The article kinda glossed over it, but one fact under-appreciated by the general public is just how dangerous acetaminophen overdoses can be.
Scientists often talk about the "therapeutic index" or "safety ratio" of a drug. It's the LD50 (dose at which 50% of recipients die) divided by the effective dose. Common hard drugs like heroin or methamphetamine have a safety ratio of about 6-10 [1]. "Soft" drugs like marijuana or LSD often have safety ratios of about 1000.
The safety ratio of acetaminophen is under 4. A typical dosing schedule for an adult is 4-6 500mg tablets within a 24 hour period [2], for a total of no more than 3g. 7g of acetaminophen can kill you, and 12g is likely to [3]. Acetaminophen is the leading cause of liver failure in the U.S, causing 50% of cases and 20% of transplants.
When they tell you "don't exceed 6 doses daily", they really mean it, and it's across all acetaminophen-containing products. The margin for error is narrower than heroin.
Yes. 4g is generally considered perfectly safe and is fairly commonplace dosing. 7g can kill you. Hence a therapeutic index of < 2.
This is why you have to be very, very careful. If you're doing 8 500mg Tylenol pills and then you also do 6 doses of DayQuil or Mucinex without realizing it's also acetaminophen, you can end up needing a liver transplant.
I wonder why it is not a more commonplace useage for suicides. Females seem to enjoy overdoes more, and men seem to enjoy violent ways. But female sucicides often "fails", seems like eating a box of Tylenols (here they come in 20 packs) would solve the "being alive" issue quite quick, no? Better not tip people off... :)
>end up needing a liver transplant
You won't get one nor should you get one if the reason is this.
It's a pretty terrible way to go. Death doesn't come immediately; you seem fine at first, and then about 3 days later you suffer intense abdominal pain and vomiting. At about 4 days you realize your liver is irreversibly shot and you're a dead man walking unless you can get a liver transplant. Then you enter multi-organ failure as your body and brain shuts down.
Acetaminophen poisoning actually featured on two episodes of House, and one of them had the suicide plotline. In S05E11, "Joy to the World" they suspected an overweight teen OD'd on acetaminophen trying to kill herself, but the actual diagnosis was eclampsia from an undisclosed pregnancy. In S06E10, "Wilson", a friend of Wilson's suffers acetaminophen poisoning while trying to manage his back pain.
Calling women females and men men in the same sentence is really something. Same with the smiley face in a comment about suicide.
Intentionally overdosing on Tylenol gives you a day or so afterwards to panic and seek medical attention and probably live instead of dying a horrible death. More violent means do not give you any time to retroactively back out of it.
And, yes, in America at least, some lucky people do get liver transplants after acetaminophen overdoses, occasionally even intentional ones.
Acetaminophen should be treated with more caution in general. So many people have reacted with shock and upset when I told them that taking Tylenol (or anything with acetaminophen in it like Dayquil/Nyquil) while drinking can cause immediate liver damage.
>reacted with shock and upset when I told them that taking Tylenol (or anything with acetaminophen in it like Dayquil/Nyquil) while drinking can cause immediate liver damage.
Maybe your package needs to be clearer but here in Sweden it says to avoid taking with alcohol.
Most people grew up taking Tylenol as kids for various things and it was never a new medicine to them that they felt the need to read. Also, there's a huge difference between "don't take this with alcohol, it will make you more drowsy" and "even one beer with this will start fucking your liver up don't even think about it". I think people associate the latter with more intense medication than some OTC mild pain meds.
I didn’t know this until recently either. I grew up on a family where if there was pain, you just take tylenol to deal with it. We always followed the dosage timing and never had issues. So recently when my wife had some chronic pain I suggested taking tylenol but even after two days the pain would not go away and she went to ER. They did a blood check to see if they could find anything. They didn’t find the cause, just suspected food poisoning, but they found her liver enzymes were near dangerous levels. This was even with timing the dosages absed on instructions. Now I am super careful wtih Tylenol.
Not to chastise you or your wife, there is an actual "Liver Warning" on Tylenol Product labels. They warn against 4000mg/day or with alcohol consumption. It's not an on/off switch, the damage occurs on a ramp that achieves a critical point after so much consumption.
Saying this to encourage label reading and to refute those who might try to characterize your wife's experience as anecdotal. And for those who stop reading a page like this one, after the first paragraph that touts "no evidence": https://www.tylenolprofessional.com/safety-and-efficacy/safe... when at the bottom it reveals the Liver Warning.
It appears his wife took under that threshold and only for a few days. 4000mg is roughly 8-10 otc painkillers in a day (depending on the brand).
That said, everyone's physical ability to metabolise drugs is different. I might worry something else was wrong, or at least get a followup test done later, if her liver tox screen showed that, just to rule out another cause.
Alcohol can actually be protective in a paracetamol overdose. Paracetamol itself isn't relatively dangerous, the metabolic product created by the liver is.
Alcohol use acutely reduces the levels of these enzymes which convert paracetamol into it's toxic byproduct as ethanol preferentially binds to the same enzyme for it's own metabolism. Therefore, acute alcohol consumption can reduce the harmful effects of paracetamol.
The reverse is true for overdose in the context of chronic alcohol use, when the liver adapts to long-term alcohol exposure by increasing the levels of enzymes, therefore rapidly metabolising paracetamol into it's toxic byproduct and worsening harm.
Source: doctor
As a side comment, the lack of medical knowledge displayed in HN threads paired with the absolute confidence some verdicts are delivered with is worrying, and something I thought this forum would be better at than other sites (looking at you, reddit). Paracetamol and NSAIDs (including ibuprofens) are safe drugs if taken to the package directions. Some of the ideas shared in this thread about taking one over the other, or not taking one ever etc, are not rational. Please consult your doctor if you are worried about your particular situation, but generally OTC medicines are not dangerous if taken to the package instructions.
Accidental overdoses of paracetamol are exceeding rare, but intentional ones are common.
Yup, did some digging on Tylenol/acetaminophen before I had some surgery, and it's a real danger. Oddly enough, it seems downing a whole bottle won't (usually) end your life as it gets mostly directly eliminated rather than metabolized, but taking just around 2-3X the high-strength dose sustained over 3-4 days can destroy your liver — at that point, you have about six weeks unless they find a new liver for you (obviously, there's wide variance in actual dosages and reactions, but that was the general median). For someone with serious acute pain, who doesn't know this hazard, it'd be pretty easy to self-medicate and load up and lose track...
OTOH Ibuprofein, doesn't have anything like that deadly profile, but enough gut and other issues.
Not a doctor, this is how it was explained to me by my doctor.
Paracetamol/acetaminophen has a therapeutic dose that is uncomfortably close to the fatal dose, but is otherwise as safe as any drug can possibly be. So long as you don’t take too much.
Ibuprofen is also relatively safe, but it has a number of ways that it can do damage even at the therapeutic dose, if you are taking it all the time.
The main one is that it depletes your mucus lining in your stomach, which can lead to bleeding and death (used to be a big problem here in Aus when codeine combined pills were available without prescription). It’s also harder on your kidneys and liver.
Completely fine at therapeutic doses taken as per instructions and not mixed with alcohol. But having it every day is going to be much worse for you than the paracetamol and almost certainly lead to health problems.
The therapeutic index for ibuprofen is considerably better: it's around 10, fairly similar to alcohol. Accidental overdoses of ibuprofen are rare.
The main issue with ibuprofen is that it can have fairly annoying (but non-life-threatening) side effects like stomach upset and GI bleeds even with normal dosing.
It can also cause kidney damage which can be life threatening, especially when you’re dehydrated (which is pretty common after drinking); tylenol is a lot safer than ibuprofin when used as directed, it only becomes dangerous when glutathione is depleted (at which point it becomes a lot more dangerous, which is why you should never drink while taking Tylenol)
> The main issue with ibuprofen is that it can have fairly annoying (but non-life-threatening) side effects like stomach upset and GI bleeds even with normal dosing.
Those side effects are more problematic when used chronically. This is when acetaminophen shines, because it has virtually no side effects at all when used as directed.
On top of that daily use brings it down to 3-5, preferably 4 or less of those a day. And they last less than 6 hours.
The 8h extended release is 650mg a tablet, and you can have 3-4 a day daily. And if you have any experience taking them you can feel the first half of the extended dose wear off before the extended one kicks in, which leads to basically NEEDING 4 a day, and staggered start times.
The folks I know who've been prescribed fentanyl weren't particularly upset about it. It is very potent, and thus measuring the dose properly is very important, but it's not particularly fussy beyond that.
