[HN Gopher] Two pharmacists figured out that oral phenylephrine ...
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Two pharmacists figured out that oral phenylephrine doesn't work
Author : sohkamyung
Score : 190 points
Date : 2023-12-21 13:40 UTC (9 hours ago)
(HTM) web link (www.scientificamerican.com)
(TXT) w3m dump (www.scientificamerican.com)
| spicybbq wrote:
| https://archive.is/wLY8e
| dist-epoch wrote:
| What's the consensus on eucalyptus oil sucking pills? Seems to
| work for me.
| vidanay wrote:
| That's the strangest name for "cough drop" I've ever heard.
| christkv wrote:
| I remember using Vicks(r) VapoRub as a kid for congestion and
| it seemed to work.
| DHPersonal wrote:
| An Atlantic article recently suggested that this is due to
| the feeling of coolness on the throat and not actually the
| opening of nasal passages.
| https://www.theatlantic.com/health/archive/2023/10/humans-
| ha...
| justinator wrote:
| Lucky. It was boiled onions for me.
| Cthulhu_ wrote:
| Eucalyptus oil is an effective decongestant. You can put it in
| an oil burner or a humidifier as well.
| rybosworld wrote:
| I was surprised when I heard they are taking phenylephrine off
| the market.
|
| In my anecdotal experience, it was extremely effective at drying
| out my sinuses, which did reduce congestion. So I asked some
| family and friends and their responses were mixed. Some said it
| did nothing and others swore it was effective.
|
| I'm not claiming that phenylephrine is in fact generally
| effective, just wondering out loud if there could be more to the
| story. I.e., it works for some people and not others.
|
| Anecdotes are not science. But if enough people share an
| experience, sometimes there is more to the story.
| JHonaker wrote:
| > Anecdotes are not science. But if enough people share an
| experience, sometimes there is more to the story.
|
| Solely relying on anecdotes as evidence is not science, but
| they're absolutely a critical part of it!
| corethree wrote:
| Science is expensive and moves slow. Sometimes anecdotes are
| all you have.
|
| Just because the science doesn't exist doesn't mean anecdotes
| are completely invalid.
| JHonaker wrote:
| That's what I was trying to say. Anecdotes are the seeds of
| hypotheses, and enough anecdotes with well-understood
| conditions make a study population.
|
| > Science is expensive and moves slow.
|
| I don't know if I agree that science is slow. Certainly
| scientific consensus is slow though. The churn of ideas at
| the forefronts of fields is rapid. In my field (machine
| learning/statistics) I'd say too rapid/short term incentive
| focused.
|
| I really take umbrage at the idea that science is some
| purely objective, ideal process. It's messy, and scientists
| are opinionated and stubborn. Some of the most obstinate
| people I've met are tenured professors... They kind of have
| to be. It takes time for good ideas to weather the initial
| criticisms, persist through replication and testing, and to
| take hold.
| corethree wrote:
| Science is slow for sure. You need to gather samples and
| run tests. Often testing for causality is impossible,
| because you literally need to "cause" the issue in your
| sample group and that raises ethical issues if the thing
| you're "causing" is harmful.
|
| It's not even the human parts that are flawed with
| science either.
|
| Science is fundamentally flawed by nature because in
| science and therefore reality as you know it you cannot
| prove anything to be true. You can only falsify things in
| science. Proof is the domain of mathematics.
| fredgrott wrote:
| Anecdotes are not science. But if enough people share an
| experience, sometimes there is more to the story.
|
| Read that again in context to the two people who found the
| science of why it does not work..
|
| You are defeating your argument...
| evanjrowley wrote:
| There is a problem with the studies these pharmacists are
| referencing. They are measuring nasal resistance, however,
| the measurement is not sufficient to capture the combination
| of things that make up nasal resistance. It's a combination
| of how much mucus is being secreted vs the degree of sinus
| inflammation.
|
| New theory: Allergy sufferers are likely primarily
| experiencing sinus inflammation. Pseudoephedrine is the
| better solution for that. For those of us who are dealing
| with secretion - phenylephrine is effective.
|
| https://www.jacionline.org/article/S0091-6749(06)00633-6/ful.
| ..
| travisjungroth wrote:
| What's a case study but a fancy anecdote? It's not very
| sciencey to form an opinion after a study and shut down
| conflicting evidence.
| bmurphy1976 wrote:
| My anecdote is that for me I've known phenylephrine worthless
| for decades and seek out pseudoephedrine when I need actual
| relief. Now we have two data points.
| exoverito wrote:
| Anecdotes are the material for new hypotheses, so they are very
| much part of the scientific process.
|
| This reminds me of the debate around monosodium glutamate (MSG)
| causing headaches. There were early scientific reports which
| found no real link and that it was probably psychosomatic
| nonsense. However more recent studies found that some people
| have a heightened sensitivity to glutamate, and since it is a
| literal neurotransmitter there is a promising pathway for the
| mechanism of action.
|
| Biology is stupendously complex, it's difficult to make hard
| and fast rules about something being categorically effective or
| ineffective.
| evanjrowley wrote:
| Thanks for this comment. I maintain the unpopular position
| that both 1) phenylephrine is mildly effective for drying out
| my sinuses, and 2) MSG definitely gives me headaches, unlike
| salt, so most likely glutamate is the culprit.
| Der_Einzige wrote:
| Silly fun fact, the chemical code for MSG (e621) just happens
| to also be the name of the largest furry "booru" site on the
| internet. I have no idea why this is.
| sarchertech wrote:
| What form are you talking about? The nasal spray isn't being
| removed because it is effective. It's the oral version that
| isn't effective.
|
| Also the placebo effect is real. So even if the boxes had
| always been packed with sugar pills, you would expect some
| people to report that it was effective for them.
|
| Additionally, even if it did have some mild effect, oral
| pseudoephedrine is better in nearly every way.
| Qem wrote:
| > The oral absorption of phenylephrine is erratic. Perhaps that
| is why it was not used as an oral decongestant until it was the
| only choice. It had long been known that enzymes in the gut
| lining metabolized oral phenylephrine to inactive metabolites,
| reducing the amount of the active compound that could enter the
| bloodstream. The most cited study found that an oral dose of
| phenylephrine had an absorption rate of 38 percent of an oral
| dose of phenylephrine, but this study measured more than just
| the compound's active form. Later studies with more sensitive
| tests found that less than 1 percent of oral phenylephrine
| enters the bloodstream in an active form.
|
| Perhaps you have a less active form of the enzyme that degrades
| it.
| fixedpointsnake wrote:
| I've been looking for this comment in all these stories
| regarding the ineffectiveness of phenylephrine!
|
| I have a similar story. Congestion is not a symptom I typically
| get. Covid, however, decided to shake things up and introduce
| me to a new set of symptoms... One of those was congestion such
| that my head felt like a balloon. Without experience treating
| this symptom, I went out and ended up with Sudafed PE, oral
| phenylephrine. It worked _immediately_, it was like a balloon
| deflating. It worked so well that these headlines regarding
| phenylephrine's ineffectiveness still cause bemusement...
|
| anddd that's my story.
| evanjrowley wrote:
| I had the same experience with phenylephrine. It dried out my
| sinuses, which helped me _slightly_ with decongestion but
| moreso with post-nasal drip.
|
| The effect was not dramatic, and as I understand it, people
| with allergies need that dramatic effect to be able to breath
| well.
|
| It seems to me phenylephrine was effective for something
| different than what the FDA had in mind, but due to their
| folly, now both phenylephrine and pseudoephedrine are
| unavailable to the average person.
| standardUser wrote:
| I think the fact that different drugs work differently on
| different people is criminally underrated.
| christkv wrote:
| I've only ever had Xylometazoline spray for the nose and
| pseudoephedrine tablets work and both can only be really taken
| for a short period of time. Overuse of Xylometazoline will have
| the opposite effect.
| mattmaroon wrote:
| I feel like anyone who has tried a PE drug knew they didn't work.
| I've wondered for a solid decade why they existed. I'll happily
| wait in the tweaker line for my pseudo.
| prmph wrote:
| They hitched a profitable ride on the placebo effect bandwagon
| Scubabear68 wrote:
| It literally did nothing at all.
|
| Before I started using Flonase for my congestion, real Sudafed
| was the only thing that would work when I had to fly. If I
| forgot, take off and landing would be miserable because my ears
| wouldn't pop.
| hunter2_ wrote:
| You probably know given your username, but Sudafed is also
| great for diving to avoid barotrauma (MEBT). Just need to
| ensure it's not less than the 12 hour formulation, lest it
| wear off at depth.
