but hardly a comprehensive meta | analysis over thousands of infants. | joecool1029 wrote: | I mentioned in my last comment that Sudafed had effects in | treating my ADHD. | | Ultimately I couldn't use it this way more than a few days a | week or I'd get lower back pain. I've also tried steeping | ephedra tea but did not notice any effects on concentration. | | Later on when I was formally diagnosed and prescribed proper | meds I was placed on Adderall first and had similar unwanted | side effects after a time. Ultimately, I settled on Dexedrine | and no more side effects (other than insomnia if I take it | too late) and haven't felt a need to up the dose for years | now. It does still have decongestant effects like the other | two. | | Considering I'm caffeine dependent and can't cycle off daily | intake without crippling headaches, where I cycle Dexedrine | off on the weekends/holidays without any withdrawal effects, | I'd have to agree: So long as it's a therapeutic dose it's | on-par or safer than coffee. | nimish wrote: | Counterculture weirdos and Paul Erdos | hammock wrote: | NyQuil is a combination medicine. The cough, cold and flu | formula contains Tylenol (fever/pain reliever), DXM (stops | cough) and an antihistamine (dries out your runny | nose/postnasal drip). | | NyQuil can be a great all-in-one product when it's what you | need. It's useful to know what it is composed of and why. All | of the medicines in it treat symptoms, not the underlying | cause, which will be fought off by your immune system. If you | have only one or two symptoms, you can always buy each drug | separately - doing so allows you to more precisely control | dosage and timing as well. | | FYI, two other common symptoms not covered above are sinus | congestion - which can be treated with Sudafed - and chest | congestion (e.g. a phlegmy cough) - which can be treated with | Mucinex. | bcrescimanno wrote: | Prior to the regulation of pseudoephedrine, NyQuil _also_ | contained pseudoephedrine and since the nasal congestion from | a a virus can often be the most disruptive factor for sleep | (at least, in my personal experience, that 's the case) it's | considered by some to the be most important component. | | NyQuil with pseudoephedrine included is now marketed as | "NyQuil D" and is available behind many pharmacy counters | with the same restrictions as other pseudoephedrine products. | However, it could also rightly be called "NyQuil Classic" (to | borrow branding from Coca-Cola). | vidanay wrote: | We haven't been able to find NyQuil D for almost a year | here in Illinois | Robotbeat wrote: | I feel like the true "Cocaine Cola Classic" would still | have some of that, um, _regulated_ stimulant in it. | Cocaine. Might be good for decongestion? | rscho wrote: | Cocaine is indeed an excellent decongestant. To the point | that it'll pierce a hole through your nasal septum | through vasoconstriction. | genewitch wrote: | afaik coca cola is the only entity in the US allowed to | import actual coca leaves, so, technically? | Cannabat wrote: | I'm not sure if it is still legal, but importing "coca | tea" - that is, tea bags filled with shredded coca leaves | - was legal at some point and a few enterprising folks | imported a few kilos of it and processed it into the | drug. | hammock wrote: | While true, the cocaine is processed out of the leaves | themselves and sold to pharmaceutical companies. The | remaining leaf product is used in the flavoring. | tshaddox wrote: | DXM doesn't actually suppress cough either, right? | hammock wrote: | According to whom? | lostcolony wrote: | Sort of! There isn't consistent evidence that -any- | antitussive is more effective than placebo. A majority of | studies show a statistically significant result for DXM, | but not all, and they aren't fully replicable which | definitely calls it into question. But that's true of every | purported cough suppressant, and there's understandable | reasons for that; coughing is a voluntary response to | irritation, so there's definitely a lot going to determine | whether you cough or not on beyond a purely autonomous | system response. Plus there's not really much clarity in | how to measure improvement (reduction in frequency may not | actually be a reduction in irritation; reduction in | severity is hard to measure. Etc). | | So, really, for a given incident, try it, see if it helps. | If it does, great, if it doesn't, stop taking it. | fpgaminer wrote: | NyQuil also contains alcohol and pseudo (in some | formulations). | | My pet theory is that NyQuil's biggest effect is simply to | make you mildly "faded" so all your symptoms are more | tolerable. DXM, the antihistamine, the pseudo, and the | alcohol are all drugs that would definitely do that if taken | in larger doses. While NyQuil doesn't have those larger | doses, the combination of all of them may amplify the | otherwise weaker effects into a general buzz/haze that helps | you go about your day/night. | lostcolony wrote: | Multiple clarifications - | | Antihistamines do not directly dry up your runny nose/post | nasal drip. Rather, they reduce the histamine response, which | is helpful when something is caused by allergies. It's | usually not that helpful with an actual cold (but allergic | rhinitis is often mistaken for a cold). | | Sudafed is what the parent was referring to with | Pseudophedrine; a decongestant. This works by shrinking blood | vessels, causing swollen passageways to open back up. It | doesn't actually do anything to reduce the runny nose or post | nasal drip, but by opening the passages more can help them | drain more efficiently, preventing that feeling of congestion | (hence the name). | | Guaifenesin (Mucinex being the name brand) is an expectorant; | it causes you to generate more mucus, and reduces the | viscosity, allowing you to cough/sneeze/etc your mucus/phlegm | based congestion out more easily. | | Otherwise I totally agree; it is worth understanding what | each of these do so you can pick and choose what you need. | Nyquil includes DXM (dextromethorphan) to reduce cough | severity, but the acetaminophen is not helpful unless you | have a fever or headache, and the Doxylamine Succinate and | Phenylephrine (both antihistamines; the Doxyl is added to | Nyquil because it's also a sleep aid) aren't particularly | helpful unless your cold symptoms are actually allergy | related. | | Better to buy DXM separately usually; fewer side effects, | cheaper, and you can pair it with what else will help you (if | you need something to help you sleep, you can add Doxyl or | Diphenhydramine if you want; YMMV as to how effective they | are) | | Don't take Guaifenesin before bed (the increased mucus/phlegm | production will make it harder to sleep), but it's good | during daytime. | | A common side effect of Sudafed is trouble sleeping; if you | don't have this side effect it can be helpful in reducing | congestion while you try and sleep, but if you do have this | side effect, obviously, don't take it before bed. | nsxwolf wrote: | Do any of these compounds actually do what they say? I have | always found all cold medicines to be entirely worthless. | Supposedly a study found guaifenesin to be no better than a | placebo: | | http://rc.rcjournal.com/content/59/5/788 | cheald wrote: | Phenylephrine is utterly useless on me. Maybe it works for some | people but it may as well be Pez for all the good it does me. | | I make it a point buy a pack of actual pseudoephedrine from my | pharmacist every 6 months or so, to ensure I have a stock when I | need it. Fortunately, I don't need it too often, but there's no | good substitute when I do. | cperciva wrote: | Pseudoephedrine is wonderfully effective, but beware of its side | effects. | | I used to take it regularly due to congestion related to seasonal | allergies, but at a recent medical visit I discovered that my | blood pressure had jumped from its usual 120/75 up to 150/105. | (My doctor was also alarmed!) I no longer take pseudoephedrine. | | I'm told that the effect on blood pressure is _usually_ mild, but | based on my experience I 'd recommend blood pressure monitoring | to anyone planning on using it, just in case (like me) they're | one of the unlucky people who experiences a dramatic increase in | blood pressure. | genewitch wrote: | there was a study published february 2022 that showed that | acetaminophen _also_ increases blood pressure. I was pretty | aware that both pseudoephedrine and ephedrine raised blood | pressure _slightly_ - but it 's always good to see it mentioned | online where other people may not have known. | cperciva wrote: | In my case, I was taking ibuprofen+pseudoephedrine, so | acetaminophen wasn't a confounding factor. | | And yes, there's plenty of literature showing a slight | _average_ increase in bp -- but it seems that there 's a wide | variance, with some people having dramatically larger side | effects. | asdff wrote: | How did you control for the pseudoephedrine in this experiment? | VLM wrote: | I'm not OP, but its elimination half life is about six hours, | so you'd superficially expect OP's BP to drop in a curve with | a half life of six hours after the last dose. It would be | really easy to chart with one of those wrist BP monitors and | an excel spreadsheet. | cperciva wrote: | I stopped taking pseudoephedrine and the following day my | blood pressure was back to normal. | 60secz wrote: | The herb ephedra (Ma Huang/Mormon Tea) contains appreciable | amounts of ephedrine and is prepared as a tea in Chinese medicine | as a remedy for asthma and cold congestion. | | It can easily be purchased online and the ephedrine ban does not | apply to it. | | https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant... | jacobmartin wrote: | Any idea how pure or clean these online sources are? | meepmorp wrote: | NB: ephedrine and pseudoephedrine are related (they're | stereoisomers), but are different drugs with somewhat different | pharmacokinetics. | pstuart wrote: | This is one of the more benign bits of stupidity that is The War | On Drugs(tm). | dataangel wrote: | I've recently had to deal with the medical profession a lot more | than in the past and I'm finding this sort of thing everywhere. | OTC medicines that by current standards would not be made OTC, | _surgeries_ that are extremely common but have never had quality | randomized trials, official sounding diagnoses that on inspection | are actually defined as "we have no idea", lack of consensus | about how to treat some of the most common conditions in the | human population (e.g. back pain), medical device approvals | abusing the shortcut of being "substantially similar" to an | existing device to evade regulatory scrutiny, the complete lack | of enforcement of what goes in supplements... I feel like my | entire understanding of the medical system in the US was a lie. | We're constantly touting that we have the most advanced | technology but if you have a complex condition you are likely to | fall prey to multiple kinds of grift. | tastysandwich wrote: | Nowhere is this more evident than in the treatment of | endometriosis. | | It seems like even gynaecologists are woefully ignorant & | untrained in this disease, leading to so much unnecessary | suffering by women (my wife included). | | Guys & gals, if you or your partner suffer from endometriosis, | listen up! | | * Find the best gynaecologist you can that specialises in endo | & can perform excision surgery. | | * Burning off the lesions (ablation) is _not_ an effective | treatment. Excision surgery is by far the most effective | current treatment. Unfortunately, it seems like many | gynaecologists do not have the training to perform this | surgery, and therefore don 't even mention it (lest they lose | your valuable business). | | * There is absolutely zero evidence that pregnancy "cures" | endometriosis, despite doctors continually repeating this myth. | My wife's awesome gyno told us - and you can research yourself | - that this is absolute rubbish. | | https://theconversation.com/pregnancy-doesnt-cure-endometrio... | | It causes me to wonder when I go see a doctor, what else are | they ignorant about? I like to think I can defer to their | expertise, and set my mind to other things. Maybe not. | tpoacher wrote: | It's not just the US, it's pretty much the same everywhere. | | Ex-doc here. | petschge wrote: | And now I am reminded of | https://dx.doi.org/10.1136%2Fbmj.327.7429.1459 and the fact | that there is no randomised controlled trials that show the | effectiveness of parachutes either. | astrange wrote: | As of 2020 there wasn't an RCT for surgical masks being | helpful in surgery. | thedailymail wrote: | Au contraire! https://www.bmj.com/content/363/bmj.k5094 | petschge wrote: | Note that this is the study that prompted the study I | linked to. But yes, worth a read too. | travisathougies wrote: | You seem to be under the impression that there is some | 'advanced technology' out there that will magically solve your | problems that the US fails to have. | | In my experience, many people have a quasi-religious belief in | the capability of modern medicine to perform what would | otherwise be called a miracle. This belief is typically held | without any evidence whatsoever. | | In reality, there are a plethora of conditions, some very | common and serious, that medicine simply has no idea how to | treat. The set of completely treatable / curable conditions is | much much much smaller than the set of all possible diseases, | yet people act as if it's the opposite. This is why things like | 'evidence based' medicine is so dangerous -- we don't have | evidence for the vast majority of impactful conditions, simply | ignoring patients with these conditions is not a workable | solution. | tayo42 wrote: | > many people have a quasi-religious belief in the capability | of modern medicine to perform what would otherwise be called | a miracle. | | That's probably because miracles are being pulled off on | ocassion | opportune wrote: | The problem with empowering people medically is that 10% of | people will benefit from it but 90% of people will get info | from Facebook and infomercials and fall victim to quacks. | Hence everything being gated behind credentials and | prescriptions (along with some good old regulatory capture). | | I disagree with the characterization of medicine not being | able to treat so many things. Many things are incurable but a | lot of medicine/public health is so effective we barely think | about it. Of course we are going to notice and pay more | attention to the things medicine sucks at treating, because | they're real problems that inflict a lot of pain due to the | lack of treatment. | | But medicine is very good at treating plenty of things like | infections (of many different kinds), traumatic/acute | injuries, and many disabilities. Most of the chronic issues | that medicine fails to address are simply lifestyle issues | that medicine tries to alleviate the symptoms for. Yes there | are certain conditions medicine doesn't begin to fully | understand like Alzheimer's or various chronic pain | conditions, or where treatment is still pretty middling like | Cancer, but a lot of the biggest things are treatable very | well - we just don't notice them much because they are | treated so well. | s0rce wrote: | Since when is "evidence based medicine" defined as ignoring | patients with currently untreatable conditions. There are | enormous amounts of funding and effort constantly devoted to | developing new treatments. I'm not sure how else you want to | practice medicine other than "evidence based". | jl6 wrote: | I feel proponents of evidence based medicine are perfectly | aware of the enormity of the problem, and are working hard to | improve the situation. | twofornone wrote: | But the point is that laymen are not, and they put too much | faith, on average, into our medical institutions. | | Our understanding of the human body has advanced enormously | with the advent of modern science, but it is still far less | complete than most people probably realize when they | interact with doctors. Not to mention systemic issues | (common to any technical discipline) where medical | professionals have to effectively practice with a degree of | faith because no one has time to actually review the | literature underpinning any given consensus, and that | occasionally breeds long lived orthodoxies which do more | harm than good... | SalmoShalazar wrote: | Who exactly should the laymen put their faith into if not | medical institutions? That, and the scientific process, | are all we've got. | ipaddr wrote: | Medical practice and research can be decades away from | each Other. Use your own judgement. Smoking was a weight | cure before it wasn't. | ajross wrote: | > In my