The people you know may be obtaining it from less reliable apothecaries; that can be a real issue.
Reminds me of a comment I saw on a drug chemist's blog decades ago where they were talking about ACE inhibitors for Parkinsons' Disease - by dicking around with nerve conductivity and acetylcholine reuptake you could "boost" the failing nerves a bit, presumably until they fail altogether.
Anyway much of the discussion was on how hard it is to make suitable drugs, and someone said "We actually have some fairly inexpensive, reliable, and well-characterised ACE inhibitors with a nice long half-life and known efficacy, but the therapeutic window of nerve gas is pretty narrow..."
I'm grateful for you mentioning this. I grew up with ibuprofen as my default painkiller without really thinking of it too much but am about to do PRP which requires no NSAIDs for a week prior and 3 months after - but they do allow/recommend Tylenol as an alternative, especially for the post-procedure pain. I just would've assumed it was a sufficiently good substitute that I could treat them equivalently but now i know to be very careful about tracking how many I'm taking each day
I was in the hospital on Thanksgiving Day last year. I received 8 diagnoses at that time, including "Diabetic Hypertension" and "Metabolic Acidosis" and E. coli infection, and Hyponatremia.
They treated me with an antibiotic, a potassium-rich saline drip and acetaminophen. Yeah that's all they put in my orders.
The thing that pissed me off so much, firstly they insisted on calling it "Tylenol" when it was not, in fact, brand-name Tylenol but generic acetaminophen (even if they could charge $$$ per pill on it) and also that they basically refused to administer it at a rate that would keep my exquisite headache pain at bay. I was literally screaming and moaning through the entire night and day. (Actually, I was wearing one of those radio-transmitting heart monitors, and mostly the screams happened when I moved suddenly, and the electrodes tore at my chest hair...) But my head was also constantly throbbing, and that's how I knew to go to the hospital in the first place.
The nurses could tell me how long to wait between doses, but they couldn't explain to me how to know that interval, given no clocks and no written-down time of dosing. So basically I had to keep guessing throughout my sleepless nights. And they didn't really inform me of a way to just put it on automatic dosing like a normal hospital would have a schedule for.
I really didn't want acetaminophen at all; I don't like it much, and it really hasn't ever relieved any pain I've ever taken it for. My parents chomped so much of it, made me sick just watching them. I lived through the cyanide adulteration episodes and though unsolved, that guy wasn't wrong.
When I finally got to visit a sane PCP after all this madness, I told him I was taking big doses of Bayer Aspirin, and he said that's fine; just follow instructions and heed warnings, and he also warned me: for Heaven's sake don't ever take any acetaminophen, because it would seriously harm my liver!!!
It's not under appreciated in the UK and Ireland where you can only buy tiny quantities of it at a time. Cash registers will literally refuse to process a sale if there is more than one pack of acetaminophen in your groceries.
Replacing Aspirin with Acetaminophen/Paracetamol was absurd. Reyes’s syndrome was nowhere as prevalent as acetaminophen overdoses, which are a horrible way to go.
There is an antidote available for acetaminophen overdose, but it's only available in the hospital. So if you think you took too much, get to a hospital quickly before your liver suffers permanent damage.
Untreated acetaminophen overdose is an extremely unpleasant way to die.
Huh, looked this up as Acetaminophen is one of the only OTC painkillers I can take. I thought NAC (N-Acetyl Cysteine) sounded familiar and low and behold I already have some I've purchased as a supplement.
Anyone can buy this stuff, no need to make it sound like it's some controlled substance. I will say if I take to much Acetaminophen I'll just head to the hospital instead of winging it!
I was trying to keep it simple. Yes you can buy n-acetylcysteine but OTC versions can vary in purity and dosage and it's not the only treatment you might need. With an acetaminophen OD you really want to be in a hospital.
The safety ratios listed in reference [1] are exaggerated, as can be determined by the following qualification: "The majority of published reports of acute lethal toxicity indicate that the decedent used a co-intoxicant (most often alcohol)."
The vast majority of so-called drug overdoses are due to polydrug intoxication. It's much harder to die by consuming a single substance. This is clear from the statistics of the few jurisdictions that report all substances in the blood in coroner's reports. See, for example, the Scottish data from 2020 (https://www.drugsandalcohol.ie/34642/7/ndrdd_report.pdf ): "In 2020, almost all (96%) [drug-related deaths] occurred after the consumption of multiple substances."
I imagine painkillers are fairly commonly used for hangover headaches, and it’s surprisingly difficult to get guidance on how long after drinking it’s ok to take painkillers (presumably as it’s complicated) - perhaps instructions should be updated to not just say don’t take with alcohol, but don’t take within a day of alcohol?
Liver failure is the worst way to go, it's slow and painful. if someone accidentally takes too much you can give them activated charcoal before you get them to the ER to give them a better chance of not going through liver failure
Perhaps it's useful to know that NAC is the treatment for acetaminophen toxicity, should you happen to find yourself in the middle of a zombie apocalypse with a Tylenol ODed friend and a supplements isle handy but no readily available medical support. :D
There has been some suggestions that acetaminophen products should contain NAC to offset some of the toxic effects, but I dunno where they've gone-- there probably isn't any money in it to study it formally.
I try to make an effort to know what the treatment/antidote is for any hazardous substance in my home... things you hope you never need to know but are glad if you do.
They also picked a study that shows honey outperforming Dextromethorphan but ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.
There are so many studies and papers published now that you can find both positive and negative results for just about anything. When someone starts pulling up singular random links to papers you should be suspicious. Be even more suspicious when someone is calling for bans or regulations based on those individually selected papers
No, you can't just "average" different studies and I'm not sure what "neutral" means in the context of some studies showing a benefit and others not showing a benefit.
Only if you assume that all studies are valid and accurate. And even then you are drawing the wrong conclusion -- if everything is "neutral" then that means that all the positive studies are wrong and all the negative studies are correct. (You seem to have erroneously assumed that a negative study means that something is bad for you.)
Also, the very claim that there are positive and negative studies for everything is handwavy nonsense. There might 100 studies, all of which agree except for one outlier ... what does that "suggest" to you?
> ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.
To be fair, you're doing pretty much the same by claiming these studies exist without proof.
An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself, and similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.
> An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself,
Auvelity is interesting, but the exact mechanism of action is not very clear.
Auvelity is a combination of two drugs: Dextromethorphan and Bupropion. Bupropion, aka Wellbutrin, is an antidepressant by itself. In Auvelity it helps alter how Dextromethorphan is processed by the body, but we can't rule out that it contributes to the antidpressant effect. I mean it's literally an antidepressant.
Dextromethorphan has a lot of interactions and gets a lot of comparisons to ketamine because it has NMDA affinity, but if you look at the table of receptors it interacts with the serotonin receptor is one of the strongest interactions. It is a potent serotonin reuptake inhibitor, which is also known to have antidepressant effects. It also has some sigma receptor interactions which might be doing something significant.
The NMDA interactions get all of the attention because if you put "ketamine" in the headline you get a lot more attention, but NMDA may be much lower on the list or even negligible for this combo.
This is straying a bit from the original post, but agreed, NMDA antagonists and related compounds effecting glutaminergic tone are showing promising directions.
N=1, I've had very positive experiences with DIY Auvelity, using 150mg Buproprion XR that I'm RX'ed with 60mg OTC DXM-only tablets.
> … similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.
Should read “NMDA receptor antagonists _may_ give rise to treatments that _may help prevent or ameliorate the symptoms_ of Alzheimer’s.
Nobody even knows how Alzheimer’s works at all — like most diseases it’s a description of some detectable symptoms, some of which could even turn out to be the body defending itself.
Thus compounds that may have a mechanism of action that affects some concomitant, visible symptoms might potentially be useful.
The use of definitive sentences about unknown results is how we end up with wellness and some “biohacking” nonsense.
In my subjective experience, Dextromethorphan (DXM, as the robo-trippers call it) does almost nothing for me, in the 1-5% range
The only cold and cough medicine that really truly works is the over-the-counter stuff, pseudoephedrine, works amazing for me. I usually pick up a box of the stuff when school starts in the fall and I go through half a box of it by the following summer.
Pseudoephedrine is a decongestant to relieve the nasal/sinus congestion.
If it helps with your coughing, it’s because it’s stopping the postnasal drip, not suppressing the cough as DXM would by shutting down the cough reflex.
Two different, but very similar use cases. DXM is a god-send in the appropriate time.