| mattmaroon wrote:
| A year ago I had an eardrum suddenly and randomly rupture
| (probably due to an infection I never felt before it
| happened) and after it healed a bit, my ENT told me that I
| should take it before a flight just to be sure to open the
| eustachian tubes.
|
| Oddly a few days later I overheard pilots in the airport
| lounge talking about times their eardrum ruptured due to a
| cold or something. It's an injury that's not uncommon for
| them.
|
| Now I pop one before a fight every time just to be safe. If
| you've never had an eardrum rupture let's just say it isn't
| fun.
| HumblyTossed wrote:
| > I'll happily wait in the tweaker line for my pseudo.
|
| HA! Indeed! I got a three pack from Costco. Should last a
| while.
| dylan604 wrote:
| How much paperwork and what forms of ID were required to buy
| that much at one time? It sounds like a sarcastic question,
| but it is a serious one. The last time I was prescribed a
| codeine based cough syrup, my signature was required enough
| times to make me compare to financing a car/house.
| eli wrote:
| It's the same process for any amount up to the limit.
| dylan604 wrote:
| and that process is????
| patch_cable wrote:
| In Washington state at least I just have to let them scan
| my drivers license.
| eli wrote:
| It depends where you live, but usually ID check +
| signature
| sixothree wrote:
| I don't think that's allowed where I live. But hey. We have
| gun shows every other month and a strangely coincidental
| amount of gun deaths. But at least I'm protected from
| dealing with colds.
| toast0 wrote:
| I seem to recall reading something that said there is an
| effective does of phenylephrine, if you take it by itself, 2x
| the dose works, but if you take it with other meds, it might be
| ok by itself. Something about the stomach acid neutralizing it.
| Might help to take it with food too.
| kstrauser wrote:
| What you're probably thinking of is topical (is that the
| right word here?) phenylephrine. If you snort it, like as a
| nasal spray, and it soaks directly into the inflamed nasal
| tissue, then it has an effect. Swallowing it does not.
|
| Analogy: you wouldn't eat hemorrhoid cream.
| zbrozek wrote:
| It's long past time to remove that regulatory friction.
| Instead, it's spread to other drugs. My wife got a cold last
| week and sent me off to get some other non-pseudo drug. Despite
| being on the shelf, unlocked, it triggered a driver's license
| scan at checkout. Very dystopian.
| tptacek wrote:
| It doesn't seem dystopian to me at all. I get carded when I
| buy alcohol; in fact, I got _declined_ recently buying
| alcohol, because my license had expired, but would not have
| been for Sudafed, where the ID is just there to rate limit
| purchases.
|
| This is a very old, recurrent HN debate.
| alright2565 wrote:
| But you don't have your identity logged with the government
| when you buy alcohol. They just verify the age and forget
| all the information on your ID immediately.
| tptacek wrote:
| They're not rate-limiting my purchases of alcohol; they
| are rate-limiting my purchases of Sudafed. That's the
| only reason they need my ID for it. Meanwhile, the data
| they're theoretically collecting is useless. Everybody
| gets colds.
| vasco wrote:
| > I got declined recently buying alcohol, because my
| license had expired
|
| Were they under the impression you might get younger when
| you renew your license or was this some kind of automated
| machine that auto-denies without any recourse?
| umanwizard wrote:
| > some kind of automated machine that auto-denies without
| any recourse?
|
| This describes a lot of bureaucratically-minded humans,
| fwiw.
| jaywalk wrote:
| The reason they don't allow expired licenses for alcohol
| purchases is because an older, similar-looking person
| (sibling, etc.) could just give their expired license to
| someone who's underage.
| pavon wrote:
| They could do the same with current licenses, either
| temporarily or permanently. When I was in my 20's I had a
| stack of old but unexpired drivers licenses because
| having your current address on your license makes makes
| some things easier.
| mattmaroon wrote:
| That's why a lot of places now scan the ID. Presumably
| the vast majority of times whoever lost/gave up/sold the
| ID got a new one from the local BMV and the old one will
| be flagged.
| xp84 wrote:
| I don't think (really, "I hope") that these scans aren't
| hitting the government database, allowing the government
| to easily build a dataset of every time you buy
| alcohol/tobacco/pornography/whatever -- that is
| uncomfortable even to me and I'm not really a
| libertarian.
|
| The 2d barcodes and magstripes on these cards do have all
| the info that's printed, though, so I would bet that a
| "gifted" ID that hasn't expired but which you've replaced
| or claimed as lost would still work at a retailer who
| scans IDs.
| jaywalk wrote:
| Yeah, the scanners they use for age restriction are just
| standalone devices that show the age without the user
| having to figure it out themself.
| mcpackieh wrote:
| And the reason they insist on checking the ID of a 40
| year old man with gray in his beard and photoaged skin is
| because... 1) A teenager might be a special effects
| makeup artist.. or 2) because the law compels them to be
| bureaucratic twats who follow the rules even when the
| rules make no sense.
|
| The correct answer is number 2, and that's the real
| reason they won't accept expired IDs either.
|
| Incidentally, the TSA does accept expired IDs. I flew
| with one and TSA didn't say anything to me; they scanned
| it into their computer then waved me through like normal.
| Then the bartender at the airport pointed it out and
| refused to serve me.
| jjulius wrote:
| YMMV, re: TSA. My wife's license was due to expire a week
| after flying, and they gave her a bunch of shit about how
| lucky she was that she wasn't trying to leave the
| following week.
| jaywalk wrote:
| The TSA's official policy is to accept IDs within a year
| of expiration: https://www.tsa.gov/travel/security-
| screening/identification
| jjulius wrote:
| TIL, thanks! :)
| lazide wrote:
| Probably more because they wanted to give her shit
| (notably pretty, or notably mean to them?) than anything
| else.
|
| Personally, when in a stirring shit mood, it can be fun
| to ask them what section of the law/code they think says
| that. I don't think I've ever gotten a straight answer
| from TSA, and very rarely a straight answer from a police
| officer. When I've been travelling with
| things that have specific actual laws that apply to them,
| I've taken to printing out the actual applicable laws
| (and their policies). It's rare they actually follow them
| at first (and multiple times I've had them instruct me to
| do something that would violate them, or had they
| themselves violate them), but showing them politely
| usually helps.
|
| I even had TSA once (many years ago), bring me my checked
| luggage with a gun in it (legally) to the gate in the
| terminal, and ask me to unlock it right there and
| demonstrate it was unloaded. A case with ammunition in it
| too (also legally). To do that demonstration, I'd have to
| pick it up and manipulate it.
|
| I politely declined, not wanting to get shot or arrested,
| and showed them their policy instead which is that needed
| to be done _before_ security, outside of the 'sterile
| area' - and I in fact had done so. They insisted a couple
| more times, I insisted I wasn't going to violate the law
| or their policies, they got a supervisor which got angry
| at them, and they eventually left. And it was transported
| to my destination, unmolested, as was I.
|
| Still a hassle, and quite concerning - they either
| legitimately thought it might be loaded and transported
| it anyway, or were so confused they did that song and
| dance for awhile until they could figure it out - and
| thought the answer was to have the passenger handle a
| potentially loaded gun in the secure area of the airport
| to demonstrate everything was actually fine? Or wanted to
| jam me up by creating an actual crime in progress?
|
| No actual feel good answers to be found there,
| unfortunately.
| margalabargala wrote:
| > Personally, when in a stirring shit mood, it can be fun
| to ask them what section of the law/code they think says
| that. I don't think I've ever gotten a straight answer
| from TSA, and very rarely a straight answer from a police
| officer.
|
| In the US, the reality we live in is that knowledge of
| the law is explicitly not a requirement for these jobs. A
| police officer is not required to know what law you are
| breaking, and can legally arrest you if they genuinely
| believe you are breaking a law they only imagine exists.
|
| Whether this ought be the case is a separate discussion.
| But this is the landscape in which a series of court
| decisions have left us.
| lazide wrote:
| Yup, which is why when in a shit stirring mood, you'd
| better be prepared to get some on you.
| datasink wrote:
| I briefly worked as a retail pharmacy technician 12 years ago.
| There were a few pharmacists that I worked with during this time
| and all of them were aware that phenylephrine essentially did
| nothing.
|
| I hadn't really thought about it until now, but these pharmacists
| did not directly work with each other, so it must have been
| obvious that phenylephrine was ineffective.
| naijaboiler wrote:
| All professionals knew it did nothing. But the problem is by
| law FDA only needs to certify that OTC medications are safe not
| that they are effective. So drug companies go to town making
| billions off those old safe but useless medications
|
| The real change is to add the mandate of efficacy to FDA for
| OTC medications.