experience, many people have a quasi-religious belief | in the capability of modern medicine to perform what would | otherwise be called a miracle. This belief is typically held | without any evidence whatsoever. | | Modern medical results would _absolutely_ be viewed as a | miracle to someone just a few decades back. Something like | 90% of cancer cases are either cured or successfully | suppressed (to the extent that the sufferer ends up dying of | some other cause). Almost all endemic diseases have vaccines. | Virtually no one dies of a bacterial infection today. Even | most autoimmune disorders have effective treatments now. | | The fact that there are problems yet to solve in medicine, | and remaining voodoo in its practice, still doesn't change | the fact that we're living in a miraculous age. | chimeracoder wrote: | > Something like 90% of cancer cases are either cured or | successfully suppressed (to the extent that the sufferer | ends up dying of some other cause). | | This is not correct. It's true in the US for prostate | cancer, which is one of the most notoriously treatable | forms of cancer, but it's not true for cancer at large. | | (It's also not true for prostate cancer in many other | developed countries, which actually have a worse track | record at treating cancer than the US does) | greedo wrote: | 90% of cancer cases are cured or suppressed? I have to call | BS. Cancer is the number two cause of death in the US. | eurasiantiger wrote: | That just goes to show how unfair the medical system | there is. Not everyone can afford treatment, and those | who cannot are already otherwise more at risk due to the | affordability of processed foods imposing unhealthy | "lifestyle choices" as well as downright hazardous living | and working conditions. | chimeracoder wrote: | > That just goes to show how unfair the medical system | there is. Not everyone can afford treatment, and those | who cannot are already otherwise more at risk due to the | affordability of processed foods imposing unhealthy | "lifestyle choices" as well as downright hazardous living | and working conditions. | | I get that this explanation fits with a common | preconception of the US, but it doesn't bear out in | reality. The US has a _higher_ survival rate for all | common types of cancer than all other developed | countries, and this has been consistently the case for | the last three decades. | | https://www.thelancet.com/journals/lancet/article/PIIS014 | 0-6... | robotresearcher wrote: | UK data from 2010-2011: | | "Half (50%) of people diagnosed with cancer in England | and Wales survive their disease for ten years or more" | [0] | | Since lots of cancers and lots of deaths are in old | people, 10 year survival is quite a high bar. | | [0] https://www.cancerresearchuk.org/health- | professional/cancer-... | chimeracoder wrote: | > "Half (50%) of people diagnosed with cancer in England | and Wales survive their disease for ten years or more" | [0] | | Lumping all forms of cancer together is misleading, | because cancers have dramatically different mortality | rates. You need to separate by type of cancer, or else | you're really just measuring the relative prevalence of | different cancers. | | As it turns out, the UK has a relatively low survival | rate of cancers compared to other developed countries, | including the US. | | https://www.thelancet.com/journals/lancet/article/PIIS014 | 0-6... | Spooky23 wrote: | We have miracle cures for many things, but medicine is worse | than ever. | | I grew up with ER doctors. There are dozens of things that | would have killed you on 1990 that you'll walk away from | today. | | But in the slow transition from a professional discipline to | a sort of IT help desk for health delivery, billing comes | first, and even that sucks. | AussieWog93 wrote: | >In my experience, many people have a quasi-religious belief | in the capability of modern medicine to perform what would | otherwise be called a miracle. This belief is typically held | without any evidence whatsoever. | | I found the same thing for science in general. When I did my | PhD and saw how the sausage was made, I was blown away by how | obviously unscientific and irrational the entire process of | science was. | csnover wrote: | The messaging in the US most commonly used to justify the | lack of universal coverage and unreasonable cost of care is | that we pay the most because we get the best treatments and | best doctors and best outcomes, so I don't think it's fair to | blame laymen for believing that. | | Also, it's not just patients that think this way. (Or, at | least, if the clinicians know, they aren't saying much to | their patients.) | | I've had docs gush about amazing wonder drugs, then I go and | read the actual Phase 3 trial data on the patient information | sheet and it has a 15% _response_ (not remission) rate. I've | been told I'm being given a "gold standard" treatment--but | not that the "gold standard" response rate is actually only | about 33%, and in another ~33% of cases it makes things | worse. | | I've had doctors refer me for surgery, tell me about how | amazing the surgeon is, what a great job they'll do, that if | their own kids were sick they'd send them to this person. | When I ask for hard data on the surgeon's actual success rate | for this type of surgery, well, they don't track that--but | look, just trust me, the guy's realllyyy good. | | Out of dozens of specialists I've seen over the years, I've | only had one ever explicitly acknowledge that, yes, I had a | real problem, but modern medicine just was not advanced | enough yet to identify the cause, so they're just kind of | winging it. For the rest, there are "many new options", | "great responses", "positive outcomes", "extremely effective" | --or there's nothing wrong with you, it's all in your head, | and the princess is in another castle. | rscho wrote: | > When I ask for hard data on the surgeon's actual success | rate for this type of surgery, well, they don't track that | --but look, just trust me, the guy's realllyyy good. | | For good reason. Tracking of clinical outcomes is the wet | dream of insurance companies. It's very toxic to the | healthcare system, because it pushes practitioners to focus | on easy cases where a good outcome is expected and causes | major inequalities in access to healthcare. | | I'm not saying the present situation is ideal, but for the | system as a whole in its current form, tracking clinical | outcomes is a very bad idea. | wins32767 wrote: | Risk adjusted scoring is entirely viable in this age of | data science, there is just no appetite for it. Doctors | fight very hard against it because who actually wants to | be held accountable for outcomes? | | Insurance companies really aren't the villains in the US | healthcare system, they're going to make money no matter | what because they pass cost increases on to their | subscribers and are capped in how much profit they can | make via regulation. | rscho wrote: | Risk adjusted scoring is currently absolutely not viable. | You underestimate the messiness of the healthcare system | by a huge margin. We don't even manage to record basic | vital signs consistently, so believe me when I tell you | that you can forget about any kind of nice statistical | trick given the weakness of our data gathering processes. | Plus it's not a matter of objectivity. Surgeons will | subjectively assess that doing easy cases will be better. | And in addition, they'll be correct. That's what really | matters. | AussieWog93 wrote: | >Risk adjusted scoring is entirely viable in this age of | data science | | It's just not unviable, I don't think it's even possible. | As soon as a metric becomes tracked, people are | incentivized to game it. | | From my own experience as a very high-volume eBay seller, | mandating a certain return rate led us to simply | discourage customers from using the (convenient, well- | designed) integrated returns systems. Mandating that only | a tiny fraction of a percentage of items can be cancelled | due to being out of stock leads to sellers sending either | the wrong item or a fake tracking number (this gets us | all the time on AliExpress). | | If data-driven software companies can't handle it for | something as simple as eCommerce, I have no idea how the | medical industry is supposed to get it right. | melq wrote: | A good portion of the largest insurance companies are | non-profits, look at Blue Cross Blue Shield and their | affiliated companies. They still make tons of money, keep | tons of cash on hand, enjoy the same high salaries as | for-profits (not saying they necessarily shouldn't), and | get special tax statuses/breaks. | | And the for profit ones are making plenty of money | whatever regulations theyre subject to: | | >During 2010, Health Care Service Corporation, the parent | company of BCBS in Texas, Oklahoma, New Mexico, Montana | and Illinois, nearly doubled its income to $1.09 billion | in 2010, and began four years of billion-dollar profits. | | I'm not saying they're villains, but "they're going to | make money no matter what" isn't a compelling argument to | me, and I have precisely 0 faith in the government to | meaningfully regulate them. | csnover wrote: | I could see that problem occurring if the metric was | "what is the success rate of everything that Surgeon X | does". I can't see that problem occurring for "Surgeon X | performing Procedure Y has N% of patients reporting | relief and M% of patients reporting complications after | the surgery". What am I missing here? | | Edit: Follow-up question: notwithstanding the dysfunction | of congress and the ability of companies to find | loopholes, and assuming no universal health care to | eliminate the role of insurers, surely a solution would | be to prohibit the use of this information in the same | way that ACA prohibits the use of pre-existing conditions | to deny coverage? | lcuff wrote: | In my mind it gets worse when the procedure is | identified: A difficult shoulder surgery by an orthopedic | surgeon gets refused because it might be result in a | mediocre outcome and lower his 'success' rate. The | patient can't get the surgery because no surgeon wants to | 'risk' his success rate numbers. | grog454 wrote: | Seems like a good system to me. If a doctor expects a | lower _than average_ success rate for performing some | specific operation, he should let some other doctor do it | anyway. | lcuff wrote: | In my mind it is not a good system, because if the | surgeon is looking at a much-more-difficult than average | circumstance, than he could reasonably expect a lower- | than-average result, but a result that might be much | better than average for a case so difficult. | | As a separate observation, any time data is kept, turned | into metrics that then become the basis for goals ("I | want to have a better-than-average success rate, as a | surgeon") then the system gets gamed. | | I had a boss once propose to down-rate agile teams that | didn't get done everything they took on in a sprint. He | apparently didn't realize that teams would immediate game | the system by taking on less actual work. They could up | their 'point' estimates for each task, and always get the | work done. | grog454 wrote: | I think you are right that there is a natural and | understandable psychological resistance to a data-based | evaluation system. I understand that the doctor may | realize something about the patient that will lower | his/her chances of success. | | I'm arguing that a sufficiently comprehensive system | would take in to account whatever that doctor realized | (and perhaps much more) and _compensate_ for it when | determining expected outcomes. | lcuff wrote: | I'm guessing that the bureaucracy of such a system would | be a significant burden. To avoid having the system badly | gamed, you'd need a second evaluation, yes? By a | _neutral_ party, (not a doctor working in the same | practice, e.g.) At added cost and time. Not to mention | I've heard more than one surgeon say "That was more | difficult than I expected based on the imaging ... once | we got in there we found <>". | | I'm also arguing that it's not just a psychological | resistance to a data-based evaluation system. That people | understand the system would be subject to being gamed, | and the overall quality of the work would actually | suffer. (A bit analogous to how peer-review and the | tenure game has interfered with good science practices.) | rscho wrote: | Other doctors? And where will you find those? No one will | ever touch you, except if you pay more. Pay more for | worse outcomes, really. | sxg wrote: | I'm guessing you haven't heard of Goodhart's Law? | (https://en.wikipedia.org/wiki/Goodhart%27s_law) Under | your proposal, surgeons will be incentivized to | selectively operate on easier patients and minimize their | complication rates while not performing surgery on very | sick patients who may also need the same surgery. | | Different surgeons in different areas treat different | kinds of patients. It's hard to accurately measure | anything in a meaningful way that should influence | decision making. To use your example, surgeon Z may also | perform procedure Y but has (N-5)% of patients reporting | relief and (M+5)% of patients reporting post-op | complications. However, surgeon Z works at a community | hospital and treats a poorer patient population with more | co-morbidities. Can you really say if surgeon X is better | than surgeon Z? | grog454 wrote: | Is it really too "hard" to perform rigorous statical | analysis? Why can't you factor in patient genetics + | background + circumstances to come up with some expected | chance of success for each procedure (in fact, isn't that | why doctors have such detailed patient histories?). Isn't | it the doctor's job to estimate and inform the patient of | the expected outcomes? | | Doctor's historical success rate exceeds expected success | rate on average => Good (or lucky) doctor. | sxg wrote: | Yes, it's absolutely very difficult to do rigorous | statistical analysis. | | Genetics is oversimplified to non-physicians. It's cool | that we can diagnose and predict the likelihood of | getting Huntington's disease using our knowledge of | genetics, but extremely few diseases are this simple. | There are huge swaths of the human genome that we don't | understand but are likely playing some important role in | the regulation of other genes and diseases. We are | nowhere close to being able to look at a patient's genome | to predict anything useful outside of a handful of | exceptions. | | Patient histories are honestly often garbage--I say that | as a physician. I look through dozens of patients' charts | every day, and there are constantly errors, incomplete | documentation, and fragmented records across multiple | institutions. Just last week I read a chart for a patient | who had a documented hysterectomy from years ago. The | brand new CT scan I saw showed a perfectly normal uterus. | Once something goes in a patient's history it's nearly | impossible to correct or remove. If some doctor from ages | ago said the patient is allergic to medication X, but the | patient denies it, what do I do? Usually, we opt to leave | the allergy listed out of fear of the consequences if the | patient is wrong. | grog454 wrote: | Are you aware of any attempts to use machine learning in | medical analysis and outcome prediction? I feel like this | is one of the few applications where it could shine. I | have no formal training in data science, but everything | I've read so far seems to indicate that noisy and | unreliable data is not an insurmountable problem. | | All of this talk about how "hard" the statistical | analysis is, is strange to me. Maybe "advanced" would be | a better term? If you get a patient with a contradictory | medical history that somehow also contradicts what they | are telling you, simply adjust your expected chance of | success appropriately (to zero perhaps). In that extreme | case, if you get a good outcome, congrats you got lucky. | If you don't, it should have 0 impact on how you are | evaluated as a doctor. | sxg wrote: | Before you can even do the statistical analysis you | suggest, you need large amounts of high quality data-- | which we don't have. One place where the US (and the | world?) gets data privacy right is in healthcare, but | unfortunately that also means it's nearly impossible to | create the data sets we need to do the statistical | analysis you want. | | Institutions face severe penalties for wrongfully sharing | patient data, so most opt to just not share any data. Any | research that is performed is done internally on local | populations with de-identified data sets. A few brave | institutions go well out of their way to create and share | de-identified data sets publically, but these data sets | still undersample the general population. This is a | critical problem because certain diseases are highly | prevalent in certain regions (e.g., Lyme disease in New | England) but unheard of in other regions (e.g., Lyme | disease in Colorado). If your ML model is trained on data | largely from New England, it's going to diagnose a | patient with the classic "target-shaped" rash with Lyme | disease even if the patient is from Colorado (high false | positive rate). If the model is trained on data from | Colorado, it will underdiagnose Lyme disease in patients | from New England (high false negative rate). The only way | I know to overcome this problem is to create even larger | data sets, but this just isn't possible with data privacy | laws. | asmithmd1 wrote: | > I feel like this is one of the few applications where | it could shine. | | Read "The Alignment Problem", a very good just above pop | sci level book about machine learning. They have one | example where ML determined seniors with COPD were at | reduced risk from pneumonia, and obviously non-sensical | result. Patients with COPD wound up in the hospital at a | lower rate than average because doctors know they need | careful attention right away. | rscho wrote: | Statistics are not the problem. The data is. 