DXM may or may not suppress coughing relative to placebo - the study cited here appears to be have been written entirely by authors from drug companies, so perhaps there is some bias. Here's a meta analysis that favors honey over DXM https://pubmed.ncbi.nlm.nih.gov/32817011/, the original study that kicked off this idea that also favors honey https://pubmed.ncbi.nlm.nih.gov/18056558/, and a different meta analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC6513626/ which found little or no difference between honey and DXM. Whether its effective or not, to me there doesn't seem to be compelling evidence that it is more effective than honey.
It's funny that TFA seems to use the comparison to honey as disparagement, rather than interpret the same information as an endorsement of the helpfulness of honey.
I think the point is honey is known as a home remedy, may already be in your house and is available at a much lower price (farmer’s markets and woo merchants possibly excepted).
Honey is also well established in medicine, especially in wound and infection management. I'm not sure of how much clinical evidence supports cough suppression, but it not huge leap to suspect that it could be a second order effect of its antibacterial properties, like in bacterial bronchitis.
It's worth nothing that all of the studies you linked were performed only on children. It is entirely plausible that DXM is effective in adults but not children because of the difference in dosage or measurement (studies on children often rely on parental surveys).
Are you sure you posted the right paper? That paper appears to present a clinically insignificant outcome for DXM in children.
I think it's perfectly reasonable to contest the research summary this article is providing. All science-based articles on interesting topics are going to be like that. But you're writing your comment as if they took a flyer on DXM, and the research consensus is in fact that DXM is not effective. It's not as bad as phenylephrine (it has detectable, if immaterial, impact in adults), but it's pretty bad.
The point of the article, of course, isn't that Dayquil should be illegal because it's dangerous; it's that it doesn't work. Having spent an unreasonable amount of time in HN pseudoephedrine threads, I think the broad consensus of this site is that phenylephrine should be taken off the shelves.
Phenylephrine was the replacement that doesn't really work but is non (or less) stimulating right ?
From what I remember it was actually quite effective topically but not through pill form. Could be wrong.
Also makes me wonder if there's an alternative function to DXM for people with colds (maybe it makes them feel better in other ways). Or it's just good marketing and associated with NyQuil having other drugs and people assuming DayQuil works
It's not that it's less stimulating, it's that pseudoephedrine basically is methamphetamine (the chemistry to reduce it to meth is truck-stop straightforward). But oral phenylephrine doesn't work at all.
The case against DXM is nowhere nearly as good as the case against phenylephrine; phenylephrine is a scam, and DXM is a drug everyone thought was the gold standard cough suppressant, but then serious studies knocked down its effectiveness.
"Using objective and subject assessment tools validated in pediatric populations, this study provided evidence of the antitussive efficacy of DXM in children, aged 6–11 years, at the current OTC monograph dose and labeled indication. Compared with placebo, DXM treatment reduced cough rates 21.0% over 24 h (primary endpoint) and 25.5% during daytime/awake hours. In addition, children treated with DXM reported greater reductions in cough severity and frequency in the mornings and afternoons over 3 days than children treated with placebo. These treatment effects were statistically significant despite the study not reaching its planned sample size and are medically relevant."
Also as I mentioned in another comment, the author of original article misrepresents the findings of their own citation. DXM was found to be effective in adults, just not children.
I work for a large agricultural company, in my part of it we sell fertilizer, chemical, and agronomic services.
As part of this, we end up putting out a lot of trials so we can actually say something true instead of “buy our stuff it’s great I promise ;)”
One of my favorite slides is when we compiled dozens of trials on something that’s basically a nitrogen fertilizer, which as much of a guaranteed positive effect as you can get in agriculture. When compared in a graph most of the trials show an overwhelming effect on increasing yield over an untreated check, however there’s always a portion of the trials where the yield decreases compared to the (untreated) check.
Real life is extremely noisy for a multitude of circumstantial reasons that are either not practical or possible to control for, so a single trial is generally worth fuckall. It takes a lot of testing to see a consistent trend across them.
And, all of this, to avoid selling a little bit of the narcotic codeine. Which was technically permitted to be sold "behind the counter" without prescription, but was made Schedule II as part of cough syrup in the US not long ago. (It used to be Schedule III or IV when combined with homoatropine or promethazine).
I wonder if the cost benefit analysis would show that this is still the best policy - I.e. are more people dying because of overdose of acetaminophen than would have from “behind the counter” + controlled acquisition of codeine products.
I would also imagine that the compliance / nationwide tracking is now much easier than when the legislation was initially conceived.
I think it was a mostly innocent bystander, because they decided to put codeine-combination painkillers (Vicodin, etc.) in schedule 2 but wrote it as just opiate combination medicines.
Isn't it a bad sign that there are such varied results? Perhaps that's only a bad sign for the state of science, but I suspect it's also a bad sign for the effectiveness of the drug.
> This article uses the trick where you pick studies that support your argument and ignore all of the studies that disagree with it.
It's even worse than that, they appear not to have actually read the analysis they cited because two of the three studies on DXM found it was effective in adults. The same efficacy was not found in children but there are other very plausible explanations for this (difference in dosage and measurement techniques).
I was wondering about that. I've taken a number of different cold medications over the years, one active ingredient at a time, to check their effectiveness while sick. Phenylephrine, as widely reported, had zero effect. But Dextromethorphan seemed to work for my kids - give it to them, stopped coughing. Started coughing again 6 hours later, etc. n=1 and it's a 4 year old, but in one of those cases my results clearly matched the studies, and in the other it didn't, at least as reported by this article.
They wouldn't be selling the placebos if the real stuff were accessible. That's the real answer. The article mentions this but just accepts the inaccessiblity of the real thing as a given.
You used to be able to get Nyquil with real sudafed in it. That was the gold standard. It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos.
As an aside:
> In January 2011, the FDA set a maximum amount of acetaminophen that could be packaged in combination opioids like Vicodin or Percocet. The odds of hospitalization due to opioid-related acetaminophen toxicity plummeted.
Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.
> It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos.
What do you mean "morons"? Say I'm a normal person who doesn't habitually read magazine articles about drug effectiveness. How am I supposed to know that phenylephrine doesn't work? It's in the drug store and they're selling it as a decongestant; I have good reason to believe it will decongest my nose.
You don't need to know anything about the new stuff. You used to be able to get Sudafed; it worked. It was moved behind the counter for $REASONS. You've got enough to guess that the new stuff is some kind of inferior substitute and that you're only going to be able to get the real thing during pharmacy hours.
Then it's also been enough time to think about bringing it back again. That's my whole complaint about this article, is that it fails to reach the correct conclusion.
> The article mentions this but just accepts the inaccessiblity of the real thing as a given.
Reality is in fact a given. If you mean that the author is just fine with that reality, that's patently false.
> presumably because they can make more money from morons buying the placebos.
If that's your evaluation of everyone who lacks perfect information then you need to look in the mirror.
> You used to be able to get Sudafed; it worked. It was moved behind the counter for $REASONS. You've got enough to guess that the new stuff is some kind of inferior substitute and that you're only going to be able to get the real thing during pharmacy hours.
Grossly intellectually dishonest and downright unintelligent nonsense. Here's a fact that is inconvenient for this moronic argument: acetaminephen is readily available on the aisle. Things not being locked away does not imply that they have no effect. The more complex reality is actually discussed in TFA.
> Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.
The misspelling of "its" is the least egregious part of this nonsense.
I read the main section of the lit review linked by OP, and it didn't seem to come to any real conclusions.
> The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. [...] There is no good evidence for or against the effectiveness of OTC medicines in acute cough.
I just can't get super upset about this. Sure, OTC companies are duping customers with marketing, but what's new about that? As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product. Or ask my doctor/nurse/pharmacist what to do, if I can't be bothered to make the effort myself.
When I want to get irrationally angry about something in a department store, I'll walk over to the shampoos, which for some reason always have a whole entire aisle dedicated to a single product, when they all do literally the same exact thing, just with different scents and advertising budgets baked into the sticker price.
The reason to take this seriously is mentioned in the article: It is possible to OD on Tylenol, and when consumers miss the fact that these drugs are all just Tylenol+junk, they might believe they need to take several of them together to get well.
It's similar to the shampoo example (a huge selection of borderline useless products that make money purely because of marketing) but with a minor safety consideration, too.
You are ignoring the existence of consumer protection, which is not unusual as it seems like regulatory bodies around the world (but especially in Europe) have forgotten the existence of consumer protection as well.
You ask what is new about this, and the answer is, in 2026 context: nothing, but compared to the year 2000: plenty. Regulators used to issue fines for this behavior, and for worst offenders, regulators used to shut them down. Lying to customers is illegal in most jurisdiction, it used to have consequences, and it should do so again.