| kridsdale1 wrote:
| Indeed. My Walgreens has a whole section of clearly and not-
| clearly labeled homeopathics for these symptoms.
|
| People want to buy them and they won't get hurt, let em, I
| guess.
| yjftsjthsd-h wrote:
| > People want to buy them and they won't get hurt, let em,
| I guess.
|
| I would qualify that as, if people _know_ what they 're
| buying and want to buy them.
| kstrauser wrote:
| And if they _know_ what homeopathy is, they wouldn't be
| buying it.
| lazide wrote:
| Oh man, good luck with that one. I've never had someone
| super into horoscopes that would stop being super into
| them, no matter how much you proved they were bullshit.
|
| They will try to shiv you though if you keep trying.
| kstrauser wrote:
| Alright, you got me there.
| abfan1127 wrote:
| you don't want to go down the road of the "FDA mandating
| efficacy". However, requiring "truth in medicating" i.e.
| demonstrable efficacy rates would be nice.
| ceejayoz wrote:
| > you don't want to go down the road of the "FDA mandating
| efficacy".
|
| This has long been a thing already.
|
| https://www.fda.gov/drugs/drug-safety-and-
| availability/fda-c...
|
| > Many OTC medicines, including phenylephrine, are sold
| because they have an ingredient that FDA generally
| recognizes as safe and effective (GRASE) when used as
| recommended on the product labeling, which is documented in
| an "OTC monograph." If FDA determined that oral
| phenylephrine is not effective, the agency would first
| issue a proposed order removing phenylephrine from this
| monograph.
|
| https://en.wikipedia.org/wiki/Generally_recognized_as_safe_
| a...
| lazide wrote:
| The funny thing is phenyl ephedrine _is_ actually very
| effective - when given IV, or directly applied to mucus
| membranes. Which this OTC drugs will never be used for.
|
| So it is an effective drug, overall. Just not when used
| this way.
|
| So good luck nailing whichever bureaucrat approved this.
| fnordpiglet wrote:
| Every human with a nose knew it didn't work, because when you
| took it, it didn't work. The fact it was marketed was purely a
| regulatory exploit by pharmaceutical companies. The truth is,
| they could have continued to let pseudoephedrine be behind the
| counter and it would have been fine. But someone realized
| phenylephrine was approved OTC and sounded sort of like
| pseudoephedrine, so they could claim the shelf space and edge
| pseudoephedrine products.
|
| Their defense to the FDA in being allowed to continue to market
| despite being proven even before they began their cynical ploy
| was consumers want convenience, which sadly is clearly true,
| that despite knowing if you walked five feet further and got
| the pseudoephedrine they would get relief they grabbed the drug
| conveniently placed. Fortunately lobbying money only went so
| far this time.
| rincebrain wrote:
| A lot of pharmacies have limited hours and long lines for
| people to say "give me the thing" compared to just grabbing
| it off the shelf at any time of day with no line.
|
| Some people I know are essentially nocturnal, and have to
| significantly disrupt their lives whenever they have to do an
| irregular medication pickup rather than having it shipped
| ahead of time.
|
| So it can be beyond just "slightly more work" for many people
| to get it.
|
| Personally, I try to remember to get some whenever I refill
| meds at the pharmacy, not because I go through it that often,
| but because if I'm feeling poorly enough that I'm taking it,
| I probably am not in a state where I want to wait an hour in
| line just to ask for it.
| gehwartzen wrote:
| This is sadly so true for many many categories of consumer
| products; by the time sufficiently enough people discover the
| product is bullshit to turn general public opinion the
| original sales already made the "innovator" enough money to
| make the whole endeavor worthwhile.
| quickthrower2 wrote:
| Someone make an app where you scan the barcode and it gives
| you the scoop (Is it BS/dangerous etc).
| jwineinger wrote:
| My dad is a physician and as far back as I can remember, he
| said it was worthless.
| xyzzy_plugh wrote:
| The US is so weird. Elsewhere, like Canada, pseudoephedrine is
| readily available without needing to present any ID. I always
| bring some with me when I travel just in case.
|
| Everyone knows phenylephrine is useless.
| paulcole wrote:
| > Everyone knows phenylephrine is useless.
|
| Easy to say now once it's proved.
| CamperBob2 wrote:
| If it took that long for regulators and the drug industry to
| figure out that phenylephrine is worthless, I certainly don't
| hold out much hope for more advanced cures.
|
| The same is true if corruption rather than incompetence is
| the explanation.
| jtbayly wrote:
| Except anyone _could_ have known it did nothing for them. My
| sister and I confirmed this many years ago.
| DHPersonal wrote:
| I recall it being the year it came out when I heard it was
| useless.
| technothrasher wrote:
| It's been pretty common knowledge for years that it doesn't
| work. That doesn't mean that common knowledge was right, but
| it certainly isn't a case of everybody only now claiming they
| knew it.
| Runways wrote:
| Actually, it's funny. My parents aren't Libertarian, but they
| kinda lean that way in terms of not trusting the government -
| etc. When they restricted pseudoephedrine, they immediately
| were suspicious about phenylephrine and eventually came to
| the conclusion that it doesn't do anything. They'd demand
| pseudoephedrine and claim that phenylephrine was just a way
| to restrict pseudoephedrine while allowing pharma to rip us
| off, yada yada. That's where my strong disdain for
| phenylephrine came from. Once I was in college buying my own
| medicine, I came to the same conclusion that one worked and
| one didn't. Pseudoephedrine was just a miracle drug to me, I
| remember stopping taking it too early and feeling blegh
| within hours.
| maccard wrote:
| We've known for ages -
| https://www.forbes.com/sites/daviddisalvo/2015/10/26/the-
| pop...
| HumblyTossed wrote:
| Everyone who is easily congested already knew it.
| stephen_g wrote:
| Nope, I remember the first time I tried to use a
| phenylephrine based cold tablet it after the big uproar about
| putting pseudoephedrine behind the counter - this is more
| than a decade ago. I've always had relief from
| pseudoephedrine but I felt absolutely no effect from the
| phenylephrine tablets (apart from the paracetamol they also
| contain, but zero decongestant effect). I looked it up and
| other people were reporting the same, I was so annoyed I
| never bought it again and from then always ask for the real
| thing.
|
| Weird thing was the pharmacists always want to know why
| you're asking (even beyond doing the drivers license check)
| and I had to say every time that the off the shelf tablets do
| literally do nothing for me.
| michaelcampbell wrote:
| It never worked for me, but I thought that was a "because me"
| thing.
|
| It makes me both exhausted and unable to sleep, and although
| I'm not very good at very many things, I'm generally an
| exceptional sleeper so this was something I wasn't willing to
| experiment on dosage experiments to make it work.
| karaterobot wrote:
| Ha. I think everyone who tried it said this. I think every
| conversation I've had with a sick person has included the
| phrase "this over the counter stuff doesn't do anything". The
| most cursory search of the internet finds an article from
| 2006 with the literal phrase "There's just one problem.
| Phenylephrine doesn't work, and most in the pharmaceutical
| industry know it."
|
| https://reason.com/2006/12/21/step-away-from-the-cold-
| medici...
|
| And 2005 is the year Phenylephrine replaced Pseudoephedrine,
| so it's not like it took anyone any time at all to figure
| this out.
| mdorazio wrote:
| In case you're not aware, it's because pseudoephedrine is used
| to make meth. As for why it's restricted in the US and not
| Canada, the DOJ believes that meth production in Canada is
| relatively low compared to the US [1].
|
| [1]
| https://www.justice.gov/archive/ndic/pubs13/13853/product.ht...
| singleshot_ wrote:
| I think the implication is that the rest of the world isn't
| overrun by tweakers?
| SV_BubbleTime wrote:
| As a pedantic correction _was_ used to make meth. Once the
| supply ran out it became just one more step to make whatever
| it needed other ways.
|
| Practically speaking, lots of things are used to make meth. I
| had to give ID last time I bought acetone. Which is crazy for
| all sorts of big brother reasons.
|
| I'm not a chemist, but as I understand it, meth isn't too
| often made with PE anymore, yet, it sits behind the counter
| forever now.
| saghm wrote:
| Obviously this isn't reflective of any actual history, but
| in the first season of Breaking Bad, one of the early
| innovations that the main characters made to how they
| produced meth was coming up with a method that avoided
| needing PE. If I remember correctly, they instead used
| methylamine, which is an amusingly smart choice by the
| writers because it literally starts with the word "meth"
| but has absolutely no utility when making meth, so they
| didn't have to worry about people getting any ideas from
| the show.