'Big | healthcare data' does not exist. Building what you are | thinking of would require huge data gathering | capabilities, that are very clearly out of reach. | | Most big medical co do a lot of data science (Kaiser and | others). Very efficient from a managerial pov. Totally | useless, medically speaking. | rscho wrote: | The number of factors you'd have to consider to achieve | that is huge enough that it makes it completely | unrealistic, both practically and financially speaking. | In fact, I'm 100% convinced that it's currently | impossible to build such a system, given the extent of | medical knowledge. | grog454 wrote: | I'm skeptical. I concede it's probably a hard problem but | there is an entire field dedicated to hard statistical | problems called data science. What is the point of having | detailed patient histories and data if it can't be used | to inform decisions? | rscho wrote: | If data science was that efficient on healthcare records, | we'd know it by now and everyone would do it. There is no | 'big healthcare data'. We gather mostly noise, and | records are full of blatant mistakes. Medicine is still | more art than science today, and records mostly give you | a 'feeling' for the patient's condition in light of your | MD education, with a little hard data sprinkled on top. | stuckonempty wrote: | This is a fallacy. At any point in history you can say | "if X field was so good, we'd have Y by now". In 1925 you | could've said, "if biology's understanding of bacteria is | so good, we'd have antibiotics by now". Within 5 years, | they did. | | There is certainly noise in healthcare data especially | when patient-reported, but is it noise to say that a | patient having X procedure later does or doesn't have | serious complications? Analyzes of medical care and their | consequences can be evaluated and it's not noise | | And big healthcare data has lagged, partially because | privacy concerns trump sharing. There are companies | selling anonymized medical records for basically every | American now though. Big data is coming | rscho wrote: | > Big data is coming | | Big _bad_ data... Let's see how we fare in 5y, then. My | prediction as a clinician with a special interest in | stats: close to zero medical progress. But insurance | priced by a ML algorithm. | aerostable_slug wrote: | Surgeons would steer away from difficult, lower- | percentage-outcome procedures which is precisely what you | don't want. | | You want risk-takers who repeatedly tackle the surgeries | and (ideally) get a more positive outcome percentage than | a newbie. | rscho wrote: | Surgeons will concentrate on easy procedures and will | basically all have an almost identical track record of | quasi perfection. So there will be nobody left to perform | procedure Y, where Y has an intrinsically high rate of | failure. Same thing for difficult patients. No one will | touch Mr X who's got a complex problem. | asmithmd1 wrote: | There are some things that are helpful that they will | answer that have steered me away from a surgeon: How many | of these surgeries do you do per year? An answer of 50 or | above is good. What is YOUR rate of <specific | complication mentioned in the consent>? Keep pushing | until they tell you their rate, not the overall rate. | rscho wrote: | They almost universally don't know their own rate. I | don't know my own rates of complications. But, if I want | you to go away because you seem to be the kind of guy | that will come back to bite me, I'll gladly tell you I | have a huge rate of complication. | asmithmd1 wrote: | For a colonoscopy I asked about the risk of a perforated | bowel. Their first response was, "that is meaningless, if | it happens to you the rate is 100%." I said if the | chances are 50:50, then I am not doing it. They said it | has happened twice in their career and based on my lack | of risk factors, it would not happen to me. | | For my daughters tonsillectomy, the doctor was very happy | to share how her stats for post surgery bleeding compared | to both other doctors in her group, and the national | average. But I live in a Boston suburb and every doctor | is a lecturer at either Harvard or Mass General. | | Another question to ask is will an intern take part in | the surgery. At teaching hospitals the answer is almost | always yes. You can ask if they operate at any other | hospitals, and again the answer is almost always yes, | they operate at a suburban, non-teaching hospital where | they will be the only one operating. | | I got a little bit humbled at Boston Childrens Hospital. | I was doing some Googling about the risks of a CAT scan | and asked if they did low-dose ones. They informed me | that they in fact invented that procedure. Sure enough, | the paper I was looking at was authored by a doctor on | their staff. | rscho wrote: | I have 10+ years of clinical experience in academic | hospitals, and have worked in Boston at Brigham and | Women's. From this experience, I can tell you 2 things: | | 1. Being a lecturer at Harvard does not correlate with | being a skillful clinician | | 2. Your view of the clinical system is very skewed, and | will bring you more risks than benefits. | asmithmd1 wrote: | Completely agree with point 1. There are many researchers | in the area who like to also practice, that lead me to | ask the # of surgeries question. | | My bias is towards surgery at a good regional hospital | (Newton-Wellesley for example) with a surgeon who teaches | downtown and does lots of surgeries. | | What is my skew that that is bringing me more risk? I | used to think all doctors were about the same. Now I | realize that is about as true as all baseball players are | the same. There are hall of famers as well as some who | could be sent down to the minors. The trick is figuring | out who is who, because other docs won't say. | sterlind wrote: | unfortunately if you need a rare surgery (to treat a rare | condition), this doesn't work very well. it also isn't | enough for surgeries with subjective outcomes (such as | vaginoplasty.) with the former you look for a competent | surgeon with many good outcomes on related surgeries of | similar complexity, and who keeps up with or participates | in research. with the latter... image boards? word of | mouth? whoever your insurance covers? I get hung up on | that kind of choice. | commandar wrote: | To some degree, there's an even more toxic element of | this already in play with the amount of weight the wider | US medical system puts behind patient satisfaction | surveys. | | Many times, things that a patient _wants_ and would make | a patient _happy_ are medically contraindicated and lead | to worse _outcomes,_ yet there 's immense pressure on | clinicians to maintain patient satisfaction metrics. | | I'm not disagreeing with you at all; more suggesting that | we're currently relying on metrics that are even more | perilous than actual clinical outcomes. | dd36 wrote: | Every doctor is the best. | Raineer wrote: | "This is why things like 'evidence based' medicine is so | dangerous -- we don't have evidence for the vast majority of | impactful conditions, simply ignoring patients with these | conditions is not a workable solution." | | Citation needed. | beebmam wrote: | Ignoring them is unethical. Treating them with an | unscientific treatment is unethical. | telchior wrote: | And the ethical alternative is, for chronic conditions, | someone who suffers for their entire life and is not | allowed to do anything about it? | | Look at every wastebasket diagnosis (yes, that's a real | term) out there. There is no "ethical", approved treatment. | In fact, there's not even an understanding of what the | condition is. Instead, doctors work down a list of bad | ideas with their patients: all the various medications, | supplements, and even surgeries that have ever reputedly | worked. Many have uncertain evidence, many more have no | evidence at all. Some patients eventually hit on something | that works for them. Others don't. | | According to your short statement: that's unethical. Bad. | Stop! | | So what's the alternative? Suicide? Doing nothing is | intolerable. | sterlind wrote: | I think you're being a little unfair to wastebasket | diagnoses. you need _something_ for insurance codes, for | drug indications, for publishing research on. having a | bucket of similar syndromes is a start for drilling down | further. and often you can treat things supportively, | even if you can 't modify the disease itself. | | doctors need to be up front with patients about | wastebaskets though, and rule out other diagnoses. it's | wrong to chalk someone's fits up to FND until you've | ruled out epilepsy and other organic causes, for example. | and even things like FND are probably "real", we just | don't know enough about them yet. | taurath wrote: | Depends heavily on your definition of unscientific. There | are many treatment modalities that exist that are | considered "ineffective" simply because they don't work en | mass on large populations. AKA they don't scale for | identified conditions. This can be as much a problem with | diagnostics and labels which create cohorts as much as the | effectiveness of treatments. | caymanjim wrote: | > OTC medicines that by current standards would not be made OTC | | Acetaminophen would almost certainly be in this category, if it | could even get FDA approval at all. The effective dose is | dangerously close to a toxic dose that causes liver damage, and | not comfortably-far from the LD50. The only reasons | acetaminophen is OTC is that it's been informally grandfathered | in, makes an absolute fortune for pharmaceutical companies, and | doesn't get you high. | sniperjoe360 wrote: | Although perhaps true about FDA clearance, I wouldn't be | alarmist and characterize the effective dose as "dangerously" | close to the LD50. | | The highest dose that therapeutically is used is about 1000mg | per dose. The fatal dose is about 15 times that amount. | | To put it into perspective, a patient would have to be | willfully taking 45 tylenol (325mg/pill) all at once to cause | lethal liver damage. Doses like that are usually not | accidental. | klodolph wrote: | Not accidental, but very tragic. It's the #1 cause for | calls to poison control, and accounts for 26,000 | hospitalizations every year, and 500 deaths. Dying from an | acetaminophen overdose is not a good way to go out, you | spend a couple days in the hospital suffering as your | organs fail and your loved ones watch. | | Other OTC drugs are much safer. I don't allow acetaminophen | in the house. Pseoudoephedrine? Yes. | | Acetaminophen also should not be taken as a hangover cure, | due to interactions with alcohol (alcohol and acetaminophen | compete for the same metabolic pathways in the liver, and | this exacerbates the toxic effects of acetaminophen). The | problem is that someone who's drinking and has a hangover | is probably going to reach for one of the two most common | OTC pain relievers in their medicine cabinet, and not | consider that one of those two pain relievers should not be | combined with alcohol. | sniperjoe360 wrote: | Yes, agree with everything factual you said. I guess the | problem isn't the compound itself but rather not enough | information regarding its use. | | I personally keep tylenol in the house because it's | probably the best non-narcotic non-NSAID pain medicine. | | We use it all the time in patients who are elderly with | decreased renal function because they don't do well with | opiates or NSAIDs (ibuprofen) | refurb wrote: | 500 deaths (many intentional attempts at suicide) in a | country of 350M where arguably every household has | acetaminophen present is _incredibly low_. | klodolph wrote: | By comparison, the number of accidental firearm deaths is | around 430 per year, and somewhere around 40% of US | households have a firearm. So we can say that having | acetaminophen in the house is roughly as dangerous as | having a firearm in the house. Obviously this is not some | kind of direct comparison between firearms and | acetaminophen. | | I included the statistic in the first place because I | thought it didn't make sense to cherry pick the scariest | statistics. I'm not fearmongering here, just trying to | illustrate that acetaminophen should be treated with more | care than we currently do. I think we could be making | better health policy decisions about which medications | are OTC and which aren't, although this topic is | incredibly complicated and doesn't just come down to | simple facts like toxicity. | [deleted] | refurb wrote: | I doubt it. | | Ibuprofen and other NSAISDs were approved not that long ago, | cause plenty of GI bleeds, have nephrotoxicity when used | chronically and increase the risk of cardiovascular events. | | And they're OTC. | | Acetaminophen is actually very safe considering the number of | serious events and the facts it's in hundreds of different | OTC combinations. | skyechurch wrote: | This is very silly, acetaminophen is very effective against | pain, and for many people (e.g. me) is tolerated much better, | especially at higher doses, than ibuprofen etc. There is | already way to much panic about drugs/medicines, especially | pain meds, especially especially for chronic conditions, | without further hysterics about the 'threat' of useful and | well tolerated chemicals. (Not a doctor, not offering medical | advice.) | | >doesn't get you high | | A huge point in its favor if you can't lay in bed opiated all | day. | tssva wrote: | I find acetaminophen almost completely useless for pain. | Ibuprofen is better but still not very effective. Naproxen | sodium is the only OTC pain medicine which is effective for | me. | nick__m wrote: | accordind to the American Dental Association, 500mg of | acetaminophen in combination with 200mg of ibuprofen is | more effective than naproxen for pain relief. | | https://jada.ada.org/article/S0002-8177(18)30117-X/fullte | xt (the result are in table 1) | slowmovintarget wrote: | After going nearly a year without taking painkillers of | any kind (not an aspirin, ibuprofen, or acetaminophen | dose), I took some Tylenol for a bad headache, and it | worked far better than it had ever worked for me before. | | Granted, I've had to learn to put up with a lot more | constant low-level pain in my day-to-day life. But I | think that's a reasonable trade off for choosing between | cooking my kidneys (aspirin, ibuprofen) or blowing out my | liver (acetaminophen). | | I had a really weird 1-in-ten-million side-effect with | Naproxen sodium. It caused hard insomnia (confirmed under | a doctor's care, this was before it was OTC). | caymanjim wrote: | I'm not saying it'd be good if acetaminophen got you high, | just that one of the reasons it's still OTC is that it | doesn't get you high, so there's no one champing at the bit | to crack down on it, the way they robbed us of the highly- | effective and fairly-harmless pseudoephedrine for the one | and only reason that it can be illicitly turned into a | street drug. | genghisjahn wrote: | How is this "dangerously close to toxic"? Extra strength is | 500mg. Adults should not take more than 3000mg in a day. | Taking 7000 more more can lead to liver problems. | | https://medlineplus.gov/ency/article/002598.htm | | Common dosage forms and strengths: | | Suppository: 120 mg, 125 mg, 325 mg, 650 mg Chewable tablets: | 80 mg Junior tablets: 160 mg Regular strength: 325 mg Extra | strength: 500 mg