Not totally accurate - there are a handful of foaming agents and surfactants that are mixed and matched to make shampoos, so really it's nearly the same except that no one has ever overdosed on applying too much sodium lauryl sulfate to their scalp.
You won't OD from sulfates in shampoo, but there are serious pros and cons to using them at all:
Sulfate-containing shampoos give you a deeper clean, but can dry out your scalp and make the color in color-treated hair fade. They're ideal for most people, especially if you don't wash your hair every day.
Sulfate-free shampoos are more gentle, but if you're supremely oily and/or don't wash your hair every day, you might not feel like they clean your hair well enough. Almost all "color-safe" shampoos are sulfate-free. They're ideal if you wash your hair daily and/or have a dry scalp... and they're a must if you dye your hair and want to keep the color looking nice!
> As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product.
But I don't have time to do that. I would rather have a retailer do that curation for me and provide me with effective high value products, and stand behind returns when they miss the mark. Then as a customer I can reward them for that value added work.
That's why Costco is great most of the time. Although they sometimes miss the mark with certain products they stock.
Additionally, if I'm buying cold medicine there's a really good chance I have a cold, and my ability and inclination to carefully analyze the ingredient list on a box of medicine smear-printed in 3pt sans will likely be diminished.
Not to mention it ignores reality. Most consumers have neither the time now knowledge to research everything they buy. That's one of the roles of government.
That's one of the important reasons - I thought - that we have the FDA in the first place. But these days I'm really not so sure. So many promising treatments rejected (or just stalled forever) while pointless placebos and worse get or remain approved.
Is the argument that because the FDA may not be perfect, the public would be better off if it didn’t exist?
The FDA handles many thousands of product categories, tens of thousands of prescription drugs, etc. Which items (and how many total) are you referring to? For many of them might there be a reason available as to why they didn’t end up as you recommended?
Is there any country on earth without an FDA where you think the result is better than the US’s FDA?
> As the person holding the money, it's my job to look at what is effective and what the act ingredients are in any given product.
I wish the industry, our health organizations, and most people in general acted as though this were true.
The environment we live in in general is increasingly hostile to people who ask those questions, do their own research, and take responsibility for their health in this way. I have first hand experience having reversed chronic health conditions myself by doing my own research. What have and do others say about it? Everything: every person on the sidelines watching who have formed opinions about how things are supposed to be, and how doctors and nurses and pharmacists are supposed to know better, attack and ridicule me and others like me and when we "look at what is effective and what the active ingredients are" we are gaslit and told we can't possible understand and know that and to leave it to the experts. Of course the definition of expert is only ever tribal and is a moving trojan horse for whatever best allows the agenda of an industry to establish its control over you.
> When I want to get irrationally angry about something in a department store, I'll walk over to the shampoos, which for some reason always have a whole entire aisle dedicated to a single product, when they all do literally the same exact thing, just with different scents and advertising budgets baked into the sticker price.
Somewhere on a shampoo forum people are complaining that all computers do the same damn thing. I guess they probably just don't know what they're talking about.
I think I have two opinions on this, from different angles.
I think the phenylephrine stuff is absolutely messed up. I personally had no idea it was ineffective, and I've bought medicine with that included, believing it would do what it says it does in the active ingredients list. To me, this is criminal, and these companies should be taken to court for outright lying about their products. (And the FDA should be slapped, hard, for not having done something about this by now.)
But when it comes to the CVS brand of acetaminophen costing $5 and the NyQuil brand costing $10, that's just... the result of normal market forces. I'm not a big "free markets" guy (because we don't, and can't, have truly free markets, and if we could and did, it would be a disaster), but it's pretty normal and common for people to pay more for something just because some company did a better job advertising it than their competitor did. That's just life.
It's funny, because when I go to a pharmacy, the store brand is usually shelved right next to the big-name brand, and there's even often a little card next to the store brand (or even printing directly on its packaging) that says "Compare ingredients to $BIG_NAME_BRAND!" And yet, people still buy the big name brand. ::shrug::, that's life.
If someone buys an overpriced shampoo, it only negatively affects them, but the are costs to overall society if people suffer health issues, addiction, etc.
In the past, a lot of people unknowingly ended up addicted to morphine, as it turned out both companies and individual doctors were happy to mislead them about the contents of medication.
That shampoo opinion is a sure tell that you're not a woman with long hair (men with long hair tend to be less picky). My hair behaves noticeably differently with different shampoos/conditioners even within the same brand, and depending on your specific porosity, oiliness, texture, and humidity of the local climate, different hair care products and routines make a big difference if you have hair past chin length and want it to look healthy.
While I can appreciate the principle of not blindly trusting OTC medicine marketing, it is not realistic to expect every person to be highly competent in fully understanding their medical choices. It is far more reasonable to expect the companies marketing healthcare products to be honest to their customers.
If anything, you need honesty from healthcare companies in the first place if you're even going to begin making an informed decision. You're putting the cart before the horse here: people absolutely should be doing their own research before medicating themselves, but it is the OTC companies that obstruct that.
And, secondary to all of this, your analogy about shampoo is misinformed. Still, it is fitting for this scenario, but not in the way you intended. There are lots of different hair types, including ethnic hairstyles that require specific treatments. There are also a number of lifestyle choices that can change your hair treatment needs. As a result, the shampoo aisle actually is stocked with a wildly varying assortment of haircare choices, but actually figuring out what product works best for your needs can be challenging because it is walled behind layers of marketing nonsense that don't inform the consumer adequately on what makes each product different. This isn't much different than the problems in the medicine aisle.
It took a lot of secondhand research to find the ideal hair care product for my thick, curly hair that would mitigate the damage of thrice-weekly swimming in a chlorinated pool. I can assure you, not everything in the shampoo aisle is exactly the same. It was especially hard figuring this out as a man, when so many products are arbitrarily marketed to specific genders.
Yeah, intentionally misleading consumers should always be at least somewhat illegal. Sure caveat emptor, but consumers having accurate information is implied and a cornerstone of a competitive market.
"Caveat Emptor" and "Do your own research" is not a basis for a functional society. Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level. And letting marketing decide what counts as "accurate information" is just letting the fox guard the henhouse.
Counterpoint: 54% of adults read below a sixth-grade level because a society has been created to facilitate (and encourage) just that. Encouraging a population to rely on the thought processes of others is exactly what leads to over reliance on marketing.
> Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level
This is obvious, but thank you for putting it so succinctly. One has to wonder how much support for "do your own research" is driven by people who want to remain proudly-in-denial about their own inabilities.
It's no surprise that the political party/forces pushing on policies that result in worse education and literacy outcomes are the same ones who want "Buyer Beware" and "Do your own research" to be fundamental product regulatory principles.
In the US at least, medicine is so highly regulated/gate-kept that I don't think caveat emptor really applies. What's happening here is more like deception of the public by the state, or by groups granted special status by the state. It's morally somewhere between fraud and treason.
> So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen
this argument makes very little sense. Plenty of very potent drugs are in the single digit mg range in a tablet that weights hundreds of mg.
More importantly, as always, it is a problem of incentives. There is no strong, commercial entity focused on removing ineffective drugs from the market, but plenty of commercial pressure to keep them. The FDA has zero incentive to clean house. The magic hand of the market is supposed to be consumers choosing not to buy these drugs because they are ineffective, but for many reasons (choice, placebo effect, basic scientific literacy) this does not happen.
I don't know what the most effective entity is. I cannot personally imagine a commercial structure to support this, but perhaps one could be built.
The other ingredients would be doing other things: making the pill/drug easer to swallow/consume, extending shelf-life, etc. You need enough of the drug for it to be effective, but not too much to overdose or exhibit side-effects.
The mass of the acetominophen isn't really important, it's just vivid writing. The point is that 8g is obtainable for orders of magnitude less when it isn't wrapped in misleading marketing.
I think it’s outrageous that pseudoephedrine has become difficult and annoying to purchase while they put that ineffective garbage out through all these combo drugs.
In Canada if you go to a drug store, the shelves are literally filled with literal homeopathic medicine. You have to carefully confirm that what you’re buying isn’t water, and there is no signage or other differentiation between actual medicine and magic.
Completely unrelated, I noticed recently that tire detailing spray that makes your tires look black, and the recommended lubricant for my garage door weather stripping, which both cost $15 or more for a little bottle, are just silicon oil that costs pennies for that amount. I have no moral problem with charging higher prices for convenience plus clarity of what the use is. I do think it’s amoral, obviously, to be involved in snake oil sales and unbelievable that the government allows it.