| jaggederest wrote:
| It's used in the P2P method and is a DEA List 1 chemical.
| It's definitely real chemistry, not fake chemistry. Much
| of the chemistry on the show was close enough while being
| vague enough not to actually help anyone who couldn't
| read the voluminous research papers on the matter.
| saghm wrote:
| Interesting! I must have misunderstand whatever
| explanation I heard about this back when watching it
| (which isn't super surprising in retrospect, given that
| my chemistry knowledge is limited to having taking AP
| chem in high school, which I'm now realizing was over a
| decade ago...)
| jaggederest wrote:
| They did throw in some red herrings, deliberately, I
| think, but the vibe overall was real enough. But honestly
| the show in general is pretty lackluster from a chemistry
| nerd standpoint (as is the synthesis of illicit
| substances in general, real snoozefest of gross white
| powders turning into gross illegal white powders), there
| are a bunch of youtube channels doing chemistry that is
| both more interesting AND won't cause visits from the
| nice people at the three letter agencies.
| Zak wrote:
| Phenylacetone, acetic acid, and methylamine are the
| ingredients in the Breaking Bad process. There are some
| fictional aspects, such as the blue color, but the
| process is real and has become the dominant method of
| producing meth. It's more cost-effective as I understand
| it, so removing restrictions on pseudoephedrine probably
| wouldn't have any effect on the meth supply today.
|
| https://dynomight.net/p2p-meth/
| toss1 wrote:
| Yup. A while back, I was stopped at the register buying
| less than a liter of acetone and denatured alcohol (for
| cleaning molds and bonding surfaces for advanced
| composites) at the same time -- forbidden. So I checked out
| one and paid, then checked out & paid for the other in two
| immediately sequential transactions. The check-out woman
| and I shared a small chuckle at how (in-)effective those
| measures were...
| pwg wrote:
| > I'm not a chemist, but as I understand it, meth isn't too
| often made with PE anymore, yet, it sits behind the counter
| forever now.
|
| Sadly, far too many laws, once on the books, are never
| considered for removal, even when the original reason for
| their enactment no longer applies.
|
| Unless enough of us voters badger our congress critters to
| repeal the "hide the PE" law, it will continue to sit
| behind the counter.
| ltbarcly3 wrote:
| Sigh. If they put it back out where smurfs could gather
| it they would start using it again.
|
| Its interesting how Americans are so trained to interpret
| everything as a failure of government we will find a way
| to think that the law that prevents meth makers from
| using sudafed is outdated because meth makers are
| prevented from using sudafed.
| Zak wrote:
| Nobody should care whether meth makers are prevented from
| using sudafed; we should (maybe) care if they're
| prevented from _making meth_.
|
| They switched methods, and the new method seems to be
| more cost-effective so it's unlikely they'd switch back
| even without the restrictions.
|
| https://dynomight.net/p2p-meth/
| jaywalk wrote:
| They've already come up with better, cheaper, more
| efficient methods. They don't need Sudafed anymore, so
| removing the stupid restriction won't affect meth
| production at all.
| chowells wrote:
| Do you actually believe this? It seems completely
| ignorant of human behavior to me.
|
| You see, it's not about dealing with large-scale
| operations. It's about keeping that one neighbor you have
| who always makes poor choices from grabbing 1000 boxes of
| Sudafed and blowing up their house. They don't care what
| the industrial process is, they care what they can get
| away with in their living room.
|
| Throttle access to pseudoephedrine sufficiently and they
| will look elsewhere. Make it easy to get and they'll DIY.
| You know, I even admire the DIY spirit involved. I just
| don't admire the externalities.
| SV_BubbleTime wrote:
| The subtext of your argument is that you think you can
| legislate away human behavior.
|
| There is a cheap process to make meth, and there's
| another process that involves Sudafed. Banning Sudafed
| does not stop meth production. But here you are still
| supporting a ban on Sudafed - because of what some
| theoretical person might do with it ignoring that they're
| doing it now without it.
|
| I don't believe this is a logical failure, I believe
| whatever culture you grew up in imparted this way of
| thinking.
| chowells wrote:
| The culture I grew up in is one where this happened about
| once a month. Well, before Sudafed became hard to get.
| Then the rate of it occuring dropped precipitously.
|
| It's almost like people in fact do base their choices on
| what's easily available.
| tptacek wrote:
| It's not so much "used to make meth" as that it is some very
| simple chemistry away from _being_ meth, and that chemistry,
| when employed by the amateurs who use Sudafed to make meth,
| is particularly rough on the neighbors.
| jvanderbot wrote:
| Paraphrasing, it's not a big deal that it's used to make
| meth - it's a big deal that it's used to make exploding
| _meth labs_.
| dreamcompiler wrote:
| Yes. Pseudoephedrine itself is a mild stimulant. Tweaking
| the molecule (npi) turns it into a powerful stimulant.
| kazinator wrote:
| Who needs meth when you have poutine _and_ maple syrup to get
| you through Christmas?
| soylentcola wrote:
| But not in (at least much of) the UK apparently. I was on
| vacation in England and Scotland a year ago and many in our
| group came down with an annoying cold.
|
| Every chemist had piles of phenylephrine tablets but no
| pseudoephedrine (or even phenylephrine nasal spray, which works
| quite well). I did not have a fun time explaining to my sniffly
| girlfriend why these were all trash and there was no point in
| buying them - she just wanted some relief and couldn't
| understand how I would somehow know better than all the
| different drugs on the shelves. It made me feel like some nutty
| conspiracy theorist, insisting that the medicine was all phony.
|
| Thankfully it didn't derail the trip, and in the end I found
| some other nasal spray that sort-of worked.
| maccard wrote:
| Pharmacies in the UK absolutely do stock pseudoephedrine.
| It's usually behind the counter and you have to ask for it.
|
| "Sinutab, or own brand, without pain relief" is what you're
| looking for, for anyone reading.
| stephen_g wrote:
| I've bought pseudoephedrine tablets at Boots on a trip but I
| think I did have to ask at the counter.
| jcadam wrote:
| I've found plain 'ol saline nasal spray works well enough...
| and, a hot toddy helps clear the sinuses.
| spookie wrote:
| Mint tea too! Or some Fisherman's Friends
| xhkkffbf wrote:
| Regular use of a neti pot has changed the life of my nasal
| passages. It's a great device.
| dfawcus wrote:
| It is generally available behind the counter in chemists all
| over the UK. One simply has to ask, and there are no ID
| requirements.
|
| There is a limit to how many they will supply, but I'm not
| sure what it is. Generally available now in two forms, with
| and without paracetamol.
|
| It used to be available off the shelf, but that changed about
| 15-20 years ago, for the same illicit drug production issues.
| petercooper wrote:
| The UK's pharmaceutical culture is poor. If "NICE" doesn't
| think something is the right way to treat a condition, forget
| it. Even people with diagnosed conditions can struggle to
| acquire medication. Also, beware of daring to mention the
| _name_ of a medication, because that 's a sign of "drug
| seeking"! (Luckily I've not been on the receiving end of
| this, but know folks who have.)
| pajko wrote:
| That's strange and I was surprised reading in the article that
| phenylephrine is ineffective. Basically this is the only combo
| that works for me all the time:
| https://www.drugs.com/mtm/pheniramine-and-phenylephrine.html
|
| It's available as Neo Citran in the EU. Tried a couple of other
| meds, neither worked, nor the parts of the combo separately
| (combined with other stuff). Only side effect is that it knocks
| me out a bit, making me feel tired. At least falling asleep is
| easier. It's the side effect of pheniramine.
| 542458 wrote:
| > Everyone knows phenylephrine is useless.
|
| It's pretty easy to find phenylephrine on the shelves in Canada
| (I'd say about half the drugs use it vs pseudoephrine) so
| obviously somebody is buying it. Anecdotally, I always tell
| people to read the labels and only buy pseudoephrine based
| medication, and it's consistently a surprise to people - I
| don't think the difference was anywhere near universally known.
| dreamcompiler wrote:
| People buy homeopathic remedies by the truckload too. They
| are even less effective than phenylephrine.
|
| The average person has no clue how to evaluate medicines.
| Stupid laws should not impede those of us who do have said
| clue.
| dang wrote:
| Please keep nationalistic flamebait out of your comments here.
| It leads to nationalistic flamewar (in the general case--not in
| this thread, but that was by luck).