Liquid: 160 mg/teaspoon (5 milliliters) | Drops: 100 mg/mL, 120 mg/2.5 mL Adults should not take more | than 3,000 mg of single-ingredient acetaminophen a day. You | should take less if you are over 65 years old. Taking more, | especially 7,000 mg or more, can lead to a severe overdose | problems. If you have liver or kidney disease, you should | discuss the use of this drug with your health care provider. | thedailymail wrote: | My understanding is that acetaminophen toxicity has been a | problem particularly for children, because 1) the toxic | dose is lower, 2) many common OTC products for children | include some amount of acetaminophen among their active | ingredients and 3) parents may give their children multiple | such products (one for runny nose, one for fever reduction, | one for nighttime relief, etc.) over the course of a day | and end up exceeding the safe dose, leading to liver | toxicity. That was the situation a few years ago at least. | freedomben wrote: | acetaminophen is often put in medications _because_ it 's | toxic. It's there to dissuade people from *gasp* taking | too much and possibly experiencing some positive feelings | or enjoyment that offends the sensibilities of decision | makers. Better that we destroy a few people's livers than | that those people get a buzz. (to be clear, this last | sentence is not my view. I'm mocking that view) | skyechurch wrote: | This also is silly, illegal drug users constantly take | their dosages mixed with much worse things than Tylenol | with no noticeable dissuasion effect that I am aware of. | Acetaminophen is mixed with oxycodone etc bc it increases | the pain relieving effect of the opiate drug (which for | many people (e.g. me), are of limited effectiveness | relative to the side effects/"buzz"), and because, unlike | NSAIDs, it doesn't thin your blood so it can be taken | after surgeries. | | Having chronic pain sucks, having something that you can | take for it, especially something boring like Tylenol | that can't be snatched away from you by | doctors/police/etc, is a huge quality of life issue. | samtho wrote: | I don't think anyone reasonable is actively arguing to | delist Tylenol as OTC, rather we shouldn't be so | restrictive on these medications that can actually really | help people. In addition we should be giving people | resources for discontinuing use when they no longer need | it. | | Also, we need to really research the NSAIDS after surgery | thing, afaik, there has been nothing super rigorous on it | and is only going off of the common knowledge that they | do thin blood. I do not like Tylenol and my partner is | allergic, we've both broken the rule about nsaids post | surgery. | freedomben wrote: | Yes absolutely. I don't want to see Tylenol go away. I | want more options, not less. I think as long as companies | are being _honest_ about the product they are selling, | even if it 's ineffective I think it should be available. | caymanjim wrote: | This is the one and only reason that Vicodin and Percocet | exist. They don't want people getting high, so they're | punishing them by trying to kill them. It's barbaric. | Literally evil. | | Edit: just to be clear, there are times when it might | make sense to take oxycodone or hydrocodone alongside | acetaminophen, but they should be prescribed separately | and with caution. The reason they're combination drugs is | because the toxicity is a "desirable" side-effect meant | to discourage abuse. It's that reasoning that is evil. | paulmd wrote: | 5:1 ratio (a dose is "take two 325mg") between therapeutic | and danger doses is really low as far as modern drugs would | be concerned. Most drugs are more in the 50:1 or 100:1 | range, drugs with a 5:1 ratio typically would not be | approved and certainly would require very close | supervision. Tylenol being OTC is complete insanity (or | rather, regulatory capture and general public comfort with | it). | | Also note that those dosages are only for single usages! | Tylenol also has a fun thing where daily/chronic usage | within the "safe" dose can still cause liver damage. | Chronic usage, you need to halve those doses. | | The causal mechanism is believed to be basically low-level | liver damage. Drinking a sixpack of beer once every couple | weeks is fine - it's still not healthy, it damages your | body, but your liver will repair itself in the meantime - | but do it every day and your body cumulatively cannot | repair the damage, while drinking a ton could cause acute | failure. Tylenol actually works the same way - every dose | is damaging your liver a bit, but if you don't do it every | day it's fine, your body will repair it. But if you do take | it daily, your body doesn't get a chance to repair the | liver damage that tylenol causes, and the actual "safe" | dosage becomes lower. | | That puts the actual "safe" dose at closer to 1500mg per | day for an adult. Having a 2.5:1 theraputic ratio on an | _over-the-counter drug_ is _absolute fucking insanity_. | | And worse, those numbers are for men - they're lower for | women. Yes, so is the theraputic dose, but they don't make | special pills for women. Taking a standard dose (two 325mg | pills) twice a day can cause liver damage to women, that's | above the safe threshold for daily/chronic use. And that's | not something people really consider when they pop a couple | tylenol. | | And then you've got combination products. OK, so you get | sick, you take a couple tylenol and a dose of cough syrup. | The dose of cough syrup likely is another 500mg or so of | tylenol. So you actually took a 1125mg dose. And then you | do it again before you go to bed. That's edging into | dangerous territory with tylenol. | | Obviously "don't do that", read the label and don't double | up on an active ingredient that's already there in | combination, but combination products are implicitly | dangerous, they are _fishing_ for that to happen, | _encouraging_ it. But the FDA wants it because it | "discourages abuse". That's literally more important than | burning out your liver. | | The rest of the world uses tylenol in very niche | situations. Usually it's behind the counter at a minimum | (not always, but usually) and you probably will be told to | take some ibuprofen instead. Ibuprofen and Aspirin are not | perfect but they are _much, much, much_ safer than tylenol | is. | | Tylenol is absolutely, completely, absurdly dangerous and | should not be anywhere near as common as it is in the US, | but drug war + legacy product sales rule the day. | | To echo another sibling commenter here, I don't allow | acetaminophen in the house period. It is an accident | waiting to happen. I _certainly_ don 't allow combination | products, and I will actively go out of my way to buy | anything that doesn't include it. This is overkill as a | single childless person who is aware of the danger, but you | never know when something could go wrong and the cat knocks | the bottle off the counter and the dog gets it, etc. You | just should not keep dangerous things around unless you | absolutely need to. Some things you can't avoid, but it's | not hard to just buy ibuprofen instead of tylenol. | astrange wrote: | Are you actually an MD? | | I actually only ever hear about acetaminophen/paracetamol | being dangerous from Americans - in other Anglo countries | everyone will happily suggest you take it all the time, | it is available OTC, and it comes as something kids will | mistake for lemonade. | | https://www.amazon.co.uk/Lemsip-Cold-Blackcurrant- | Flavour-Sa... | | > Ibuprofen and Aspirin are not perfect but they are | much, much, much safer than tylenol is. | | Only short term. Ibuprofen is less safe taken | chronically, it'll destroy your stomach lining. | cortesoft wrote: | > For the average healthy adult, the generally | recommended maximum daily dose is no more than 4,000 | milligrams (mg) from all sources. But in some people, | doses close to the 4,000 mg daily limit for adults could | still be toxic to the liver. | | https://www.health.harvard.edu/pain/acetaminophen-safety- | be-... | | 4,000 mgs is easy to hit for people who don't realize | that it can be dangerous. I know lots of people who would | say "Well, my pain is bad, let me take double"... which | for extra strength would be 4 x 500 MG, which is 2000 MGs | in a single dose... which then if you do it twice in a | day is right there at the 4000 MG mark. Most people are | fine with that, but some people can get really sick. | | If the person then does it 3 times a day, they are close | to the danger zone for most people and over the danger | zone for some people. Then multiply that by a few | days.... | | You can easily say, "Well, they are taking more than they | are supposed to!", but it is really common to take a bit | extra if you feel really bad without realizing how | dangerous it is, because Tylenol is `safe` | paulmd wrote: | No, I am not. It's a dune reference. | | Ulcers ("destroying your stomach lining") is less bad | than "destroying your liver", and typically you will have | to screw up harder before other NSAIDs reach that level. | Tylenol literally is dangerous _following the directions | on the bottle_ , because those directions aren't | calibrated for chronic usage, when they say "daily max" | they don't mean you take it _daily_ , that dose is even | lower. | rscho wrote: | This is wrong. Kidney failure from NSAIDs is very common, | and also very dangerous. And can develop at recommended | dosage. | astrange wrote: | I had a roommate who nearly died (his words) from taking | a chronic regular dose of ibuprofen for a month or two | when he was sofa-ridden after tearing his ACL. | ulfw wrote: | Actually every country is different in that regard. In | many parts of Asia (e.g. Singapore, Hong Kong) good luck | even finding ibuprofen or aspirin. It's usually behind | the counter rather than in open display. | | Instead there's dozens and dozens of GSK's Panadol | paracetamol (acetaminophen), some of which even next to a | cash register as a throw in. | cwkoss wrote: | Note that metabolism of drugs is roughly proportional to | bodyweight. A petite 100 lb person may only need 200mg for | an effective dose. An obese 400 lb person may require ~4x | that dosage for the equivalent effect. | | The one-size-fits-all drug dosing we do in this country | seems crazy to me. | | "Research Chemical" drug users have developed techniques to | calibrate doses of substances with unknown potency - start | with ~100th of what you expect to be an active dose and | then gradually double it until proper effects are achieved. | | I'd imagine it would be more expensive for pharmacies to | distribute drugs in this way, but allowing patients to | titrate their doses could significantly reduce/avoid | negative side effects from just throwing the same | standardized dose at every person with a prescription | regardless of bodyweight. | ratsmack wrote: | This is especially important when it comes to children. | This is because kids vary in weight in relation to age | more than adults do, but the vast majority of drugs are | dosed by age. This is just insanity at it's finest. | cwkoss wrote: | Yep, and that's only using the rough metric of | bodyweight. There are a number of other major factors | like size and health of liver, whether the patient has | any under/over expression of metabolic enzymes, etc that | can further complicate the determination of proper | dosage. | | Would be super cool if we had an objective measure of | proper dosage - such as blood concentration or excreted | metabolites - to give us more insight into how the drug | is being metabolized by the individual. | simulate-me wrote: | Is there any evidence that harm is being caused from age- | based dosing? | cowmoo728 wrote: | Most people don't read the label on medicines that they | take. Take two extra strength acetaminophen tablets, | combination liquid cold medicine, some of the sleep aids | with diphenhydramine + acetaminophen, a glass of wine, | repeat for 3 days, and you're easily into danger territory. | emerged wrote: | Well I was in the ER 2 days ago and my liver enzymes were | bad. I don't drink, he said it was the acetaminophen I've | been taking. I had been taking significantly less than the | recommended amount for less than a week. | paulmd wrote: | (to be clear: not a doctor) | | the "daily" recommended doses are for a single day. If | you are taking it daily you need to _at least_ halve the | recommended dose. I wouldn 't have said a week was a | problem but... yeah. Tylenol is dangerous. | | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913076/ | | Specifically this study referenced: | https://jamanetwork.com/journals/jama/fullarticle/211014 | | > One study reported that ingestion of the recommended | maximum amount of 4000 mg of APAP for 2 weeks resulted in | the asymptomatic elevation of alanine transaminase, up to | three times normal, in 40% of patients.19 These | transaminase elevations did not amount to any clinical | significance, and after the APAP was discontinued the | transaminase levels returned to normal.19 Yet, while | asymptomatic, chronically elevated aminotransferases may | be of concern to healthcare providers, leading to further | costly diagnostic studies or changes/restrictions in | necessary medications | | If anything the summary in that review is underselling | it. Average was 2.78x baseline (3x is considered | clinically significant) and 20% of the population was | over 5x the peak (so, 20% had clinically significant | elevations from the study). By peak levels, around 27% of | the population saw peak levels of 8x baseline. So | basically, even the "average" participant was almost to | the threshold of clinical significance just from this | study (at the recommended daily dose) and a cohort of | around 20-25% will see clinically-significant warning | signs at the recommended dosage, even among healthy | patients. And risk factors significantly increase that. | | That's basically a "liver stressor" enzyme, even if it's | not killing the patients over the course of the study, | it's not a good thing. That's your body's warning signal | that it's stressed. And generally that's an | uncontroversial finding I think, everyone agrees tylenol | is a liver stressor, but they just have various | thresholds of the acceptable risk. Would I do it daily? | No. | | And in med-speak, that's what they're saying here too. | Use with caution, don't go above the recommended dosage | in acute situations and use caution with chronic dosing. | https://pubmed.ncbi.nlm.nih.gov/11847957/ | | Anyway, the rule of thumb I always heard is that half of | the "daily" dose appears to be more appropriate for | _chronic daily_ usage. I am not a doctor and you can do | whatever you want, but that is personally what I would | hold to. Going less, or picking a different FDA-approved | alternative like ibuprofen or aspirin, is always a | perfectly acceptable choice. | | That number appears to be reasonably supportable too. | Instead of "half of our patients were over triple their | baseline ALT level" this study found that 50% of the | daily doage, chronically over 12 weeks, gets you to a 20% | average increase in ALT levels. It's never not going to | be a liver stressor and if you have other risk factors | then you should probably stay away entirely (I think | that's just good advice in general) but 20% increase in | ALT after 12 weeks is a hell of a lot better than | tripling your ALT in 2 weeks. But even then, during a | 12-week study of 94 healthy adult patients, at half the | recommended dose, they still had to withdraw one | participant due to hepatotoxicity. | https://pubmed.ncbi.nlm.nih.gov/25899926/ | | (as far as risk factors, see the first link above for a | good review, aggravating factors for hepatoxicity can | include things like non-alcoholic fatty liver or | nutritional deficiency. Which basically describes an | overweight computer-toucher with a poor diet to a tee.) | rscho wrote: | > the "daily" recommended doses are for a single day. | | No. We've got thousands of people living more or less | permanently on the maximum daily dose, including some | children and vulnerable populations. Yes, some of those | people have elevated liver enzymes. Yes, Tylenol is | dangerous, but certainly not more than the alternatives. | NSAIDs are certainly not any less dangerous, especially | in populations with high prevalence of diabetes and | kidney failure. | | Tylenol overdose is one of the most frequent suicide | plans in teens, with lethal doses usually starting from | 8g. This is one of the reasons Tylenol has such a bad | reputation. | paulmd wrote: | The intervention-based study (giving patients a | controlled dose and measuring the enzyme response) found | that over half of study participants will have | clinically-significant elevation of ALT at the | recommended dose, and 20-30% will have numbers as bad as | 5x sustained. Short study aside, that's not what I would | personally choose. | | Remember, there were never Phase trials showing 4g is the | right maximum either. It's just grandfathered in Uber the | "well I guess if it were dangerous we'd have noticed by | now" standard. But did a statistically large enough | segment take exactly 4g over a course of years such that | we can definitively say that's safe? Most people are | taking lower doses and shorter doses. At least on paper. | | It's "there's no double-blind study that shows masks can | prevent the spread of covid!" redux. And actually it's | worse because there already is a standard for what | clinically-significant elevated levels of that enzyme | are, and _healthy study participants_ are blasting right | by it. That 's not relevant .... because? | | It's not just a random number going up from some un- | related mechanism, it's liver stress, they even think | they know what the mechanism is. It's a reaction that is | well-known for this drug, as a warning sign for this | problem. Claiming that it suddenly doesn't mean the same | thing it'd mean if you took 0.001mg more is just | pedantic. It was never formally studied and approved, it | would be completely unsurprising if they got the number a | little wrong. | | And again - that's study participants who are _chosen to | be healthy_. If you 're fat, or aren't getting your | macronutrients, your risk is much higher. | | Using a lower dose or using something else is always a | valid option. "The dose makes the poison" and using the | lowest effective dose is absolutely standard practice and | any doctor is going to tell you that's a baseline they | always operate under. | | Anyway, do whatever you want personally, but I would | personally think strongly about staying at half the | recommended dose or less for chronic usage, or looking | for an alternative option. 