Ugh yup. My regular pharmacy is a pharmaprix (shoppers drug mart), which is one of the biggest chain pharmacies in canada. The cold and flu isle is right in front of the pick up counter, so when I was sick a few months ago one of the pharmacists flagged me down when they noticed me hovering around the cough drop/coldfx/oscillococcinum part of the isle. The amount of proverbial snake oil on the shelves is bad enough that she was apologizing for how confusing it was. Got me set up with OTC pseudoephedrine instead! (There's some combo PSE/acetaminophen meds they sell in front of the counter, but they're mixed in with the sugar pills.)
It's really worth talking to your pharmacist even if you know what you're buying. There's so many more options behind the counter and they're really knowledgable.
In Canada all homeopathic medicine must clearly identify itself as such and must also state that it's based on traditional form of medicine and not based on any kind of scientific evidence.
The very "medicine" you linked to in fact displays it right on the cover.
To be fair, they are clearly following that rule, yes. But also, if I went to a clinic, and got told it was my fault something didn't get treated because I spoke to the person dressed as a doctor wearing the "Aspiring Dr. Soandso (Untrained but did watch House MD all the way through)" nametag instead of the one that said "Dr. Soandso", I would be pretty pissed. They were still in the clinic, dressed like a doctor.
I think there's one thing most people agree on: drugs should be safe and effective.
DXM is fine but oral phenylephrine should be banned. The only reason it's in any of these drugs is because they don't want to lose sales when the real version that works is locked behind the pharmacy counter after hours. It's a scam to keep sales up.
I had a cold a year or two ago, I had used the last of a bottle of actually working cough medicine, attempting to buy a replacement failing to do so, I found it had been banned. Turns out the active ingredient was morphine, which is apparently quite an effective decongestant in very low doses(and variants have been used as such for thousands of years)
That started me on a quest for a good cough medicine. My research turned up some interesting results.
Different countries have their own go-to medications for decongestants. Actual different drugs, not just the same thing under a different name.
None of them work.
Anything that does work is banned unless the people making it have been doing so for a couple of hundred years, then it seems that they just pretend it's not there.
When challenged the industry defended their sale of ineffective products by saying if they didn't work, people wouldn't buy them.
Anecdotal evidence is taken as gospel in many public health circles. When an attempt to have a substance banned was rejected on the basis of no evidence of abuse, it appears that means 'try again later', not gather evidence. You only have to wait for someone who shares your ideology once and it gets done and getting it undone is too much work for anyone to consider.
It's almost enough to send you off to a music festival to gather your own supplies for home remedies.
I get that the discussion here focuses on doubtful decongestants, but just the mention of acetaminophen makes me think of
pharmaceuticals and people's relationship with them in the US. It's a strange world to me, especially how deeply ingrained the brand names are in people's minds - years of evidently successful marketing.
What, to me, should be illegal, is building expensive branding around a group of very basic analgesics - well and other groups like antihistamines.
In the UK I can buy an own-brand 16-pack (8 g) of paracetamol in a supermarket for £0.35 / $0.45. At the same time, I can buy a packet of Panadol (GSK), same substance, same content, same amount, for £2.35, nearly 7 times the price of generics.
How is THAT legal, and how are people so unaware as to actually buy it? "Unaware" may be the key here.
Same situation in the US. I can buy NyQuil/DayQuil, or I can buy the pharmacy-branded version for a lower price. Here it's usually not such a dramatic difference; probably the pharmacy brand is a a 30-40% discount off the big-name brand.
> How is THAT legal
Why shouldn't it be? Companies are free to set prices to whatever the market will bear. In this case it's based on customer ignorance, which makes it feel icky, but I don't think that's a reason to legislate this sort of thing.
> and how are people so unaware as to actually buy it?
Yeah, I don't know. I do remember that, many many years ago, I didn't know about this, and would always go for the big-name-brand version. At some point I learned to look at the active ingredients and just buy the cheapest one that had the same ingredients in the same dose, but I don't recall when or why I learned that, or why I didn't know that before.
I think there's also an implicit quality judgement sometimes, even if it's unfair. When it comes to groceries, say, canned tomatoes, and I see some fancy-looking Italian brand that I've heard of, my brain will automatically rate it much higher than the grocery store's own branded version of it. Maybe that's an effect of marketing/advertising, maybe it's something else, I don't know. And sometimes it's actually true: tomatoes are not all created equal. I think something similar happens with drugs, even if it's an entirely different kind of product.
People also often assume that something that costs more is automatically higher quality. For some types of things, that can be true (because yes, there is such a thing as a better tomato, and sometimes it costs more to cultivate said better tomato), but for drugs in a regulated environment, that doesn't really make sense. But people pattern match on what they know and what they feel.
We see this all over. Generic brands can be on-par with (or even 100% identical) to name-brands, and the name brands still make money. For example at my local grocery store, you can buy distilled white vinegar from Heinz or the generic brand. The generic brand costs half-price (or less if you get the bigger container), but the product should be chemically identical.
There can be some arguments made (maybe you think the generic cuts corners and it is only 4.5% vinegar instead of 5%), and the same arguments can be made for the drugs. But IMHO they come nowhere near to justifying the price gap.
The thing that is particularly frustrating in the case of the drugs is how the brand-name is (for many people) the vernacular name. I grew up in a family that called many drugs by their actual name (eg ibuprofen & acetaminophen), but when I go to the doctor, many of them insist on calling them Advil & Tylenol. Sometimes it seems to take them a second to recognize the generic name.
FWIW my guess is most people are aware, and do know that supermarket/drugstore acetaminophen / paracetamol is the same, in some relevant sense, as Tylenol / Panadol. It's not like the retailers lack marketing resources. But for these off-the-shelf drugs the total $/£ amounts are small for a lot of people.
Then, there _are_ arguments about whether generics face adequate testing to ensure the same quality as the originally-approved name brand drug. A lot of this is FUD - I'll happily buy generic acetaminophen in the US - but it's not a totally irrational concern. I doubt any regulator ensures generic equivalence to the same degree of conformity that a big pharma companies' own quality control does.
For example, I personally find real differences in the jankiness of different asthma inhalers, even amongst generics. Maybe that's because I don't shake/use/clean them exactly per the directions, but then that's real-world use for you. My personal experience says brand-name Ventolin has solved a "robustness against user error" problem in a way some alternatives often have not, suggesting the FDA does not enforce equivalence on this dimension. It's not enough of a difference for me to go name-brand, since out-of-pocket price differences can be egregious, but I do distinguish between otherwise-unknown generics.
Finally, you may trust the UK regulator and so do I, but traveling somewhere without good regulatory oversight, I'd probably reach for Panadol - assuming it seemed authentic - over a generic brand I'd never heard of. Brands have value and brand owners have a lot to lose, which is a kind of insurance (see 1982 Tylenol recall).
OTC decongestants that actually work, some useful info for those of us with bad sinuses.
- pseudoephedrine taken orally.
- phenylephrine, but only as nasal spray, not if you take it orally.
- Oxymetazoline (Afrin) nasal spray and others in this broad family
- propylhexedrine, sold OTC as Benzedrex as a vapor inhaler. Unfortunately people crack open the inhaler and swallow the whole thing as a drug of abuse, so often they are out of stock seemingly because of shoplifting, or not sold at all because the pharmacies don't want to deal with the hassle.
Anything that goes directly in your nose has the potential to cause rebound congestion after a couple days which can be pretty bad.
Calling Dextromethorphan a placebo is quite a stretch. Sure, I think the point is that it makes you intoxicated so that you don't really care that you're sick, but it is definitely active.
Nasal phenylephrine is a miracle when I am trying to sleep with a stopped up nose. A spray in each nostril and my nose is clearer than even normal within a few minutes.
Absolutely true. Phenylephrine liquid applied directly to nasal mucosa is a quick and effective decongestant. It doesn't last as long as oxymetazoline (the other big nasal spray ingredient), but it also doesn't cause you to become dependent on it as much as oxymetazoline does.
> Most studies have found that dextromethorphan performs the same as a placebo
The citation linked does not support this claim. In fact it suggests the opposite:
"Dextromethorphan was tested in three of the included studies (Lee 2000; Parvez 1996; Pavesi 2001). One report on a series of three successive studies on a total of 451 adults favoured dextromethorphan 30 mg given in a single dose to placebo in terms of cough counts (measured through cough acoustic signals using a microphone on the nose) and subjective visual analogue scales (Parvez 1996). Differences in mean changes of cough counts between active treatment and placebo varied from 19% to 36% (P value < 0.05) in the three studies (up to a net difference of eight to 10 coughing bouts every 30 minutes). This study did not report on side effects.