|
| https://news.ycombinator.com/newsguidelines.html
| danielbln wrote:
| Not technically a decongestant, but I swear by Ectoine nasal
| spray, personally. As far as I understand, Ectoine is extracted
| from bacteria that live in harsh conditions like in the extremely
| salty dead sea. It does so by building a water barrier around
| itself, or something like that.
|
| It's sold as an anti allergic nasal spray (it definitely helps
| with my light dust allergy at night) but it also works very well
| when suffering from Rhinitis.
|
| Also doesn't build dependence, which is a big plus.
| denton-scratch wrote:
| Ha! As far as I'm aware, every drug promoted as "doesn't build
| dependence" turns out to build dependence. Even cocaine and
| diazepam used to be pitched as not dependence-forming.
| danielbln wrote:
| True, though at least I can say from myself that after
| prolonged use not using it for a few weeks has no adverse
| effects (unlike classical decongestant sprays).
| rincebrain wrote:
| Something to keep in mind is that how fast dependence
| builds can vary very largely between people.
|
| I have a few times taken opioids for weeks on end because I
| had very invasive surgery with quite extraordinary amounts
| of pain during recovery, and have never felt the desire to
| take more after the pain stopped being above a very high
| threshold.
|
| I've known others who have taken opioids for a couple days
| for something that healed much more rapidly, being very
| afraid to take them, and had to be sure they disposed of
| any left because they definitely felt the urge to take more
| beyond relieving immediate pain.
| danielbln wrote:
| Ok, but this is not an opioid, and it has no known
| rebound effect. The compound had been on the market and
| in use in consumer products for more than 20 years.
| denton-scratch wrote:
| > it has no known rebound effect
|
| That sounds like "famous last words". The fact that they
| don't know of the effects is probably because they
| carefully avoided looking for them.
|
| I've tried cocaine; didn't like it. I use OTC
| codeine/paracetamol for pain; I don't need the
| paracetamol, but you can't buy straight codeine OTC in
| the UK, so I'm forced to buy a proprietary compound. I'm
| never tempted to take it if I don't need it.
|
| So it probably sounds as if I'm the type who doesn't fall
| to addictions; but in fact I've been addicted to alcohol
| and nicotine for 40 years. I've tried repeatedly to quit
| both, and failed.
|
| There's just one psychoactive drug I've used that is
| definitely not addictive: LSD. If you can bear to
| continue tripping for more than about 3 days, it stops
| working, no matter how high the dose, and you won't get
| re-sensitized until several weeks of abstinence.
| kridsdale1 wrote:
| And heroin. And Percocet. And OxyContin.
| britzkopf wrote:
| I've bad hay fever, for which an allergist prescribed
| corticosteroid nasal spray. When I told him I didn't want to
| take it until allergy season because of dependence, he told
| me that's not a problem and the drug will work better if I
| take it ALL the time. He is the medical professional I guess
| but I still couldn't bring myself to take that advice.
| ch4s3 wrote:
| People build weird behavioral dependencies around nasal
| sprays in rare circumstances, but its not a real risk. If
| you take enough corticosteroids long enough you can have
| mild withdrawals after stopping but again its not really a
| thing to worry about.
|
| Your doctor is right, corticosteroid nasal sprays need to
| be taken before the onset of symptoms to be most effective.
| They basally dampen the allergic response and if you
| already have a bunch of immune signaling molecules bouncing
| around its too late.
| badwolf wrote:
| Not medical advice, but you'd probably get a similar response
| just by using regular ol' saline nasal spray for those lighter
| allergy or dust symptoms.
| danielbln wrote:
| I've tried, but regular water sprays don't last as long,
| somehow.
| bethekind wrote:
| So how does it actually work? Sounds like a gimmick to me.
| Bacteria produced anti-allergy nasal spray?
| corethree wrote:
| Seems like the entire food regulatory body the USDA and the FDA
| are just in the pocket of the industry. Lack of funding is the
| least of it. Paid off and corrupt is likely the better
| characterisation.
|
| Seems like Literally nothing you eat is regulated at all.
|
| Unless it kills you. Then if it kills people the FDA acts only
| after they see a good amount of people dying.
|
| Almost all of this is universal knowledge now. I wonder why
| there's no outrage or pressure to change.
| corethree wrote:
| I hope a lawyer jumps on this and sues on behalf of the American
| public.
|
| Refund all instances of the sold chemical, put the company out of
| business. Is it possible?
|
| If it can't be refunded funnel the money into actually creating
| an effective regulatory body. One can dream.
| VikingCoder wrote:
| I need more caffeine. My brain read,
|
| "Two Hot Pharmacists Figured Out That Decongestants Don't Work"
| kridsdale1 wrote:
| Maybe you've been browsing too many alternative websites.
| magicmicah85 wrote:
| I've known this for a long time. Put me on a watchlist and give
| me my meth, my sinuses are clogged.
| burkaman wrote:
| I feel like I'm living under a rock, how is everyone in these
| comments so intimately familiar with this subject? I've never
| heard the word "phenylephrine" in my life.
| booleandilemma wrote:
| It's the internet. I have a feeling a lot of people are not.
| One tab for HN, another tab for wikipedia.
| HumblyTossed wrote:
| That might define you, but not the rest of us. Think about
| it, most people likely to reply on this subject probably know
| something about it.
| jannyfer wrote:
| I strongly agree that non-experts in HN comments write as if
| they are experts. Without some sort of upvote counter, it
| becomes hard to distinguish confident bullshit from
| expertise.
|
| Certain individuals are prolific bullshitters too. I'd read a
| questionable comment and notice it's the same person.
|
| (My observation is general, not specific to this topic)
| BobaFloutist wrote:
| As someone who also browses Reddit, I assure you that an
| upvote counter does little to prevent confident bullshit.
| singleshot_ wrote:
| It's pretty handy to know the names of all these drugs
| because frequently there is a nineteen dollar package of
| Advil and a nine dollar package of Walgreens Ibuprofen. It's
| pretty easy to figure out all the names of these drugs
| because all the generics say things like "compare with
| Claratin." And it's smart to use the generic because the
| active ingredients are molecule for molecule the same.
|
| I guess the generics could be using cheap corn starch...
| lazide wrote:
| Some medications, the adjuvants/buffering compounds help a
| lot to alleviate issues or maximize the effectiveness of
| the drug. Things like PH buffers to do less damage to
| stomach linings, etc.
|
| Same with pesticides - the brand name products often
| include things like better surfactants that make them much
| more effective. At least based on the papers I've read.
|
| Not always of course.
| kridsdale1 wrote:
| Many of us have severe allergies.
|
| I came to the conclusion about these drugs on my own years ago.
| alteriority wrote:
| https://xkcd.com/2501/
| willcipriano wrote:
| When I'm sick I "do my own research". If you are similar you
| are familiar with over the counter remedies and their purported
| effects. Not that many 'effective' medicines are available over
| the counter in the US and this was a very popular one.
| orev wrote:
| If you take any kind of OTC medicine, it's assumed that you'll
| read the directions (which includes the list of ingredients).
| Clearly most people don't, and they just rely on the marketing
| material printed on the box/bottle to understand what the
| medicine does.
|
| If they did read the ingredient list, people would realize that
| all those products in the pharmacy are mostly remixes of the
| same handful of chemicals sold at different prices.
| burkaman wrote:
| I do know to always buy the generic version of a medicine
| when it's available, but I also generally rely on the FDA to
| not let companies lie about what a drug does. Apparently that
| has failed in this case.
|
| I guess I only buy decongestants like once a year at most
| though, I would probably pay more attention if I needed them
| more often.
| dessimus wrote:
| Sure, but one hopes that a national brand takes care to avoid
| any type of contamination that might cause a scare on the
| level of the Tylenol scandal in the 80s. A generic making
| 20-some store brands might be more lax.
| AnthonyMouse wrote:
| > If they did read the ingredient list, people would realize
| that all those products in the pharmacy are mostly remixes of
| the same handful of chemicals sold at different prices.
|
| This is one of the major problems with putting
| pseudoephedrine behind the counter. It had been an ingredient
| in many of these combination products -- after all, if you
| have a cold, you have the combination of symptoms that come
| with a cold and want to take the corresponding combination of
| drugs.
|
| But the combination products are convenience products. You
| could just as well buy the ingredients individually and take
| them together. People buy the combination product to be saved
| the trouble, which isn't compatible with the trouble of
| getting something from behind the counter.
|
| So there generally isn't a combination product available with
| the decongestant that actually works in them. And
| phenylephrine, in addition to not working, has more dangerous
| side effects (e.g. larger increase in blood pressure) than
| pseudoephedrine. But now it's the thing in the bottle grandma
| gets when she has a cold.