20% of the healthy population, | plus the unhealthy population, is a decent chunk of | people. | rscho wrote: | I personally prescribe loads of painkillers, including | the whole range of the WHO ladder, and many of those | patients have liver tests. It rarely happens that we have | to discontinue Tylenol due to hepatitis. I see people on | NSAIDs with kidney failure every week. So again yes, | Tylenol is toxic. But from personal experience, it's | rarely a clinically relevant problem. | consumer451 wrote: | Here are some interesting related HN posts regarding | Acetaminophen: | | https://hn.algolia.com/?dateEnd=1648670057&dateRange=custom&. | .. | paulmd wrote: | > doesn't get you high. | | this is the big one. Phenyl-epinephrine doesn't work at all, | it's consistently failed to outperform placebo, and the only | reason it's on the market is because the FDA doesn't like | pseudo-ephedrine (sudafed) because it can be used as a | precursor for meth. Same reason they've required individual | blister packs for sudafed (if only there was some illicit | drug which gave you the focus and drive to perform repetitive | tasks for hours on end...) | | Same thing for imodium. The reason all of a sudden it's in | blister packs? People found a way to abuse it and the FDA is | going to ruin it for the rest of us. | | In the case of acetaminophen, the FDA actively uses it as a | poison to "discourage" addicts from taking large doses of | painkillers or cough syrup. The point is explicitly that if | you take too much, you'll burn out your liver, the FDA is | actively inserting poison into the medicine to "discourage | abuse". | | In all of these cases, the common factor is that it makes | things much more annoying or even dangerous/lethal for | average people, while addicts are completely unaffected. No | opiate addict in the world is going to get clean because of | _individual pill blister packaging_. Meth addicts will just | pop some pills and churn through the sudafed blister | packaging, etc. | | I am waiting for the other shoe to drop on imodium, now that | the FDA is targeting it, it can't be too long until it's | behind the counter or pulled entirely. And as someone who | (TMI warning) suffers from what I'd term as moderately | frequent IBS (never diagnosed but maybe I should) that's | really going to suck for me. | | The FDA is simply an instrument of drug-war policy, they're | not oriented towards patient care and outcomes at all. | edmundsauto wrote: | What makes you say the FDA is actively adding poison to | other drugs, are there first hand sources from them? This | sounds like it could also be a case where they want to | lower opiate consumption, and so adding some Tylenol | increases pain relief without increasing opiate intake. | | I am not sure that's wise policy, but if you don't think | Tylenol is all that bad (again, I'm not sufficiently | informed to say this, but the FDA obviously thinks it's | safe), then it's not a bad overall policy. | | It sounds like it could be either situation, I'm just | looking for more evidence before making up my mind. (Yes, I | am aware the US government poisoned people during | prohibition in this exact manner, but I dispute that has | any relevance as the decision makers and cultural awareness | is very different now. We've come a long way since the 30s) | samtho wrote: | Why can you go to the store and buy rubbing alcohol to | drink? It's primary ingredient is just ethanol. The FDA | literally mandates that the ethanol is not able to be | safely consumed and is cut with poison that is not easily | separated from ethanol. | | Similarly, cutting opioids with Tylenol is not actually | intended to be a deterrent to someone who gets their | hands on the pills rather it deters people involved with | illicit drug manufacture and distribution from using it | as a base to grind up and sell. | | Tylenol is really not super safe, at least by todays | approval standards. Most official sources, which | unsurprisingly have a huge bias towards Tylenol's safety, | state that allergic reactions are very uncommon, but | recent meta-analysis' are beginning to uncover that mild | to moderate allergic reactions to acetaminophen is more | common that originally thought. It does not get reported | because if you're already feeling like crap when you take | it, some mild itchiness, redness, and discomfort would | not be out of the ordinary without the Tylenol. As | mentioned before, the toxic dose is much too close to the | effective dose, I've heard from medical professionals | that doubling a single recommended dose on extra strength | Tylenol is enough to cause long-term damage to your | liver. On top of all that, the fact that it is a weak | pain reliever at best would solidly put this as a drug | that's not super useful. | | I have a very low opinion of how we go about drug policy | in the US. I am on a very controlled medication due to a | sleep disorder (that causes hypersomnia) which I cannot | go off for safety reasons. I also cannot get it filled | more than 24 in advance without complicated authorization | procedures that must be completed in the correct order. | It's a goddamn mess and serves only as a punishment to | law-abiding patients for needing this medication. It also | does nothing to curb illicit use because synthesis of a | more potent product is so trivial. | | This is an example of poorly targeted legislation, which | was put into place because it's the only thing they could | exert control over. It does not further the stated goals | of drug enforcement because it's so easy to manufacture | this stuff and the resulting product is so easy to move, | bad actors can simply avoid this system. While I'm | spending 3 hours every month orchestrating the | complicated dance of my prescription between my | providers, the pharmacy, and my insurance, someone is | making a batch of shake-and-bake meth in about 3 minutes. | rootusrootus wrote: | > Why can you go to the store and buy rubbing alcohol to | drink? It's primary ingredient is just ethanol. | | AFAIK most/all rubbing alcohol (at least that which is | sold in the US) is isopropanol, not ethanol. You can buy | ethanol in not-for-consumption form, as denatured | alcohol. | wombatpm wrote: | And it's chemistry that forces the additional benzene in | denatured alcohol. Water- ethanol forms an Azeotrope at | 95% ethanol. Benzene is added to break the azeotrope and | get to 99.99% ethanol. Chemistry not a conspiracy | ac29 wrote: | No one is selling 99.99% grade alcohol as an antiseptic | in the US. Its usually 70%. | | There are additives in ethanol sold as an antiseptic to | discourage drinking (various bitterants, not benzene). | aaaronic wrote: | Rubbing alcohol where I am is isopropyl alcohol (which is | highly toxic -- your body metabolizes it into acetone), | not ethanol. A kid in my high school class ended up | getting his stomach pumped when drinking it to try to get | drunk. | CamperBob2 wrote: | _What makes you say the FDA is actively adding poison to | other drugs, are there first hand sources from them?_ | | "Not everyone thought it was a good idea to make alcohol | deadly, when making it illegal hadn't stopped drinkers, | and New Jersey Senator Edward I. Edwards called it | "legalized murder." However, the Anti-Saloon League | persisted, arguing that legal alcohol had killed many | more in its day than denatured alcohol would kill during | the transition to a teetotaling world. "The Government is | under no obligation to furnish the people with alcohol | that is drinkable when the Constitution prohibits it," | said advocate Wayne B. Wheeler. "The person who drinks | this industrial alcohol is a deliberate suicide... To | root out a bad habit costs many lives and long years of | effort..."" | | https://time.com/3665643/deadly-drinking/ | drdeca wrote: | This makes me wonder if it would have been possible to, | instead of using something that causes significant harms | to health, instead something which just causes a rather | unpleasant experience. | | But, I guess one important thing is whether such an | additive is compatible with the altered substance still | being usable for the purpose for which it is being made | available. | | Now, presumably something as simple as "dissolve large | amounts of capsaicin in it" wouldn't work (I'm not even | sure if capsaicin can be dissolved in alcohol), but, what | about something along those lines? Or something that just | causes headaches, or vomiting? | mardifoufs wrote: | They already add a bittering agent to ethanol when it's | sold as a disinfectant. It's not toxic, just very | unpleasant | CamperBob2 wrote: | I think that's what they ended up doing, post- | Prohibition. A bottle of rubbing alcohol from the | drugstore is either isopropyl alcohol, which is toxic by | itself but not intentionally so, or ethanol mixed with a | denaturing agent that's more benign than methanol or | whatever they were using back in the day. | rootusrootus wrote: | I also wonder where the idea that the FDA 'denatures' | hydrocodone with acetaminophen comes from. AFAICT, if you | overdose on vicodin it's more likely the hydrocodone will | kill you before the acetaminophen. | netizen-936824 wrote: | This is entirely false. | | You can overdose from ~4 grams of APAP which you can | ingest by taking 6 7.5/750 hydrocodone/APAP tablets | | That's not nearly enough hydrocodone to kill you | salawat wrote: | Look up DXM. | | You will never find it without either Gualfenisin or | acetaminophen. | | Does DXM need either of those to do what it does? | | No. | | Would it simplify dosing to be sold alone so that laymen | didn't have to worry about potentially overdosing on | three drugs at once instead of just one? | | Yes. | | However, from the war on drugs perspective, that makes it | "easier to abuse" to achieve it's hallucinogenic side | effect. Bundled with acetaminophen or gualfenisin | however, you'd have to be a chemist intimately familiar | with how to seperate the other two components to distill | DXM in any amount with abuse potential, and the naive | non-chemist trying to get high will either end up puking | their guts out (Gualfenisin OD) or burning out their | liver (Tylenol OD, which is exacerbated by alcohol | consumption as well). | | The Tylenol one is particularly problematic, because | acetaminophen is also commonly prescribed with other | common multi-drug formulations that people may not | realize are additive. | | When you take the route of adding a substance that does | harm to discourage a pattern of behavior, you are | poisoning. Poisoning being the act of artificially and | with intent increasing the toxicity of an imbibed | substance to disincent some pattern of behavior. | | This is actually based on a natural pattern of behavior | by the way. There is a mushroom that is generally | completely harmless... Until you drink alcohol. | Metabolizing the mushroom depletes the supply of the same | enzymes that detoxify alcohol (and Tylenol). | | https://en.m.wikipedia.org/wiki/Coprinopsis_atramentaria | | So to be clear... If you call this mushroom poisonous, | and it targets the same enzyme that alcohol does, then | adding something like tylenol to something that doesn't | need it to do it's job, you are poisoning. | | It just happens to be handwaved because in the | establishment's mind, those damn druggies aren't worth | caring about anyway. | | Not a partaker of DXM, but _very concerned with the | ethical implications, and the adverse contribution to | trust in public health measures that this practice | entails._ | lr4444lr wrote: | Dextromethorphan HBr? It's definitely sold on its own in | the US. | throwaway48375 wrote: | https://www.amazon.com/dp/B005E74U3W/ | | https://www.amazon.com/dp/B09LKLNKZ7/ | Broken_Hippo wrote: | You keep mentioning blister packs: I wish they were on all | OTC drugs and many prescription drugs. On OTC drugs, I also | support package size limits. These keep folks safer, | lowering both accidental and intentional overdoses. I | suspect that it taking longer to open and having a handy | way to estimate what youve taken helps. | | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC31616/ | | There is plenty of cough syrup without acetaminophen sold | in the US, by the way. People like all-in-one products, | though, hence there being many with it in it. I'm gonna | need some evidence for the "FDA actively uses it as a | poison", though. I'm not so convinced a lot of folks think | about side effects of tylenol but instead, see it as rather | safe. | | And it really doesn't matter if a few folks will find ways | around an intervention. An improvement doesn't need to be | perfect to be implemented nonetheless - because, it is _an | improvement_ and as such, better than before. | seszett wrote: | Not sure I understand what you're saying about blister | packaging? Are there drugs that don't come in blister | packaging in the US? | | Here all I can think about are the | paracetamol/acetaminophen effervescent tablets that come in | tubes of 8 x 1g (or 16 x 500mg). | replygirl wrote: | oxy doesn't even come in blister packs here. at least not | as of a few years ago, when i got it for spraining my | ankle | zerocrates wrote: | There are drugs that come just in bottles: the typical | OTC pain relievers (acetaminophen/paracetamol, ibuprofen, | etc.) are all offered this way and you can easily buy | bottles containing hundreds of pills. And of course there | are others. | | Prescription drugs are pretty routinely dispensed in just | pill bottles also, though I'm sure there are some for | which this isn't allowed. | m-p-3 wrote: | > official sounding diagnoses that on inspection are actually | defined as "we have no idea" | | I suffer from IBS, and it's basically a diagnosis of exclusion | of everything else. | | > lack of consensus about how to treat some of the most common | conditions in the human population (e.g. back pain) | | Back pain isn't a condition, it's a symptom. And with the | amount of conditions and diseases that have this symptom in | their list, it's not surprising there isn't a "one-size-fits- | all" remedy or cure to it. | FireBeyond wrote: | Before my gout became more obviously gout (I had elevated | uric acid, but there was often little to no crystallization), | one of my diagnoses was "seronegative arthritis" - "It looks | like you have arthritis, but you have neither RF or CCP in | your blood, so... huh." | lowbloodsugar wrote: | In the US medicine is a _business_. Their job is not to make | you better. Their job is to get as much money as possible out | of you. | Madmallard wrote: | I'm feeling this way too hard. I have a condition where any | food I consistently eat I become sensitized to and begin | developing severe reactions that are alike anaphylaxis in | nearly every way but not quite as severe. I have been | hospitalized several times now with starvation issues. Yeah | immune suppressants sorta worked but you can't exactly stop a | full on immune response so it just bought a little bir of time. | | (1) mast cell testing - negative (2) ige testing - mostly | negative but i also avoid things i react to (3) endoscopy - | mostly negative but some inflammation (4) psychological - | medications didnt do anything | | (5) Non-allopathic stool testing from Genova Diagnostcs? | astronomically high secretory IgA levels, high zonulin levels, | disturbed gut flora populations and altered stool enzyme | levels. -> point this out to doctors "sorry cant help ya there. | _that's unvalidated_" | | Me - well fucking figure out something to try then!!!! | | Dead end. I am so sick of evidence based medicine. | emmelaich wrote: | I had a condition recently, now resolved. During that time I | had many consultations with specialists and did quite a bit of | research myself. | | It's astonishing. 