A study involving 44 participants tested a single 30 mg dose of dextromethorphan versus placebo (Lee 2000). Both treatment groups showed a decline in cough frequency (from 50 to 19 per 10‐minute period in the active treatment arm compared with 42 to 20.5 in the placebo arm, P value = 0.38 at 180 minutes follow‐up). Mean subjective cough scores showed a decline from 2.0 to 1.0 in the active treatment group compared to a decline from 2.0 to 1.5 in the placebo group (mean difference in decline in cough scores 0.5 at 180 minutes, P value = 0.08).
Pavesi and colleagues also tested a single 30 mg dose of dextromethorphan versus placebo (Pavesi 2001). Outcomes were measured through a three‐hour continuous cough recording, measuring cough bouts, cough components, cough effort, cough intensity and cough latency. Average treatment difference was 12% to 17% in favour of dextromethorphan for cough bouts (P value = 0.004), cough components (P value = 0.003) and cough effort (P value = 0.001), with an increase in cough latency (P value = 0.002)."</i>
Two out of the three studies found DXM was effective in adults. The studies did not find the same efficacy in children but that could be due to differences in dosage (adult dosage is 30mg, child doses vary based on body weight) or in measurement techniques (as far as I can tell the child studies measured results via parental survey as opposed to more objective techniques like cough recordings).
Btw, the cosmetics industry functions similarly, but worse. Although I suppose the health dangers are lower (the monetary ones are not).
For anti aging stuff, the workhorse ingredient is retinol (with a few formulation variations).
However, it is very difficult to buy _just_ retinol - most beauty brands bundle up retinol with a bunch of other ingredients. This has a couple of issues:
1. You won't know your retinol dosage. These creams almost never tell you the retinol proportion and concentration.
2. You're overpaying by _a lot_. The luxury name brand cream will cost maybe 10x more than the similarly sized $9 bottle of retinol from the ordinary, but it will only contain some fraction of retinol.
Tbf this has been slowly changing and I see even La Roche Posay sells retinol bottles for $50. Insane markup, but smaller than what was the case 5 years ago.
This is all compounded with the fact that it's very difficult to tell if your anti aging cream is actually working from your own experience:
- its effect is slow acting
- it's difficult to compare the result with the counterfactual, unless e.g. you only use it on half your face
> Historically, Sudafed has contained pseudoephedrine, the wonder drug equally good at clearing congestion and making crystal meth.
It's much better at clearing congestion than at making crystal meth. And, as the joke goes, it's easier to make an effective decongestant from meth than it is to buy it from a store.
I am still bothered that Australia limited the sale of small quantities of codeine in 2018. I had not realized it limited acetaminophen last year to limits similar to the UK.
At least in the States I can still economise.
On the record, I am 100% for making common painkillers, cold and flu remedies completely over the counter. It blows my mind people are making things that used to be prescription (for good reason) OTC, but limiting purchases for things like acetaminophen. I still find it burdensome to deal with the pseudoephedrine controls, and I don't even use it often.
I'm not sure what it is in the Dayquil - the DXM or the "decongestant," but there is a stimulant effect that is half of what I buy it for. It is the most effective medication I have found for getting me off the couch and able to power through a workday with a moderate cold, and definitely does something that Acetaminophen alone doesn't do.
Interesting that in the US metamizole[0] (dipyrone, or Novalgin and Analgin comercially) is banned in the US due to agranulocytosis[1] risk. It's fairly common in Europe, Asia and South America.
The FDA did this to us by outlawing effective but problematic products and replacing them with relatively safe but ineffective products. And then letting product makers off the hook on claims and pricing
I only know one person who has ever found phenylephrine effective. It's definitely not for me, but they've done single-blinded self-studies (with help) to see if it's a placebo effect, and it's pretty clearly not.
DXM is also not a placebo, although it might be specifically for cough.
I don't especially want the FDA to ban them, but requiring separating out the acetaminophen might not be the worst idea.
I use DayQuil/NyQuil when I get a cold and in my case, it's always worked well. It suppresses the symptoms and lets me carry on with my day-to-day. I did try once going 1 week without it and it was hell.
When the hubbub about phenylephrine first started, I decided I still felt less miserable taking DayQuil/NyQuil, and switched to the "High Blood Pressure" formulation, which drops the phenylephrine, alcohol and sugar.
It takes it down to just the Tylenol, the DXM (, plus the antihistamine in the NyQuil), and the great slightly tearable taste for the ritual of "time to pretend I'm not sick for a little while".
> Take your standard 12-ounce bottle of DayQuil, which costs around $15 at CVS.
...
> So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen, which separately would run you about 16 cents at Costco.
Why are they comparing the price of CVS DayQuil to Costco acetaminophen? Either compare CVS DayQuil to CVS acetaminophen or compare Costco DayQuil to Costco acetaminophen.
Yeah that seems odd. It's also a very different delivery mechanism. Might be easier to get a sick and snotty kid to drink some (maybe?) tasty liquid vs cheap pills.
Dextromethorphan is definitely not a placebo. Take enough and you'll go to space and meet God. Smaller doses produce euphoria and dissociation, which, even if they don't make the cough go away, makes it easier to tolerate a cold -- same reason antitussives have historically contained alcohol, cannabis extract (which may incidentally work as bronchodilator but was not the reason I imagine it was in antitussives)
Funny amphetamine used to be an over the counter cold medicine, which the article doesn't mention despite talking about the meth precursor?
Fine article but these two details stuck out to me while reading it.
Came here to say this, the author is hating on dextromethorphan like he never robotripped before. But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that.
> But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that.
Ketamine is neurotoxic itself and can cause permanent brain damage. I can't find the info but there was someone in the tech industry who accidentally overdosed and suffered a two year bout of severe debilitating depression culminating in suicide.
Sorry to say, we shouldn't really base our opinion on drug safety from people who accidentally overdose or are generally reckless with drugs. There's people who drink for the first time and end up in the hospital.
If you want to do it the smart way, just consult erowid.org and use a little common sense.
The post I replied to stated that a DXM OD is dangerous then mentions ketamine without stating its OD dangers giving it the appearance of a safe alternative.
You need much higher doses of dxm to get the psychedelic effects compared to ketamine. Ketamine is a pretty safe drug when used responsibly and occasionally, especially because you can slowly dose to the required intensity and it wears off quickly. Like any drug there are risks involved. Most notably psychosis and addiction. Apart from the immediate toxicity, of course. And that is very much higher for dxm in my experience. It's also a very weird trip and it took me a while (2 weeks) for my brain to fully settle again, whereas with ketamine I would bounce right back feeling better than ever, which of course increases its addiction potential. What we didn't know back then is that ketamine is actual toxic to the kidneys in prolonged high doses, so yes, be careful.
>I can't find the info but there was someone in the tech industry who accidentally overdosed and suffered a two year bout of severe debilitating depression culminating in suicide.
This is a story about mental health, psychedelics, psychology and the mind. It is a story about the joy of family, the joy of friends, the joy of being in love, and the joy of doing scientific research. It is a story about life, the world, and how amazing they both are.
After 18 months of intolerable torture, and after many months of consideration I have decided to end my life.</i>"
Ah indeed, I misremembered. That is also a very similar compound, identical structure but more saturated carbon bonds (non-aromatic ring). It's always delightfully silly to get your own correction corrected!
> If you walk down the cold and flu aisle at CVS and start looking closely at labels, you will count about 100 products and around six active ingredients
It's so utterly ridiculous how much space the Cold and Flu section of the medicine aisle takes for no reason at all.
And the whole thing about combining so many medications is just silly, especially the marketing for it. "Why take 3 medications for your cold symptoms when you can take just this one?" then gets countered with "Why take a cold medication that has ingredients for symptoms you don't have?"
IMO, DayQuil should never have existed simply for the reasons the article mentions: It leads to people being unaware of what they're taking. Yeah, the label is right there, but you gotta consider the lowest common denominator when selling things to the general public.
Until the late 1960s, codeine was considered the definitive over-the-counter cough medicine. It worked well. Maybe a little too well, because it was easy to get addicted to it. So the FDA banned it from OTC sales and dextromethorphan was substituted. Which brings us to today.
In the pharmacy in the US there are about 1000 over the counter drugs made if varios combinaciones of about 50 ingredients. Many of them contain acetaminophen. I can see how accidental liver damage can occur.