| scottyah wrote:
| Just because two medications contain the same active
| ingredient doesn't mean they'll have the same results. A lot
| of work gets put into speed and location of of release.
| stephen_g wrote:
| Well for me I remember the big news about gangs buying up cold
| tablets for the pseudoephedrine that they had in them to make
| meth, so the pharmacies making it harder to buy them. Then the
| new ones on the shelves (which are marketed as 'PE' here) just
| plain don't work at all, unlike the real ones (which you can
| still get but you have to ask the pharmacist for). So I read
| the ingredient list and googled it, and was annoyed to find my
| experience confirmed and that they'd replaced a really useful
| medication with one that basically everyone reported didn't
| work.
| Scoundreller wrote:
| > Well for me I remember the big news about gangs buying up
| cold tablets for the pseudoephedrine that they had in them to
| make meth, so the pharmacies making it harder to buy them.
|
| You missed the step where cartel super-producers (that didn't
| depend on small qtys of feedstock from pharmacies) just
| started producing 5% more to make up for it.
|
| The organized producers appreciated the government shutting
| down their nibbling competitors.
|
| Sucks for the public though, paying the price for an
| ineffective measure.
| tptacek wrote:
| It's not that simple. Industrial-scale meth production
| (obviously) doesn't use Sudafed; amateur small-scale
| production does. But small-scale meth production has its
| own distinct externalities: it sites "meth labs" in
| residential areas, which catch fire, create hazardous waste
| problems (some of which require specialist cleaning crews),
| and attract additional crime.
|
| The policy doesn't have to cut off the meth supply to be
| successful on its own terms.
| alwa wrote:
| And for that matter, small-scale meth enthusiasts, wisely
| or not, were in fact robbing stores for it at the time.
| Meth access aside, there's probably some social benefit
| to tamping down on robberies in these places where sick
| and vulnerable people need to go for their meds.
| ch4s3 wrote:
| This just isn't a factor anymore, Big Meth produces a
| product so cheap that it would be ridiculous to try to
| produce it at a small scale.
|
| Moreover we already have the most draconian and well
| funded drug agency of any OECD democracy, surely they
| could cope with some trailer park meth labs without
| having to hassle everyone with allergies or a cold.
| tptacek wrote:
| You're still looking at this as a drug restriction
| problem --- we all agree, that's hopeless --- and not as
| a neighborhood safety problem.
| peyton wrote:
| I just don't see how selling snake oil made my
| neighborhood safer. Like I don't see how those two things
| are connected at all other than through motivated
| reasoning. Not to mention anybody can still walk into my
| local Walgreens at 4 A.M. with a mask and a tire iron and
| take as much Sudafed as they'd like.
| tptacek wrote:
| Selling snake-oil didn't. Sudafed PE shouldn't have been
| sold.
| ch4s3 wrote:
| A nation wide blanket restriction is a dumb way to go
| about any attempt at neighborhood safety. It is a best
| indirect. But again, making meth in a home lab hasn't
| been economically viable for the better part of 10 years
| now, so why is the restriction still in place?
| jfengel wrote:
| You may not know the word "phenylephrine", but you almost
| certainly know Sudafed (and perhaps its generic name,
| pseudoephedrine).
|
| If you live in the US or several other places, you probably
| know that the "good" Sudafed is kept behind the counter, and
| you have to sign for it. You may have also noticed that there
| is another version, called "Sudafed PE", that you can just pick
| up off the shelf.
|
| A lot of people have done that and concluded for themselves
| that the PE version didn't work. That's why there are so many
| people commenting that they already knew the thing the article
| is about.
|
| So... a lot of people were familiar with "PE", and apparently a
| lot of them knew that it stood for "phenylephrine". And it all
| touches on a bunch of existing controversy about why the
| effective medication is locked up.
|
| It wasn't always. People knew that Sudafed was an pretty
| effective drug. (It was even used, under a different brand, on
| Apollo missions -- there was a TV ad with an astronaut
| endorsing it.) A lot of people are grumpy that a well-known
| effective medicine was made hard to get, and something else
| sneakily substituted.
|
| The point being, it's not entirely a surprise that people are
| aware of the phenylephrine -- especially if they're older than,
| say, 40, and live in the United States. They remember,
| sniffily, when cold medicine started to suck.
| burkaman wrote:
| Thanks this is helpful, I'm aware of the Sudafed/meth issue
| but I didn't realize the alternatives were all clearly
| labeled PE. That explains why it's so obvious to a lot of
| people.
| gambiting wrote:
| It isn't labeled as such in the UK. Both the "full fat"
| version and the placebo worthless one are just called
| Sudafed - but the proper one is kept behind counter and you
| have to ask for it.
| 6stringmerc wrote:
| This is a fantastic write up and as for anecdotal
| confirmation, an award winning career journalist cited his
| "on deadline" setup was a box of Sudafed and a pot of Coffee,
| then a bottle of Jack Daniels once it was all in. Very
| effective compound and I also didn't know the PE
| longhand...only went to the counter...
| garciasn wrote:
| I can't even imagine this combo; I can barely tolerate
| Sudafed alone.
|
| It's like drinking 15 cups of espresso all at once for me.
| Jittery; quick tempered; but a clear head and nose. Good
| with the bad when you're ill but holy fuck would it be
| brutal without the head cold + alcohol + caffeine.
| mdasen wrote:
| I think it'll depend on who you are. If you have allergies or
| often suffer from nasal congestion, you'll likely know it. If
| you're someone whose nose just kinda works, there's no reason
| you'd be aware of it.
| pfranz wrote:
| Hard-won experience? I vaguely remember when Sudafed got put
| behind counters because it was used to make meth. I don't
| frequently get sick. Often, the last medication I bought is
| expired by the time I need it again. One year, I found
| something that worked for me. Another year, I thought I bought
| the same thing, but it just didn't work. The one I had
| originally bought (same brand) had a behind-the-counter version
| that worked. It's annoying to catch the pharmacy when it's
| open, but now I just ask the pharmacist for generic Sudafed
| with the smallest-lasting dose (so I can decide if I want to
| take more).
|
| I've found with most medications looking for an active
| ingredient and an amount is helpful. You can search for
| effectiveness or side-effects. The brand I got last time isn't
| always available and they'll have 3-hour or 12-hour versions
| with warnings about exceeding recommended dosages (or mixing
| medications). Or company annoyingly package similarly-branded
| things that just aren't the same.
| samtho wrote:
| > I've found with most medications looking for an active
| ingredient and an amount is helpful. You can search for
| effectiveness or side-effects.
|
| Is this not common practice? I would be uncomfortable taking
| an ambiguously labeled "cold medicine" pill, personally. I
| know which medicines are effective for me and which are a
| waste of time and money.
| lazide wrote:
| The vast majority of the population has zero interest in
| looking at what is in medicine, and even less interest in
| researching those long complicated names.
|
| They buy a brand that promises to fix what they don't like,
| and if it works, they buy more next time.
| jampekka wrote:
| This is something quite striking in US where there is a
| full aisle of "cold medicines", "headache pills", "back
| pain reliefs", "muscle ache aides" etc, and they are all
| the same stuff (ibuprofen/"Advil" or
| paracetamol/acetaminophen/"Tylenol") in different
| packages. In Finnish pharmacies it's mostly just three or
| so "generic" paracetamols or ibuprofens in different
| brands.
| lazide wrote:
| Sounds like an untapped market just waiting for more
| market differentiation to 'help' the consumer!
| cbm-vic-20 wrote:
| You get that in the US, too. The funny thing is that in
| many cases, the generic compound is sold in a box that is
| similar to the box that the "brand-name" version is sold
| in; they'll sell the same thing in different colored
| boxes.
|
| https://www.cvs.com/search?searchTerm=acetomeniphen
| https://www.cvs.com/search?searchTerm=ibuprofin
| squeaky-clean wrote:
| I think this only supports their point. If you follow the
| acetomeniphen link and filter only for CVS brand items,
| there's still 51 different ones. Sure some are sensible
| divisions, like low dose for children, liquid versions,
| nighttime versions with something to make you drowsy.
|
| But there's also one bottle of pills labeled as Arthritis
| Pain Relief. And one labeled as Muscle Pain relief. Which
| both have exactly the same medicine and the same time
| release capsules.
|
| There's a Migraine variant label, a Tension Headache
| variant label. Just "Headache" relief. There's Back and
| Body pain relief (though that one is Apsirin, it's just
| showing up in the acetomeniphen search).