80pc or more of shelf products in a pharmacy | will do nothing and many will make things worse. | lkxijlewlf wrote: | > in the US was a lie. We're constantly touting that we have | the most advanced technology but if you have a complex | condition you are likely to fall prey to multiple kinds of | grift. | | I feel like so much of what goes on day to day is one grift or | another. | zoba wrote: | Hopefully you never get something unrecognized by current | medical knowledge. You visit progressively more esteemed | experts: local, regional, national, global. Then you get to the | top, and (in my experience) that's it. | | I thought for sure there was a "ok now we hand this off to the | labs so we can learn" step... but, no. It was just a shrug and | literally "come back in 8 months if you're still having | problems." | | I became my own lab and fixed my problem. I reported my | findings to the doctors, and never heard back. | | Pretty disappointing. | perlgeek wrote: | My impression of the medical system (both here in Germany, and | through reports from the US) is that it's very much like | everything else: much is crap, much is mediocre, some good, and | a very small, excellent sliver. | | This goes for doctors, drugs, surgeries, devices. | | If you want good results, you really have to take matters into | your own hands, search for possible treatments yourself, | evaluate several doctors until you find a competent one, | research possible adverse side effects yourself etc. | | Example: somebody in my family had two different surgeries by | non-standard methods that gave her significant advantages over | the regular methods; one of them offered (to our knowledge) in | only one hospital in Germany, the other in three. In both cases | her regular doctors didn't know about these methods, and were | really surprised to hear about them afterwards. In both cases, | she learned about these methods through some non-medical | channel (a relative read about it in a newspaper, stuff like | that). | | If you just go to the next specialist for the field you need, | chances are you don't get the optimal treatment, and the rarer | the disease, the less like you get a good treatment. | rscho wrote: | Robot? | ipaddr wrote: | This is the reason why the US system is better than Canada. | In Canada you can't shop around and need referrals for | specialists. | fpgaminer wrote: | IIUC the vast majority of Americans don't have that | privilege either and need referrals. You have to be on more | expensive health plans to be able to pick your specialist. | (That's been my past experience with HMOs). I finally got | on a PPO recently and it was a bizarre but pleasant | experience to just ... refer myself to a specialist :) | s0rce wrote: | Why can't you shop around? You aren't forced to go to a | specific doctor. It certainly might be challenging but | that's also the case in the USA. | paxys wrote: | You can find the best medical care in the world in the US | if you have the means to pay for it. I don't think people | will agree though that it is the indicator for the best | healthcare _system_. | ionicgiraffe wrote: | I would even say that any person of any country with | enough financial resources could afford and get the best | treatment in whatever country of the world would happen | to be offered. | sterlind wrote: | I think you can shop around in Canada, if you have private | insurance. the universal healthcare system is just a | baseline, to keep people from dying on the street after | medical bankruptcy. many jobs offer supplementary health | insurance as a benefit. | | the US just uses ERs as an infinitely shittier but equally | costly version. | jimbob45 wrote: | >the complete lack of enforcement of what goes in supplements | | I agree with everything you said except for this. If resources | are finite to approve and regulate drugs, 3rd-party supplements | are the first thing I want tossed before any other more | critical medication. | kingkawn wrote: | Welcome to medicine! | egberts1 wrote: | First hand experience. | | Totally useless as a decongestant for me. | | Stick with pseudoephedrine. | sammalloy wrote: | Now do cough medicine. The last time I looked at the literature, | experts were asking why 95% of cough medicine was allowed to be | sold when none of it was known to work. The list of OTC medical | products that don't work is very large. | emmelaich wrote: | For some, pseudoephedrine make scuba diving _possible_. | | The difficulty of getting some is very annoying. | twofornone wrote: | I have the impression that many cold drugs are similarly useless. | Dextromethorphan comes to mind[0]. I think its the nature of | colds, they are not particularly severe and symptoms are easily | influenced by placebo effects. Many of them are really just | relying on caffeine for daytime meds and antihistamines for | nighttime formulations. That whole market feels like a borderline | scam. | | 0. https://pubmed.ncbi.nlm.nih.gov/11045895/ | annoyingnoob wrote: | Are there any good decongestants? | | Seems like all of them have potentially serious side effects. | Pseudoephedrine works but drives up my blood pressure. There are | any number of sprays like oxymetazoline but they all create | addiction issues if you use them too much. | joecool1029 wrote: | Phenylephrine does have one use that the author missed: It's used | in ophthalmology to dilate the pupils before eye exams. | | On the topic of other use case medications, I used to take | Sudafed (the real pseudoephedrine kind) during allergy season for | a few weeks each year and noticed my productivity skyrocketed | during that time, when I normally had issues context switching. | Eventually I narrowed it down to taking Sudafed and saw this | post: https://accidentalscientist.com/2005/08/the-sudafed-test- | for... | | This lead to an ADHD diagnosis and proper meds and my life and | work productivity improved pretty dramatically. | belkinpower wrote: | I ran into the opposite situation a few weeks ago. I was | wondering why my allergies were so much worse on the weekends, | and eventually narrowed it down to me only taking my ADHD meds | on weekdays. | throwra620 wrote: | [deleted] | astrange wrote: | Bit disappointing that everyone starts commenting about | amphetamines on a post about Sudafed working the same way as | Strattera, which isn't a stimulant. | | Though him telling people Strattera has no side effects | hopefully didn't surprise anyone when they went on it, it feels | (literally) like being kicked in the stomach and can make you | quite nauseous. | joecool1029 wrote: | I didn't like the safety profile on Strattera nor the | inability to take it 'as needed'. Rare, but there were | reports of liver injuries on it. My doctor seemed to be | unimpressed in it when I asked about options on and said in | her experience amphetamines almost always had the best | efficacy in adult ADHD patients. | trepetti wrote: | The title is misleading as written in the article. It should be | "The Uselessness of Phenylephrine as a Decongestant". | Phenylephrine is a lifesaving medicine in emergency medicine to | increase the blood pressure of people with hypotension. | p_l wrote: | The lack of availability of proper pseudoephedrine in USA led to | situation where there are papers describing how to turn | _methamphetamine_ into pseudoephedrine, not the other way around. | | With explanation in abstract that its easier to buy meth than | pseudoephedrine. | reincarnate0x14 wrote: | It would be interesting to see if there were any reliable stats | on how many, if any, people were caught by the ID check laws | trying to manufacture from pseudoephedrine, because even at the | height of the meth panic that engendered the laws something | like 95% of pseudoephedrine outside of a handful of high-risk | areas was very obviously not being used for any illegal | purposes. | stjohnswarts wrote: | I don't about anywhere else but the only thing you have to do | is walk up to the pharmacist and show an ID. I couldn't care | less. I'm buying like a couple of weeks worth. I've had the | same process in two different states, and not sure why it's a | big deal? We can't have nice things because meth cooks were | coming with shopping bags and stealing it all. | cuteboy19 wrote: | Are chemistry papers describing the synthesis of | methamphetamine illegal? | matthewmacleod wrote: | No. | techsupporter wrote: | > With explanation in abstract that its easier to buy meth than | pseudoephedrine. | | People may laugh at this, as they should since it is an absurd | situation, but this isn't entirely wrong. | | Neither my wife or I drive and during the pandemic she gave up | her license after getting an appointment at the DOL was | difficult. Both of us carry US passport cards as our ID. | | This has resulted in several situations where we've been turned | down for purchasing restricted items like alcohol or drugs | containing pseudoephedrine, particularly the latter, because a | passport card can't be scanned by the usual point of sale | systems. There are a couple of places in Seattle that are happy | to accept a passport card but even at them it's sometimes been | dependent on who is working the counter that day. | slaymaker1907 wrote: | As someone who moved to Seattle during the pandemic, I knew | when you mentioned getting an appointment with the DOL that | it was probably WA. I had to go out to Wenatchee (2 hour | drive each way) to get my license because everywhere else was | booked. | cdjk wrote: | My favorite REAL ID compliant ID to use is my Global Entry | card. | Rediscover wrote: | Gotta chime in on this. Seattle (in general a great place) | has some pretty horrible things re: purchasing alcohol. | Idiot/mis-placed store/bar-workers who only want a state ID. | My U.S. passport=NO. My U.N. passport=NO. | | Freakin' weird. | | Edit: I worked at Boeing for eight years, _very_ often in a | sec /reserved area. My passport was good there. Buying booze | down the street from [Boeing] plant 2, no. | mypalmike wrote: | Weird. Even during covid when I was wearing a mask, I never | got ID checked at a store in WA. It seems much laxer here | than in other states I've lived in. | ashtonkem wrote: | Not entirely unique to Seattle, in my experience. | | Seared into my head is my experience of trying to buy | alcohol in Boston back in 2009, when I was in town for a | wedding. I had just turned 21 so buying alcohol was still | novel and exciting. I had multiple bars and liquor stores | refuse my valid Illinois license, forcing me to hand | alcohol to my father to purchase, and find shady bars that | wouldn't card me. It was extremely frustrating to have to | rely on such tactics despite being legally allowed to | purchase alcohol. | morpheuskafka wrote: | > My U.N. passport=NO. | | I wouldn't blame a regular store clerk for not knowing what | a UN Lassiez-Passier is, especially since it doesn't have | the word "passport" in the name. But a passport, especially | one from their own country, definitely ought to be | recognized. | sbierwagen wrote: | When I lived in downtown Seattle in 2010 I had no problems | using a passport to buy alcohol. (Unfortunately, routinely | carrying around my passport resulted in me losing it, and | replacing a lost passport is a giant pain in the ass) | mattkrause wrote: | > People may laugh at this | | Not to spoil the joke, but the paper by "O. Hai" and "I. B. | Hakkenshit" is satire--I would be absolutely gobsmacked if | anyone is actually doing this. | p_l wrote: | The process described is true, but the authors are | anonymous - and rightly snarky | ericbarrett wrote: | Why not get a non-motorist ID card? Every US state has these; | here's Washington's: | https://www.dol.wa.gov/driverslicense/gettingidcard.html | michaelmcdonald wrote: | I believe this is the key element: | | > she gave up her license after getting an appointment at | the DOL was difficult. | | I'm not sure what DOL is a reference to; however I now many | individuals struggled to get appointments at the Secretary | of State (SoS) and that is also where one (at least where I | live) would need to get a non-motorist ID. Same amount of | frustration / time spent to get a non-motorist ID as it | would be to renew your driver license. | zacherates wrote: | DOL = Washington Department of Licensing: | https://www.dol.wa.gov/ | fragmede wrote: | DOL ~= DMV = RMV | cestith wrote: | In Illinois, it's the Secretary of State's Driver | Services office. In Texas, it's the Department of Public | Safety, and your plates may be in one building/location | and your driver's license/state ID in another part of | town. | | Maybe the most honest state is Missouri, where plates, | stickers for them, and your driver's license are all | handled by the state's Department of Revenue. | nostrebored wrote: | But why get one? A passport/passport card is a _better_ ID | document in almost every way. State non-motorist IDs should | really cease to exist and we should increase access to | passport cards | [deleted] | dylan604 wrote: | Except for the way of not being scannable at point of | purchase machines that was clearly stated. So if the one | point qualifying for "almost every way" is hitting right | out of the gate, then it doesn't seem to be that viable | of an option. | thrwy_918 wrote: | >State non-motorist IDs should really cease to exist | | State non-motorist IDs are some of the only IDs available | to non-citizens who live in the US and don't drive | InitialLastName wrote: | Don't they presumably have a US alien ID (Green Card or | otherwise) and/or a foreign passport? What other | documents could they use to establish identity to be able | to get a State ID? | jacobsievers wrote: | And, a government photo ID is required to get a passport. | A state ID is very useful for non-driving citizens, as | well as non-citizens. | techsupporter wrote: | We are aware of these. The reason is: Because unless you | get the "enhanced" version, due to the ridiculous REAL ID | situation you have to have another card anyway. For me in | particular, where I work operates a medical clinic in a | facility owned by the federal government so a non-enhanced | card doesn't get me in the door, but a passport card does. | | For my wife, it's because she has even less tolerance for | paperwork than I do and it's easier to just go to the | pharmacies we know have their heads bolted on straight than | it is to gather up all of the stuff and go to the | overworked and harried DOL. | [deleted] | dylan604 wrote: | Would that not still require an in-person visit that | they've already stated was not possible? I'd assume the | state would require a new photo for a new ID at the least | to make an in-person visit required. Probably need new | fingerpritns as well (if that's something WA does). | f7ebc20c97 wrote: | Society wouldn't function if people weren't willing to | bend the rules. | dylan604 wrote: | Not really sure what you're on about here. There's a time | and place where bending the rules is possible. Attempting | to get a government issued ID and not following the basic | rules of showing up in person is not really one of them | in my book. | hammock wrote: | Many Americans have difficulty obtaining ID, because they | cannot afford or cannot obtain the underlying documents | that are a prerequisite to obtaining government-issued | photo ID card. | | Underlying documents required to obtain ID cost money, a | significant expense for lower-income Americans. The | combined cost of document fees, travel expenses and waiting | time are estimated to range from $75 to $175. | | The travel required is often a major burden on people with | disabilities, the elderly, or those in rural areas without | access to a car or public transportation. In