On DayQuil specifically, the only time I took it I was about as useful as someone stoned. I would have been better off and less dangerous to society if I had just taken rest..
As far as pain management I personally find acetaminophen does nothing for pain and only helps with fever. Similar ibuprofen only helps me with sever muscle pain associated with over exertion or bruising.
Having unfortunately suffered from nerve pain I can say the pain relief opiates provide, even at low levels, is on a whole different level. My experience is that taking them only for pain, when it is unbearable, was not addictive and made pain on the level of I need to go to the hospital bearable.
Just bring back ephedrine and pseudoephedrine! Nobody cares if a few enterprising nerds could cook it into methamphetamine! Oh my gawd someone might experience some unapproved, unrentiered joy! Send in the SWAT teams! This is what the War on Drugs™ gets us.
It should be legal. Caveat Emptor applies always. to everything. I'd rather have choices available in a marketplace rather than a nanny state stifling innovation through its own incompetence.
in the specific case of this article, "innovation" and "choice" are exactly the problem here. we know what works well - they're well-studied generic compounds. there's no social reason whatsoever that "dayquil" or "tylenol" or "sudafed" should exist when generics are readily available and clearly labeled.
With computerized registers and loyalty programs, it is way too easy to profile. I am not too worried about looking like I chug too much aspirin; it's the further out assumptions or speculations that models (like I myself once designed or otherwise) might make that I worry about, that would not require proof, and would not be documented somewhere. I mean there is also stuff "like" congestion pricing to worry about, and maybe that would work better to make people think about liberties and tech. Dunno.
This should be divided into three parts: marketing and selling people questionable combo drugs at insane cost (bad), the case of oral phenylephrine (idiotic + bad), and the efficacy of the other drugs in the mix (guaifanesin, etc) (unclear).
The more general deeply-entrenched golden goose here is branding, which applies to much more than OTC medicines. Make it so the active ingredients have to be listed prominently - the largest text on the front of the product package - and these concerns diminish greatly.
It would also fix the homeopathic snake oil as well, which has started showing up as options in previously-reputable medicine aisles. So at any rate, be on guard if you don't want to end up accidentally buying a bottle of water plus flavoring in your cold-addled state.
Making the active ingredients prominent is a good start but not sufficient. As the article points out, the word "phenylephrine" looks/sounds similar enough to "pseudoephedrine" to broadly fool the population.
That's why I said "diminish greatly" rather than solve - by doing something basically everybody should be able to agree on regardless if you think a given product should be on the market or not.
They should probably have to split up large words with dashes or even spaces "phenyl-ephrine" "psuedo-ephedrine". Maybe even "phenyl-eph-rine" "psuedo-eph-edrine". One authoritative list published by the FDA (they already keep a list of what's allowed to be sold OTC in the first place, right?) of how the active ingredient names have to be distinctly stylized to best inform.
It just seems like a quick patch that doesn't acknowledge or address the root cause: that the FDA is supposed to be regulating both safety and effectiveness, but it is largely abdicating the "effectiveness" role over to companies' marketing departments. If corporate marketing can convince the public that the serpensoleum drug works, then that's enough to put it in a shiny box in the drug store.
The problem is that you're butting up against the highly profitable cult of ignorance. For instance if something isn't intended to actually treat a disease, then it's basically exempt from FDA regulation as it's a "supplement". Then the seller is free to imply whatever they want, regardless of efficacy.
I'm advocating something that ideally can sit in the middle of the two philosophical/regulatory regimes with more people on board - being able to buy whatever you want, but regulation aimed at preventing companies "innovating" by simply confusing the market. And while I'm sympathetic to extending the scientific-maximalist approach onto the "supplement" industry that is currently harboring copious amounts of straight up fraud, I would also say that throwing down such a gauntlet doesn't seem like a great idea at the moment!
Yea don't even get me started on the "supplements" loophole. There are so many problems to solve. Making even small amount of progress towards fixing anything would be miraculous, given the economic forces wanting to make the problems even worse.
The author has a point about dextromethorphan and phenylephrine. However, he does guaifenisin dirty:
>You’ll also find lots of cough medication with guaifenesin, which has similarly thin scientific backing.
He links ( https://pubmed.ncbi.nlm.nih.gov/24003241/ ) which shows that guaifenisin had no measurable effect on sputum volume or consistency (p = 0.12 for volume). But there are other studies with broader outcome measures which show positive effects:
>The pilot study was a randomized, double-blind study where patients were dosed with either 1200 mg extended-release guaifenesin (n = 188) or placebo (n = 190), every 12 hours for 7 days [...]
>Subjective measures of efficacy at Day 4 showed the most prominent difference between treatment groups, in favor of guaifenesin.
>The DCPD assessment of symptoms also indicated advantages for ER guaifenesin over placebo for the between-day changes from baseline in response to the questions “Over the last 24 hours how often did your phlegm prevent you from going to public places?” (Day 2; p = 0.0016) and “Over the last 24 hours, how difficult was it for you to bring up phlegm?” (Day 5; p = 0.0070).
G tends to do well in subjective (symptomatic) assessments, even when subjects are blinded, but poorly in objective assessments. However, this isn't enough to condemn it.
The real reason that all these drugs are mixed together seemingly willy-nilly is actually to prevent people from overdosing and going wild with a singular drug, or cooking up more potent mixtures from it. Guaifenesin in particular has been mixed with decongestants, for the primary purpose of preventing use as a precursor.
If they sold these chemicals as singular treatments then the abuse would go through the roof. The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this.
I injured my legs, then on top of it, had a minor cold recently, and finally grabbed a bottle of Coricidin HBP out of desperation. I have also been stocking up on 0.0% beers. Between doses of the former and bottles of the latter, I managed to get some great-quality sleep and rest.
The other thing to notice about the Cold and Flu section of your pharmacy is that most all the treatments are supposed to relieve congestion, clear phlegm, and serve as an expectorant, such as all the cough drops with lemon, or menthol. If you are a lifelong smoker with a productive cough, this is great. That includes habitual pharmacy patrons who've always purchased their cigarettes and cigarilloes right there at CVS, next to the candy aisle and the booze aisle.
If you live in a desert and/or suffer from chronic E-N-T dryness and dry coughs, then these treatments will make your life a living hell and must be avoided at all costs. Think about it.
All you need to do is read the warnings and follow the instructions. It is not difficult. It does require literacy and intelligence, but a caregiver or the patient themselves should not have difficulty with the terminating the drug type and the dosage limits. If they do have difficulty, just see a nurse or a PCP. It's not rocket science!
All these overdoses are happening because people do not read the warnings and they do not follow the instructions; and if they cannot understand the warnings and if they cannot follow the instructions, nor even consult a professional, then perhaps they deserve an overdose?
Dextromethorphan is useful. The problem is solely with oral phenylephrine being sold for something that it does not work for. The precise suggestion then is for oral phenylephrine to not be sold for such indications.
> Why do we even have combination over-the-counter products at all?
In America? No idea. In the UK it's because they sell codeine+tylenol OTC, and they want it to poison you if you try and get a codeine buzz from it. Incredibly this is true.
No it should not be, but not because of the dextromethorphan or the phenylephrine being ineffective. By far the biggest issue is the acetaminophen it contains, which it isn't super obvious about, and frequently leads to acetaminophen overdoses. The vast majority of acetaminophen overdoses occur because people combined different medicines containing it (like DayQuil and Tylenol) without realizing they were taking the same thing multiple times. Its a completely preventable cause of liver failure and we should not be making cocktails with it that don't clearly show exactly what they are.
Please no. We need to be going the other way on that trend: converting things which won't easily outright kill/maim you (and dare I say, even potentially addictive ones) at normal doses from Rx to OTC! Acetaminophen is one of the few cheap, easy, and working products on the shelf!
A concern with OTC drugs is specifically that they won't be taken at normal doses. People confuse brand names and drug names, and don't realize they are taking more than the reccomended amount. This is especially problematic with combination drugs.
Doesn't OTC specifically mean the ones that can't just be on the shelf ? Where you do not need a prescription but a pharmacist still has to be asked to hand it to you "over the counter" ?
There are people who don't know that Tylenol and acetaminophen are the same thing. That is not a reason for us to make everyone's quality of life and access to healthcare worse because some people are ignorant.
The desire to nanny-state things to the lowest common denominator is ruining everything, and it's a major driver for various problems all the way to the housing crisis and the cost of healthcare in the first place.
OTC drugs should be both available and regulated to be sold in such a way to minimize harm to people who use it.