| maweaver wrote:
| Most of them (especially the cold medicines) are not just
| ibuprofen/acetaminophen but are a "cocktail" that will
| also include dextromethorphan, guaifenesin,
| phenylephrine, diphenhydramine, etc in different
| combinations/amounts depending what they are intended
| for. I don't personally use them but I could see how it
| could be useful rather than buying a bunch of individual
| medications.
| skissane wrote:
| > This is something quite striking in US where there is a
| full aisle of "cold medicines", "headache pills", "back
| pain reliefs", "muscle ache aides" etc, and they are all
| the same stuff (ibuprofen/"Advil" or
| paracetamol/acetaminophen/"Tylenol") in different
| packages
|
| In Australia some years back, Reckitt (British-Dutch
| multinational) got in trouble with the ACCC (Australia's
| competition and consumer protection regulator) for doing
| this. Selling "Headache Pain", "Back Pain", "Period
| Pain", etc all next to each other, despite the three all
| having identical active ingredients. The ACCC took them
| to court for misleading consumers, and won.
|
| https://www.accc.gov.au/media-release/full-federal-court-
| ord...
| josefresco wrote:
| You must not have allergies. Congratulations. Joking aside, I
| wouldn't know a single thing about these drugs if I didn't have
| crushing seasonal allergies.
| rvbissell wrote:
| My reply is a bit off-topic, but: I'm beginning to personally
| notice a correlation with sugar intake and degree of my
| allergy symptoms. I can't say if I was just oblivious before,
| or the personally correlation is recent. I started noticing
| it when I began avoiding foods containing sugars or breads.
| My allergies aren't completely gone, but they very much spike
| up when I relapse on my voluntary diet restriction.
| josefresco wrote:
| While I can't say I have definitive proof, my allergies
| decreased significantly after I was diagnosed with an
| autoimmune disease, and as a result started consuming less
| sugar (among other things like dairy). I still get
| allergies, but much less severe than then first 3 decades
| of my life.
| Nick87633 wrote:
| I have seasonal allergies and I found an effective method for
| myself: When I realize the allergies are kicking in (usually
| after 6 hours of watery eyes and sneezing) I take a claritin
| and a zyrtec together, as well as spraying my nose with
| Flonase. Usually this knocks it off and I will keep taking
| one of the once-a-day meds for a bit to prevent reoccurrence.
|
| Zyrtec and Flonase together is probably the best normal combo
| and is generally accepted to be ok.
|
| Disclaimers: I'm not a doctor. Combining a nose spray and a
| pill is generally accepted practice and studied in several
| peer review studies I've seen. Stacking claritin and zyrtec
| pills together is not generally accepted practice, so don't
| do it.
| TillE wrote:
| Yes, cetirizine and fluticasone are a good long-term
| treatment for allergies.
|
| Direct decongestants like pseudoephedrine are of limited
| use because you quickly develop a tolerance and they become
| ineffective. With corticosteroid nasal sprays, they work
| best after consistent use over several days and keep
| working more or less forever.
| simonebrunozzi wrote:
| Please make room for me under there. Same feeling. :(
| milofeynman wrote:
| I think a lot of people watched this Vox video about sudafed 2
| months ago and became armchair experts tbh:
| https://youtu.be/ZlFF7A8nk0w
| schwartzworld wrote:
| It's the "active" ingredient in most cold medicine. There's
| real Sudafed behind the counter, and everything else is just
| varying amounts of phenylephrine, acetaminophen, guaifenesin,
| and dextromethorphan. If you read labels for otc medication,
| you see these same names over and over again.
| quickthrower2 wrote:
| Lol... I am more familiar with it via watching Breaking Bad
| than anything else.
|
| But in general for any HN topic the people who have something
| to say get attracted to the article.
| annoyingnoob wrote:
| I have bad allergies and have at times relied on Sudafed so
| that I could breath through my nose. It was apparent to me the
| very first time I tried a product where phenylephrine had
| replaced Sudafed that phenylephrine does not work at all. I
| never purchased another product with phenylephrine.
|
| I've found that conservative and non-continuous use of Afrin is
| a better option for me.
| flybrand wrote:
| How dare they do their own research.
| seattle_spring wrote:
| Sadly "do your own research" usually means saving a few
| Facebook political memes and panning through Infowars
| headlines.
| user3939382 wrote:
| Snorting salt water works for me though it's very unpleasant.
| Very spicy food/capsaicin as well.
| msluyter wrote:
| Takeaway: when faking data, make sure your numbers are randomly
| distributed. ;)
|
| Seriously, this was fascinating and disturbing that it took so
| long.
| hn_throwaway_99 wrote:
| So many folks saying "phenylephrine is useless". The _oral_
| formulation, yes, precisely because not enough of the drug
| actually makes it to your nasal passages.
|
| So just take a nasal spray. I get it, all the pills that include
| it should have it removed, but I don't understand why people just
| wouldn't use the nasal spray. Personally I don't like
| decongestant drugs at all because I always feel like I get a
| stronger "rebound", and a netty pot makes me feel considerably
| better in any case.
| sp332 wrote:
| The effect from the nasal spray is fast and quite strong.
| Sometimes it even hurts, but there are days when having a very
| dry nose is the better option.
| mrkeen wrote:
| > but I don't understand why people just wouldn't use the nasal
| spray.
|
| I heard it didn't work! But I haven't exactly gone looking for
| studies.
|
| Also I know I'm doing it wrong. I read instructions somewhere
| that say if you spray it in your nose and it dribbles back out
| again, you didn't get it into your sinuses, where it needs to
| be. Every. Damn. Time.
| smeagull wrote:
| Because if you're using a spray then you may as well use
| Xylometazoline.
| beej71 wrote:
| The trade-off was worth it, though, since there's no longer a
| meth problem.
| Hitton wrote:
| _> The most cited study found that an oral dose of phenylephrine
| had an absorption rate of 38 percent of an oral dose of
| phenylephrine, ..._
|
| That's not very much.
| dreamcompiler wrote:
| Misleading title (par for the course for what Scientific American
| has become).
|
| _Decongestants_ work.
|
| Oral _phenylephrine_ does not.
|
| Pseudoephedrine works just fine but it was moved behind the
| counter long ago and now you have to ask the pharmacist for it,
| because besides the fact that it's a great decongestant it can
| also be used for making meth. TIWWCHNT (this is why we cannot
| have nice things).
|
| The over-the-counter replacement for pseudoephedrine is
| phenylephrine and it's basically a placebo when ingested orally.
| (It works well in nose drops and nasal spray.)
| kazinator wrote:
| > _TIWWCHNT_
|
| Because of asshole governments that wage beyond-insane wars on
| drugs?
| wenebego wrote:
| Yes
| vintermann wrote:
| There's much insanity and cruelty that's done in the name of
| fighting drug use.
|
| I don't think restricting sale of medicine that is often used
| to make methamphetamine is one of them. Back when it was over
| the counter, how much of the profit from selling
| pseudoephedrine decongestants was really profit from selling
| a meth precursor?
|
| Private profits from legal meth seems like a problem any
| society has to deal with.
| euniceee3 wrote:
| Lol they did not buy the precursor, they stole it.
|
| Had this same conversation with someone missing a number of
| teeth, they reported that chicken feed contains
| pseudoephedrine and is able to be collected by using a
| piece of wood as a capillary sieve.
| kazinator wrote:
| I had a conversation in around 1992 with someone missing
| a number of teeth who claimed that AIDS probably came
| from mutated molecules of latex rubber in "those damned
| condoms".
| bsder wrote:
| "A Simple and Convenient Synthesis of Pseudoephedrine From
| N-Methylamphetamine" https://improbable.com/airchives/paperai
| r/volume19/v19i3/Pse...
| sib wrote:
| Or because of asshole manufacturers of illegal and dangerous
| drugs?
|
| Porque no los dos?
| adrr wrote:
| Did it prevent meth usage? Meth production just moved to
| Mexico and became more potent as the production was
| industrialized. Overdoses increased, addiction rates
| increased.
|
| Poor law with no thought process behind it. I think there
| is still push to make prescription only as well.
| aidenn0 wrote:
| I have a friend in law enforcement, and he claims that
| their crackdown on meth labs where he worked (Indiana),
| even before the Sudafed restrictions, was not to reduce
| supply. Even in Indiana in the early aughts, most of the
| street drugs came from Mexico. Rather it was due to the
| hazard that the meth labs caused to the surrounding area
| (not to mention financial issues with remediating
| property that had been so used).