Texas, some | people in rural areas must travel approximately 170 miles | to reach the nearest ID office. | egberts1 wrote: | All you had to do is ask for a free state ID card. | | - It's Federal law. | | I don't know why people keep forking over money for state | ID. It's a state government scam. | djrogers wrote: | > Underlying documents required to obtain ID cost money | | Err, no they don't. At least not with any of the IDs I've | gotten in California for the past several years.... | tshaddox wrote: | Where can you get a certified birth certificate for free? | scythe wrote: | Yes, but you live in the People's Republic of California. | Rebelgecko wrote: | The county in California where I was born charges $32 for | a birth certificate. Most (all?) of the proof of address | documents also require you to spend money. If you already | have multiple utility bills in your name it's NBD, but if | you live with someone it could be a pain in the ass. | | Then a DL itself is another $40. A non-driving ID is like | $30, although there's discounts depending on age and | income. | ericbarrett wrote: | That's true and all, but the person I was replying to | already has a federal passport, which suffices for all | levels of state ID. | dredmorbius wrote: | Do you have any specific citations on that? | | I find it a credible claim. There was a story a few years | back which made the rounds that ... turned out to be a | case of fraud. | | http://www.miamiherald.com/news/nation- | world/national/articl... | | https://www.inquirer.com/news/mark-damico-johnny-bobbitt- | kat... | | That said, given frictions of obtaining ID and necessity | of having same, I could well believe that this is an | issue. | deltarholamda wrote: | The US would elect a baby-eating space alien from Tau Ceti VI | as president if Zbleqq'takkx's primary platform plank was "make | it so you can buy real Sudafed without a lot of hassle and | faff." | astrange wrote: | Yeah, US voters do seem to like electing presidents for | things only Congress has the power to do. Of course, | presidents also like proposing things they can't do. | | Presidents' main differences are on foreign policy which is | the one thing nobody asks them about. | [deleted] | arkades wrote: | Pseudoephedrine is still available -behind the counter-. You | literally just have to ask the pharmacist for it. | | Let's not turn grad students having a laugh into an actual | statement on public policy. | nanidin wrote: | My state attempted to make pseudoephedrine require a | prescription. One of the state lawmakers that was opposed was | a doctor and he cited studies where phenylephrine was less | effective than placebo. I wrote to my representative, who | called me after voting for the bill to tell me that some | sheriff told him phenylephrine is equally effective. | | Every time you buy the stuff from the pharmacist, they're | logging the purchase in a national DB and you're signing an | acknowledgement that it's a huge felony to go beyond the | limit. But they never tell you where you are vs the limit, | and the limits aren't clearly stated. End result: chilling | effect. | | My mom timed her purchases incorrectly (family of 5 with mom | shopping for all at the time) and went past the limit. After | that she was flagged and had to have an actual doctor's | prescription in order to purchase pseudoephedrine for 6-12 | months. That is a HUGE hurdle for most people, and doctors | don't want to see people who have cold symptoms. Heck, I was | turned away from a CVS Minute Clinic recently because I had | COVID like symptoms in the last 7 days. As in refused to see | me, even though I had recently tested negative for COVID and | had a fever + persistent cough. | ashtonkem wrote: | "I asked a cop about how effective an OTC medicine is" is | an absolutely insane thing for anyone to say, let alone a | legislator. Sadly it does not seem like such behavior | receives the social opprobrium it deserves. | p_j_w wrote: | Good to see your representative was getting his information | on the effectiveness of medicine from a cop and ignoring | the doctor. Emblematic of modern America. | ibejoeb wrote: | You don't just ask the pharmacist for it. You have to produce | an acceptable form of identification that can be used to | record the transaction in the universal database. It's | unavailable to anyone who doesn't have one of those. | leetbulb wrote: | If you don't have any form of identification, getting | pseudoephedrine from a pharmacy is probably not too high on | your to-do list. | ibejoeb wrote: | I suspect you're wrong. How many people do you think | would prefer not having medication to having medication? | radicality wrote: | He's definitely wrong. Sometime last year I had a cold | and I know pseudoephedrine helps me. | | I ran out and wanted to buy some at the local cvs. Now, | I'm not a US citizen but I've been here a few years | already and am a permanent resident. I do not have a US | state ID or a US driving license, and in my many years it | has _never_ been a problem. Everyone was always happy | with my green card as my ID - bars, domestic flights, | international flights back to USA, bank account openings | etc. But not for purchasing pseudoephedrine at CVS... | | I literally stood there with my green card and my | European passport and was begging the cvs clerk to sell | it to me, but the told me it's impossible, system doesn't | accept those IDs (and they tried, even showed me their | computer screen). And so I had to leave empty handed and | with a runny nose, and came back later with an American | friend to buy it... | exolymph wrote: | > Let's not turn grad students having a laugh into an actual | statement on public policy. | | Not to put too fine a point on it, but... at least _this_ you | can 't stop me from doing. | gojomo wrote: | Which means it's not available outside of the pharmacist | counter's more-limited hours. And there's often an additional | line to wait in before acquiring. And, as another thread | points out, extra ID requirements. | | So how exactly do the costs/benefits on this "public policy" | sum out? | | Benefits: | | * some grandstanding politicians enjoy the superficial | appearance of being "tough on meth" | | Costs: | | * Americans waste $billions on an ineffective placebo | decongestant | | * Legitimate manufacturers of a working medicine, | pseudoephedrine hcl, lose sales due to extra | cost/effort/stigma associated with the purchase. They shift | real productive resources - inputs & worker hours - to making | & marketing placebos instead. | | * Larger cross-border criminal organizations - of the kind | that regularly murder politicians south-of-the-border - grow | in market-share, sophistication, & power. | | * Meth continues to be available at high volume, & low costs, | unaffected by the pseudoephedrine limits. | | * Recent meth formulations - likely prompted by the limits on | the pseudoephedrine-process - seem to create a stronger & | more-destructive addiction among abusers: | https://www.theatlantic.com/magazine/archive/2021/11/the- | new... | | If we don't listen to 'grad students having a laugh' who are | pointing out the wasteful absurdities of 'public policy', | we'll keep such nonsense destructive rules indefinitely. | | The 'serious folks' among politicians & suited 'public- | policy' types are derelict in their duties. | toast0 wrote: | > Larger cross-border criminal organizations - of the kind | that regularly murder politicians south-of-the-border - | grow in market-share, sophistication, & power. | | Are you suggesting my neighborhood friendly drug dealer | could hook me up with some real sudafed? Might be nicer | than trying to get it from the pharmacy when I need it. | leetbulb wrote: | In my state, I'm able to walk down the road to a 24/7 chain | pharmacy and buy pseudoephedrine whenever I want. The | pharmacy, in combination with the state, uses ID to regulate | how much an individual may purchase over some time frame(s). | | Most doctors will just write you a prescription and you can | get it delivered to your home. Super easy. | mypalmike wrote: | Same here. But I think the edge cases are worth listening | to as well. Green card residents, for instance. Sudafed is | kind of a lifesaver for me at times and I feel fortunate to | be able to buy it relatively easily. | Johnny555 wrote: | Around here, you pick up a card from the shelf with a picture | of the product you want, then wait in line for the | pharmacist. Then they say "Sorry, we're out of that one, what | else do you want", "I don't know, what do you have", "sigh... | here's what we have left...". | | Then you show your drivers license and the pharmacist records | it and you pay and finally walk out with your sudafed. If you | want to buy several boxes because it's allergy season, well | too bad, you can't buy 2 boxes today, you have to come back | tomorrow for the second one. | | It's actually easier to buy as a prescription, then the Dr | can write you a prescription for any amount you need/want. | dsp wrote: | lol | https://improbable.com/airchives/paperair/volume19/v19i3/Pse... | cjhveal wrote: | Authored by O. Hai, and I. B. Hakkenshit | BatmansMom wrote: | "While N-methylamphetamine itself is a powerful decongestant, | it is less desirable in a medical setting because of its | severe side effects and addictive properties... Other side | effects may include violent urges or, similarly, the urge to | be successful in business or finance." | [deleted] | solveit wrote: | Thank you for making my day. | jjoonathan wrote: | Phenylepherine has excellent "not being easily convertible into | meth" properties, if only it had actual decongestant properties | to go along with them... | | Sigh. | bee_rider wrote: | I bet sugar pills would be even harder to turn into meth. | mh- wrote: | And more useful, too. They can be turned into things like | Pez, or Tic Tacs. | chrischen wrote: | I just recently got scammed by this. I'm not sure why they even | allow selling and marketing this. | akdor1154 wrote: | For all phenylephrine oral is useless, FYI phenylephrine nasal | spray seems to work well as a gentle decongestant, anecdotally | much better than saline spray, and not as strong (or addictive) | as oxymetazoline. | AtlasBarfed wrote: | My college buddy stayed with me about 22 years ago while he went | to med school, and then when he graduated he moved out. I found | after he left a box of phenylephine with "PLACEBO" scribbled over | it. | | That is to say, this has been known for at least 20 years. And | yet this big, ok, medium-big, lie persists. | dr_orpheus wrote: | There's only a couple drugs I know by name to look for on package | labels and pseudoephedrine is one of them. | | The other one is diphenhydramine (an antihistamine i.e. Benadryl) | because its common side effect of drowsiness means that its also | one of the most common sleep aids. It has been more than once | that myself or someone near me was having an allergic reaction | and the 7/11 down the block didn't have any Benadryl but did have | some sleep aid. | baggy_trough wrote: | Phenylephrine must be totally useless since pseudoephedrine | barely does anything in my experience! | [deleted] | ygjb wrote: | It's not super effective on me either, except for triggering | crippling anxiety, but remember that we are outliers, and it's | a very effective medication for most folks. | throwawayboise wrote: | Same. The original Sudafed did dry up a runny nose somewhat, | but also made me jittery like I'd taken a big hit of | caffeine. | noobermin wrote: | Man I have congestion so often and I always took phenylephrine | and always felt it was hit or miss. Now I know it wasn't just me! | thehappypm wrote: | I need a tl;dr: what medicine should I take if I'm congested?? | JohnTHaller wrote: | pseudoephedrine. The ingredient in Sudafed, Nyquil, etc that | actually works. You'll usually need to go to the pharmacy | counter to get it and show ID. They track how much each person | gets because some folks were using it to make meth a while | back. The replacement in the OTC Sudafed, etc out one the | shelves, phenylephrine, doesn't work. | Zak wrote: | I wonder how difficult it would be to get the restrictions on | pseudoephedrine rolled back now that it appears unlikely they're | accomplishing their original goal of limiting the methamphetamine | supply. Concern (legitimate and otherwise) over ability to | breathe is a popular topic in politics lately. | jrnichols wrote: | Difficult. Dianne Feinstein was the figure behind the changes, | as part of her war on drugs. She wanted pseudoephedrine made | prescription only too. | | https://www.drugcaucus.senate.gov/press-releases/feinstein-g... | | ironically, OR and MS, the states listed in that report, are so | far the only 2 that are starting to roll back the restrictions. | | Our elected officials seem adverse to admitting something | doesn't work well and rolling it back, unfortunately. | Zak wrote: | Every time she's mentioned, there's something to make me | dislike Feinstein more than I already did. It does seem | likely her strong opposition would be a high bar to clear, | though as the oldest current senator, she may not be a factor | for a long time. | noobermin wrote: | Hate to do this but hopefully she will step down at some | point, willingly or not due to her age. | reincarnate0x14 wrote: | It really is amazing how someone manages to be on the wrong | side of seemingly everything, and yet is locked into office | past the point of senility. | noobermin wrote: | Another arrow in my quiver for why the US is honestly not | a country to bet on for the next 20 years. | astrange wrote: | The only countries with better demographic trends than | the US are in Africa. | sydthrowaway wrote: | India? | orthecreedence wrote: | Yeah once in a while she does something and I think "ok, | that makes sense." But she's generally a broken clock. | vkou wrote: | This means that either your calibration mechanism for | 'wrong side' is flawed, or the system is rigged in a way | that it consistently produces bad outcomes. | | Speaking for myself, am shocked and outraged that red | senators and other congresscritters are consistently on | the wrong side of seemingly everything, yet they keep | getting elected. Of course, my political calibration | mechanisms are quite in tune. | Zak wrote: | Feinstein is weirdly not aligned with the left or the | tech industry given where she's from. Her strong anti- | drug and anti-encryption stances are easy examples. | | If I had to pick a single organizing principle to | describe her positions it would be a bureaucratic sort of | authoritarianism (as distinguished from the strongman | authoritarianism of someone like Donald Trump). | | I do believe the system is rigged in a way that | consistently produces bad outcomes. The US Senate is | structured to reward voters for keeping incumbents in | office, and plurality voting virtually guarantees two | dominant parties. | orthecreedence wrote: | > the system is rigged in a way that it consistently | produces bad outcomes. | | Yes. That one. | | "Real" change (ie, still a useless liberal democracy, but | at least a bit more in service to the people) would start | with voter reform and getting rid of FPTP entirely. | astrange wrote: | You wouldn't like the results of either of those if you | like "extreme" positions. | | - The most popular replacement for FPTP (which is biased | away from centrism) is RCV (which is biased towards it). | | - FPTP does turn it into a two-party system, but US | parties are weak. They don't control who joins them, who | gets elected, or how anyone votes. In the UK you can | actually get fired from the party for voting wrong. | orthecreedence wrote: | I don't care about "extreme" positions in the context of | liberal democracies. I can confidently say that there are | great improvements we can make within them while also | supporting abolishing them entirely. I like to be at | least somewhat pragmatic. | | RCV/STV is absolutely an improvement on FPTP in almost | every way. | | As far as strong vs weak parties, that seems to be an | issue with the UK. FPTP and weak-parties are separate | sets. You could have FPTP with closed party membership, | or RCV/STV with weak parties. | reincarnate0x14 wrote: | Feinstein's hard authoritarian and surveillance state | preferences haven't endeared her to many people who are | also shocked and outraged by the usual collection of | utterly repugnant red senators, so option B there. | [deleted] | baggy_trough wrote: | Very difficult. Regulations live on regardless of their | negative effects because there's very little incentive to get | rid of them. | A4ET8a8uTh0 wrote: | Worse, there is an incentive to keep them going as there are | entire industries and associated