| samstave wrote:
| > _" Pseudoephedrine works just fine but it was moved behind
| the counter long ago and now you have to ask the pharmacist for
| it... ..The over-the-counter replacement for pseudoephedrine is
| phenylephrine and it's basically a placebo"_
|
| But this is the entire issue, they knew this from the get-go
| and made billions based on fraud.
|
| How many Nyquil/Dayquil and other decongestant commercials have
| you seen in your life time... Ive seen thousands. to the point
| their jingle and tagline are still easy to recall.
|
| The issue here is fraud, most of the marketed products were
| oral.
|
| So, here is a conspiracy: If they knew that it was useless, but
| sounded good on the label - then maybe they could get away with
| putting even less of the substance, if any, in the products to
| save costs?
|
| I would assume the FDA would require batch testing at some
| interval?
| dang wrote:
| Ok, we've put that in the title above. Thanks!
| pwarner wrote:
| I always buy as much Pseudoephedrine as I can since I get
| regular head colds. It's always funny to ask for "as much as I
| can get".
| bonniemuffin wrote:
| Same. Any time I visit a pharmacy counter for any reason, I
| add "and the largest box of sudafed you can legally sell me",
| to make sure I always have a stockpile on hand.
| ike2792 wrote:
| I remember DayQuil being a lifesaver when I was in college in the
| early 00's and I needed to power through a day of classes with a
| bad cold. Then I remember at some point in the later 00's it just
| didn't work anymore (turns out they switched normal decongestant
| meds to phenylephrine in 2006). Once I found that out I started
| buying the behind-the-counter stuff with pseudoephedrine and it
| suddenly worked again. Not sure you need to be a pharmacist to
| figure this stuff out.
| stronglikedan wrote:
| Phenylephrine gives me food poisoning like symptoms, so I have to
| avoid it. Apparently common cold stuff used something different
| than Phenylephrine when I was a kid, because they did used to
| work before they started making me ill. Thank goodness for
| Dextromethorphan!
| kayson wrote:
| The article suggests that dextromethorphan (which is a cough
| suppressant, not a decongestant) might be ineffective as well.
| victor106 wrote:
| > So, we took the political route, contacting then-congressman
| Henry Waxman, whose committee at the time had FDA oversight.
| Waxman's office wrote four letters imploring the agency to
| reconsider oral phenylephrine's effectiveness.
|
| For all the hate that politicians get on public forums like hn,
| this is one of the few cases where they actually made a
| difference.
| BobaFloutist wrote:
| The only thing that can stop a bad guy with a politician is a
| good guy with a politician.
| skywhopper wrote:
| I mean, anyone with sinus allergies who has tried all the
| medications knows that phenylephrine doesn't work. While it's
| been nice to have "official" confirmation, it was incredibly
| obvious to those of us who really benefited from the old
| pseudoephedrine version of Sudafed.
|
| Rather than put my name on a state government watchlist that
| tracked whether or not I bought "too much" Sudafed, I figured out
| that Zyrtec (cetirizine) worked well enough for me, and could be
| had cheaply at discount warehouse stores.
| StopHammoTime wrote:
| I actually have HN to thank for knowing this. About a year ago
| someone pointed out how useless the non-pseudo alternatives are.
| Colds are nowhere near as bad anymore.
| rain_iwakura wrote:
| same here, I remember reading a random reply on here about it
| and then getting Claritin-D or whatever at a CVS near me when I
| had a cold and then covid. Both times I experienced huge
| relief.
| duffpkg wrote:
| As someone who has worked in healthcare for 20+ years now, at
| least in those circles it was widely known that phenylephrine was
| a placebo at best, when it was mandated as the on the shelf
| replacement for psuedoephedrine (Sudafed) nasal decongestant.
| Again in healthcare circles there was a clear understanding of
| this being a DEA driven policy to replace an effective medicine
| that could be abused to create methamphetamine with a different
| medicine that was ineffective but could not be turned into street
| drugs. As best as I can tell the policy resulted in harm to
| millions of people while not reducing the spread and availability
| of methamphetime one bit and ancillary costs to the healthcare
| system in the billions of dollars.
|
| Off the top of my head, https://pubmed.ncbi.nlm.nih.gov/19230461
| from 2009 but there are many earlier studies as I recall.
| tobinfricke wrote:
| I often wondered why German pharmacies continue to stock
| homeopathic remedies. Maybe phenylephrine was our equivalent?
|
| As someone who suffered chronic congestion, and had experienced
| the effectiveness of pseudoephederine, it was immediately
| obvious that phenylephrine did nothing. It's just surprising
| that this "open secret" has taken 20+ years to be publicly
| confronted.
| quickthrower2 wrote:
| pseudopseudoephedrine?
| 0x500x79 wrote:
| Another thing -- if you are ever need Sudafed (the real stuff)
| and they are out ask for one of the allergy medicines, the -d
| version. Claritin-D, Zertec-D all have the primary active
| ingredient as Sudafed bundled with the Allergy medicine.
| dools wrote:
| Yeah no shit!
|
| EDIT: in Australia you can still buy pseudo you just have to show
| ID. Everyone knows PE doesn't work.
| jeffparsons wrote:
| Yeah, it's pretty weird here. Pharmacies stock both: the
| placebo on the shelves, and the real one behind the counter,
| usually called "such-and-such ORIGINAL" or something.
|
| So if you don't want a placebo, you have to know that the real
| one exists, ask for it, and then present ID so they can track
| how much you're buying.
|
| I've only bought the real one a couple of times. One was to
| help with a long-lasting post-viral cough in advance of an
| important meeting. I can't for the life of me recall how I
| already knew about the distinction.
| siliconc0w wrote:
| I think we need like three or four different certifications
| escalating in terms of difficulty to get:
|
| 0) generally recognized as safe and free of containments - it
| won't kill you and you get what is on the label. This should be
| applied and enforced through some kind of mandatory batch
| testing. Supplements desperately need this because you really
| have no idea about what you're getting.
|
| 1) Plausible Efficacy - this is 0 plus a plausible efficacy for
| the marketing claim. I.e there is some mechanism of action or
| reasonable amount of evidence this could work. Marketing would
| have to make this clear. Most OTC medications should be under
| this standard.
|
| 2) FDA proven efficacy - this is the highest standard of proof,
| basically the current standard. Prescription medications should
| be held to this standard.
|
| maybe 3) YOLO/Emergency/Terminal illness authorization - can't be
| marketed, only listed in a government index and you need a DR co-
| sign and acknowledge that it may kill you, is unproven and the
| outcome is recorded for the purposes of later study.
| peyton wrote:
| The FDA doesn't prove anything. They evaluate claims.
| _rm wrote:
| Or we could just dissolve it and go back to being responsible
| for our own outcomes.
| SuperNinKenDo wrote:
| Nice to be vindicated. To this day people look at me like some
| kinda maniac when I talk about the difference in effect before
| and after they took pseudo out.
|
| The only reason I know is because someone's mother hoarded pseudo
| tablets and had probably 30 years supply.
|
| One year as a teenager I got such bad hayfever that my nose was
| literally just running constantly and I was losing 2 litres of
| water an hour in just watery eyes, I could barely see, my skin
| was inflamed, and I was having trouble breathing.
|
| All the hayfever medicine I took was totally ineffective.
|
| She gave me a single pill, and the effect was actually
| incredible. I've never seen such an enourmous effect in such a
| short time from any medicine except maybe morphine. In the space
| of 15 minutes I was almost completely back to normal. My nose not
| only stopped running, but became completely unclogged. My eyes
| stopped watering and subsequently completely lost any irritation,
| my skin cleared up and my breathing was completely normal.
|
| Not only that, but after suffering like that for days, I was
| completely normal for the rest of the season. The drug just
| completely broke some kind of inflammation cycle and the hayfever
| never returned.
|
| I really think that the gaslighting around this was a kind of
| crime perpetrated on people. Rarely has there ever been a drug
| that can improve quality of life so effectively. Hayfever for
| those who suffer it significantly is truly hell. It's not a
| scratchy throat or itchy eyes, it's a full body experience.
| Imagine having a bad flu,but it can last months, and nobody has
| any sympathy for you whatsoever. And then society takes away a
| completely effective treatment, substitutes with one that has
| essentially zero impact, and gaslights you incessantly that
| you're wrong and it works at least almost as well.
|
| End rant I guess.
| aidenn0 wrote:
| No article touching on pseudoephedrine is complete without a link
| to _A Simple and Convenient Syntheses of Pseudoephedrine From
| N-Methylamphetamine_ [1]
|
| 1:
| https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
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