careers built around them. | astrange wrote: | That's actually evidence they're good, since nobody's built | a country with so many successful industries and no | regulation. They wouldn't be able to solve the coordination | problems. | Zak wrote: | For a long time, I've had the idea in the back of my mind | that all laws should have expiration dates, and the maximum | duration shouldn't be very long (12 or 18 years would be two | or three senate terms in the US). Ideally, it would be | combined with something to keep the scope of each bill | narrow. | baggy_trough wrote: | It wouldn't work because what would happen would be a mass | reapproval of all regulations. | | What I'd like to see is a constitutional amendment that the | total body of federal laws and regulations can't be any | longer or more complicated than a person of average | intelligence can be taught in a week. | kevinpet wrote: | Or simply require that they be read in the house / senate | before a vote. Not "read" but actually read, word for | word out loud, by the sponsor. | brimble wrote: | > It wouldn't work because what would happen would be a | mass reapproval of all regulations. | | Sunset provisions are an idea I tentatively like until I | consider what happens with the fucking stupid, pointless | "debt ceiling" crap Congress has decided to make | themselves do. I imagine how fun it'd be watching months | of idiotic brinksmanship over keeping murder illegal, | because one group of legislators wants to grand-stand | about abortion. Then repeat for practically everything | else. | | No thanks. | Zak wrote: | I used to think a limit on the total size of the law like | that would be a good idea, but some areas of regulation | are inherently complex. I still hold a related position: | an adult of reasonable intelligence should be able to | easily learn all the laws that they're likely to | encounter, _and_ learn which fields are subject to | detailed regulation. | | To give an example, the regulations governing design of | commercial aircraft can almost certainly be simplified | from their current state without killing people, but | probably cannot be simplified to the point that someone | who isn't already an expert on aircraft design can learn | them in a week without killing people. Knowing that field | is subject to special rules is enough to avoid | accidentally violating the regulations. | baggy_trough wrote: | Currently there's no limit to the complexity that | governments can inflict on us. Since there's no garbage | collection process for laws/regulations, we wind up with | an enormous body of legislation and regulation which | almost nobody understands or adheres to. It's terrible | for the rule of law. | cardiffspaceman wrote: | Sunset provisions are popular actually. Jimmy Carter put | that idea on his platform in '76, and it was carried out to | some extent, and his own state was the example that sold | people on it. I sense that they have waned since. | | I believe there are restrictions on the breadth of laws but | they are not honored very effectively. | dylan604 wrote: | Pessimistic me says not likely. Once these regulations are put | in place, it is nearly impossible to get them removed. It takes | a literal act of Congress. Now you have to spend useless energy | against attacks of "soft on crime/drug abuse/etc" types of | nonsense for suggesting removing an item from the list. Don't | bother resorting to facts. Those are useless in the emotional | knee jerk reactions that will ensue. | sva_ wrote: | It probably still makes it a lot more difficult to make meth in | a "homelab", as alternative synthesis paths are probably a lot | harder. So they're leaving it to the "clandestine pros", | ironically ;). | | Also, in legislation, it seems like making things illegal | passes several orders of magnitudes more easily, than anything | that gives normal citizens more rights. | starwind wrote: | WHY DO YOU WANT CHILDREN TO GET METH?--Opponents of rolling | back restrictions on pseudoephedrine | | But more seriously, the FDA ends up regulating something like | 30% of the economy and getting them to deregulate something is | near impossible | ashtonkem wrote: | The restrictions the state places on us largely function as a | one way ratchet, alas. There is a lot about American drug | policy that is wildly unpopular, and yet here we are. | | A huge portion of the issue is that we're largely ruled by | people who don't need to deal with any of the inconveniences | they cause; if any senator or rep has a runny nose I'm sure | they can get an aide to sort it out for them. The rest of us | are not so lucky. | JumpCrisscross wrote: | > _how difficult it would be to get the restrictions on | pseudoephedrine rolled back_ | | Likely a non-starter until the FDA revokes phenylephrine's | designation as a decongestant. | eikenberry wrote: | Pseudoephedrine restrictions were recently was rolled back in | Oregon, where you had to have a prescription to get it. Now | we're able to buy it over the counter with ID. So it can | happen! | rootusrootus wrote: | It's happening slowly. Oregon had pushed it all the way to | requiring a prescription to get pseudoephedrine. It does still | require a visit to the store pharmacy and showing your ID to | prove you are an adult, but at least you can buy it without a | prescription now. I think only a couple states ever went that | far. But at least it is a step back in the right direction. | somebodynew wrote: | The ID check isn't for age verification. Federal law requires | IDs to be recorded* to enforce restrictions on the maximum | quantity that an individual is permitted to purchase per | month. | | * Edit: Where the word "recorded" appears, this comment | previously said "scanned and submitted to a central | database". While most states use a central database, the | comment reply below pointed out that this goes beyond the | minimum that federal law requires. | rootusrootus wrote: | I am not aware of a centralized federal database. My | understanding is that federal regulations stipulate that | the pharmacy must see photo ID and take note of who bought | the pseudoephedrine, when, how much, and keep that | information logged either on paper or electronically. To be | available to law enforcement on request. | | The Oregon law does have a central database requirement, | however I believe this is in all cases a decision made by | each state individually. | somebodynew wrote: | You are correct, I was conflating two separate steps of | the process. Federal law only requires keeping records | and these could technically be done on paper. In | practice, more than two thirds of the states participate | in a central electronic database called the National | Precursor Log Exchange. | patwolf wrote: | I'm also irked by the fact that OTC cough suppressants like | dextromethorphan are equally useless. | hammock wrote: | Citation? Dextromethorphan works very well for me. (Also DXM is | a recreational drug which is why it's always sold OTC with | either Tylenol in it or as an extended-release formula) | cardiffspaceman wrote: | Chris Rock has a few brilliant, hyperbolic, minutes on how in | some neighborhoods "tussin" is a cure-all. | ConceptJunkie wrote: | https://pubmed.ncbi.nlm.nih.gov/11045895/ | mrguyorama wrote: | Mucinex (Guaifenesin) fixed all my illness cough problems. It | makes your mucus thinner and produces more of it to make your | coughs "more productive" which means you finally get that junk | out of your throat. Eliminates tickly throat coughs and also is | useful in pretty much all situations that involve coughing. | It's a genuine magic bullet for me, where no cough suppressant | has ever worked, through my entire 30ish year existence. | djrogers wrote: | In the vast majority of cases for my family, Dextromethorphan | is a miracle drug. We're in the middle of cold and allergy | season here, and my kids (and I) stop coughing within 5-10 | minutes of taking an appropriate dose. | | Once every 3-4 years I'll get a cough so bad that DXM won't | fix, and when that happens my doc gives me a prescription for a | codeine based cough syrup that fixes it (and renders me useless | as a human being). | genewitch wrote: | I dunno, codeine makes me love my family even more, as an | anecdote... | mdoms wrote: | When I get a cold I simply get plenty of rest and ride it out. | Drugs are not necessary for minor ailments. | codr7 wrote: | I recommend simply getting a Yoga nose cleaning thingy, it will | also help prevent getting sick in the first place. | zaroth wrote: | By the way, if you want something that works, that you can buy | without a prescription, I cannot recommend "BronkAid" aka | ephedrine sulfate 25mg highly enough. | | It's sold "behind the counter" in the US at major pharmacy | chains, which means you have to ask for it by name, they won't | even have the cards in the aisles that you then bring up and | redeem. | | You have to show ID -- not sure if that's a Federal or a State | thing, and you're limited in the quantity you can buy at once, | but the limits are not overly restrictive. | | It's sold mainly as an anti-asthmatic. I personally have | borderline asthma, meaning I've never had an asthma attack but in | a test chamber my total lung volume increases 20% after puffing | albuterol. | | It opens up my breathing tremendously, very useful as a pre- | workout, has a nice nootropic effect, and for me personally does | not cause any increased heart rate, although for many people that | is an undesirable effect. Perhaps best not to stack with | caffeine. | | And when I have a cold, I like it better than suppressants, | expectorants, or even pseudoephedrine because I get clearing | without turning into a leaky faucet. | | Just my anecdata... | gojomo wrote: | My understanding, consistent with your impression, is that | ephedrine has more of a _full-system_ effect, including lungs | & bronchial tubes, along with (in many people) more of a | general full-system stimulation. In contrast, pseudoephedrine | has a greater nasal/sinus effect with a bit less full-system | spillover (but still noticeable in some people, or at higher | doses, or in combo with caffeine). | | So it's worth it for people to be aware of ephedrine options - | like ephedrine sulfate or ephedrine hcl ('Primatene') - but | many will still find pseudoephedrine better for their symptoms. | It's worth trying both, separately, depending on personal | chemistry & concerns. | djrogers wrote: | Shh! Don't talk about the secret stuff! My pharmacies run out | of it too often as it is... | PragmaticPulp wrote: | The article comes _so close_ to explaining a way to make it work, | likely due to his hesitancy to recommend exceeding the | recommended dose: | | > Why is oral phenylephrine so useless? It is extensively | metabolized, starting in the gut wall. You can find a | bioavailability figure of 38% in the literature, but that appears | to be the most optimistic number possible, and you can also find | studies that show 1% or less. Overall, the Cmax is highly | variable patient-to-patient, and the lack of cardiovascular | effects at low doses argues for very low systemic effects (and | expected low efficacy as a decongestant). The bioavailability | increases at higher doses as you apparently saturate out some of | the metabolic pathways, but at the 10mg dose typically used for | decongestants, you can forget it. | | Phenylephrine has variable Bioavailability. The bioavailability | doubles if you take it with Tylenol, which is actually common in | the context of colds. (Source: | https://pubmed.ncbi.nlm.nih.gov/25475358/ ) The maximum dose was | probably chosen based on worst-case scenarios, whereas the | average person who complains it doesn't work is probably | absorbing much less. | | Always consult with your doctor, but I've found that taking a | second dose of phenylephrine if the first one hasn't worked | within about 30 minutes usually does the trick. Or just take it | with Tylenol. It's worth checking your blood pressure to make | sure you haven't started entering the realm of side significant | side effects, though. | | Also I should point out that pseudoephedrine isn't available | behind the counter everywhere. It's prescription-only in some | places. | JumpCrisscross wrote: | Do we have a study showing these (second dose within 30 minutes | or paracetamol + phenylephrine) performing better than placebo? | PragmaticPulp wrote: | We actually have a lot of studies where even standard 10mg | phenylephrine taken alone outperforms placebo: | https://pubmed.ncbi.nlm.nih.gov/17692721/ | | Note that Figure 3 also mentions the Tylenol combination | effect and even shows how 10mg Phenylephrine + Tylenol | performs somewhere between 10mg and 45mg of phenylephrine. | | The article author just cherry-picked the one study where | phenylephrine performed the worst. Cherry-picking a single | study to support a conclusion and ignoring meta-analyses | would normally get someone torn apart in the HN comments but | apparently everyone loves pseudoephedrine so it gets a pass. | natechols wrote: | "Data from 7 crossover studies involving a total of 113 | subjects were reanalyzed and then pooled for meta-analysis" | | This is a huge red flag - I've read too many of Derek | Lowe's blog posts to take that kind of study very seriously | as medical advice. Much more promising leads than this have | utterly bombed in clinical trials, it happens all the time. | PragmaticPulp wrote: | Read the whole abstract. They showed which studies | reached statistical significance on their own. | | You could just read those studies and ignore the meta- | analyses if you want. | | I honestly don't understand this current trend of | assuming meta-analyses are inherently incorrect and | cherry-picking the worst study as the source of the | truth. | natechols wrote: | It's not the meta-analysis part that's the biggest red | flag, it's "a total of 113 subjects". That's the size of | a Phase I trial, and the road to Phase III and clinical | approval has a crazy high attrition rate. | epmaybe wrote: | funnily enough, phenylephrine is used daily in ophthalmology for | dilated eye exams. On that note, there's a bunch of esoteric | drops that used to be used because of their useful | pharmacokinetics, diagnostic/therapeutic abilities (cocaine, | hydroxyamphetamine, pilocarpine 0.125%, homatropine), but are no | longer being manufactured due to cost. | boringg wrote: | I used the, I believe, dayquil version one time (active | ingredient pseudoephedrine) in the US and my ability to focus | that day was on a completely different level even being sick. I | almost wanted to keep using it for productivity purposes. | | Also love that I had to go to a controlled substance area of the | pharmacy to get it. | EamonnMR wrote: | Sometimes I wonder if NSAIDs are the same deal, or if there's | just a subset of people they don't work well on. | throwawayboise wrote: | Tylenol (acetaminophen) does nothing for me. Advil (ibuprofen) | does usually work. I used to get more headaches when I was | younger, but I rarely get them now. Two things that have | changed that might be related: I no longer use CRT screens, and | I no longer drink diet soda (used to drink 4-6 cans a day, most | days). | | Aside from headaches, Advil does better on other aches and | pains than Tylenol, which does almost nothing. And it's better | for the liver. | genewitch wrote: | better for the liver, worse for the stomach. It's a sliding | scale, you have to decide how much you care about whatever | hurts not hurting anymore versus damage to organs you can't | even see. | | Also i used to get wicked headaches from diet soda when i was | younger, too. Is it possible to be "slightly" | Phenylketonuric? I had to google the spelling, and it's | interesting that "hyperactivity and behavioral issues" is | listed as one of the symptoms. I doubt "slightly" is | possible, that was tongue-in-cheek. | | Also as an aside, for pain that the standard dose of | ibuprofen doesn't seem to help, emergency medicine studies | have found that an additional standard dose of acetaminophen | alongside the ibuprofen has greater pain reduction efficacy | than vicodin. | JshWright wrote: | There is a significant amount of evidence supporting the | efficacy of NSAIDs. Note that they are more effective for some | types of pain than others, due to the mechanism by which they | work. | skyechurch wrote: | NSAIDs and Tylenol definitely work differently on different | people and on different types of pain ime. The stronger ones, | like Torodol, can be very effective on even quite serious pain, | but you can't even get it _with_ a prescription anymore in the | USA. ___________________________________________________________________ (page generated 2022-03-30 23:00 UTC)