Honestly, combination drugs are out of fucking control. Some people don't know Advil is ibuprofin. Some people think all Advil is ibuprofin. Both are wrong!
It used to be true that doctors could tell people that it was okay to take [X] brand drug with [Y] brand drug but anymore, there are a half dozen formulations of each in varying combinations on the shelf and half of them have some of the same ingredients. Basically every brand has a "fuck it lets just mix everything together, flu" version on the shelf now.
I agree that drugs should be regulated, but that regulation should be primarily about ensuring that they are effective, safe when taken as instructed, and that they contain the ingredients they say that they do and don't contain ingredients that aren't listed.
It is not the government's responsibility, nor should it be, to try to solve the fact that someone can do something stupid with medication and harm themselves. Medication, by its very nature, interacts with and changes your body: that's the entire point. There is no way for something to be effective and also impossible to abuse or misuse. Regulating drug safety should always be based on following the instructions for how to use that drug.
That's not to say we can't do more the educate people, but ignorance should not lead to inaccessibility. There are tens of millions of people in this country that are fully capable of reading a box and following instructions and they should not have to live a worse quality of life because some people are not willing or able to do so.
We don't have to prevent people from being stupid, but we do want to mitigate it, because medicine is supposed to be accessible to everyone, and part of the safety profile of a medication plainly is the ability for it to be administered safely.
> safe when taken as instructed
Part of that means that instructions and ingredients should be clear.
I am educated and knowledgeable and a trip to the pharmacy is more complicated than it needs to be. You damn near have to pick up every damn box to see what is actually in things, if your pharmacy doesn't have things locked up, and half of the time I ask a pharmacist for pseudoephedrine even they give me combination drugs instead.
I don't think we should take anything off the shelf (except oral phenylephrine). If anything, I think we should make more drugs available OTC.
I blame doctors and nurses. At least the ones I personally know tell patients "Advil" and "Tylenol" and never mention ibuprofen or acetaminophen. Actually, it's true for pretty much all OTC medications - they just use the branded names Immodium, not loperamide. Claritin. Zyrtec. Benadryl. Dramamine (drowsy/non-drowsy). The list goes on.
When asked, they always tell me one of two things:
1. They were trained on these names instead of the ingredient (scary!)
2. They want the "easiest" thing for the patients (i.e. so they don't have to look at the label).
Eh, from what I gather from the healthcare professionals I know, I think that is mostly doctors adapting to the language accessible to their clientele. I don’t think it’s about being “easy” as much as it is “doable”. I’ve heard that it’s often hard to even get an accurate list of current medications out of a person, brand name or not.
Now I suppose ibuprofen/acetaminophen is common enough that people may be familiar with it, but I could see how in a clinical setting defaulting to brand names is the only reasonable default for accessibility.
I’ve had multiple doctors remark specifically about my use of generic drug name in discussion. “So I presume you’re a little bit familiar already”, etc.
We can do both - and already do. Ibuprofen is perfectly fine for non prescription. Super dose ibuprofen pills are prescription.
And then there's OTC drugs which are sort of in a weird middle area - and where some of these I feel personally might work best. Make them easily accessible to anyone without a prescription but at least a pharmacist has to hand it to you. They are the experts at dosing and what combinations of drugs are safe after all !
It should be replaced with Dipyrone, which is much safer and more effective, but was restricted in the 70s in the US and parts of Europe.
In fact, it’s so effective against pain and fever, it keeps doctors from having to resort to prescribing opioids. Countries that haven’t restricted its use do not have nearly the same problem with opioid abuse.
It makes me wonder if its continued restriction is motivated by profits off the opioid crisis, rather than patient safety.
All drugs should be legal, full stop. And I should be able to get medical drugs on my own, without a permission slip from a doctor I have to convince.
Drug prohibition has caused magnitudes more harm than decriminalization and legalization.
And part of this article is about claims from what is likely inert or mild effect at best. Remember, we used to have amphetamines, pseudoephedrine, and much more potent drugs to alleviate colds and such. But because of the forever-drug-war , we're stuck with substandard crap, and everything good gatekept by doctors.
Yes, and the question lends itself to control (or lack of) by relevant medical "authorities".
I honestly do not trust somebody with a doctor license who I talked to for 7 minutes out of 259200 minutes (6 months).
For example, when I went on a camping trip, I got bit by 15 ticks. After I got back, went to doc for 15 day doxycyclene, gold standard. And its cheap, like $15. NOPE, fucker wanted the ticks in a bag to grind up and waste a $400 Lyme test. And that test is only 60% accurate, tons of false negatives.
If I could have, I would have bought doxy, scaled it to my weight, and did the 15 day run.
But nope. I ended up getting the second recommended, amoxicilian as "fish antibiotics".
One of the reasons doxycyclene is so effective is because it's less overprescribed. Antibiotic resistance is a real thing, and the day we run out of viable ones is going to be ugly. Having a gatekeeper isn't a bad idea.
To add to this, despite all efforts to educate people, many STILL don't know that antibiotics don't work against viruses and will want one when dealing with a cold or other viral infection.
If we let antibiotics be over-the-counter, every damn infectious bacteria will be a super-strain in a year.
Antibiotics are routinely given to all of their farm animals as part of their food, for prophylaxis. But allowing humans to buy when they're sick is somehow the super-strain-end-of-times??
Except bacteria can be attacked whenever, the sooner the better.
Antivirals need a rapid and early timeframe to work. Getting a fucking doctor to say yes is almost always too long, and you missed your treatment window. That is unless you go the ER, and lucky to not get shoved aside. Then pay $$$$$
Those are two separate issues and we obviously should not be just giving feedstock and animals antibiotics constantly. That's no good for anyone.
Maybe the better solution is that the government should be paying for the Lyme test as a public health measure. Knowing which areas it is spreading too is extremely important.
And on the flip side I know someone whose father got Lyme but didn't know it for years - he was not very symptomatic at first and ended up with major nerve damage. Not one to mess around with
That's why I went amoxycillan. I can buy medical grade as "fish antibiotics".
Alpha-gal wasn't prevalent then. It was primarily Lyme and rocky mountain spotted fever. Doxy and amox is the gold/silver standard for both.
I don't need a fucking doctor to tell me I was bitten by 15 ticks. I removed them myself with a tick puller. I don't need to he told that I probably got a disease from at least 1 of them. So yeah, its either going to cure the infection before it starts up, or is a prophylactic to prevent it.
And in more sane countries, I can go in a pharmacy, tell the pharmacist and reasonablely and cheaply treat myself. US? Not so much.
But, I can smoke delta8, tobacco, and drink until my lungs and liver give out. But how dare I take some antibiotics when I need them.
You make a good argument for expanded use for true "OTC" meds (Over the Counter - as in can't be sold on the shelf in bulk but has to be given by an actual Pharmacist).
I generally agree, but it seems darkly comical to be worried about gatekeeping antibiotics as a tick disease prophylactic when the vast majority of antibiotics are applied non-therapeutically to farm animals.
Read the article. It doesn’t even ask if dextromethorphan and phenylephrine should be illegal. It asks if intentionally misleading consumers about their efficacy should be.
The article is not about "should people be allowed to buy this product because it's potentially dangerous/addictive/etc" but "Should the company be allowed to sell this product because it consists of acetaminophen plus two useless ingredients and is basically a scam".
What is the argument for legalizing drugs that are contraindicated for all medical purposes, are toxic, and have a high addictive potential? How does it benefit me or society if my neighbor is permitted to choose to basically roll the dice on afflicting themselves with a debilitating chronic illness (severe addiction)? If I don’t want to do illegal drugs why would I ant to support this?
I went to a southeast asian country and got a staph infection. I walked down to the pharmacy, asked the pharmastst for a topical and an oral antibiotic. 3 days later i was healed, continued the course the rest of the week and that was it. $12 dollars american.
I got another staph infection previously in the united states. Needed to go to a doc in the box who misdiagnosed it. A few days went by and i needed to go to another doc in the box who gave me topical and trued to give me a steroid shot. Needless to say it progressed and turned into fullblown MRSA which required admitance and a IV antibiotic. Extremely painful. I don't have the ability to add the costs but north of $10k easily.
I'm sorry that happened to you. Sincerely. That sounds incredibly frustrating, painful, and scary.
I think your maximalist conclusion of "drugs should be legalized" might have some second-order effects that might be net worse for society, though. Addiction, misuse, MRSA, overdoses, etc.
Legal status of these chemicals is not going to prevent your neighbor from getting them and becoming addicted.
Legal status (along with stigma associated with it) does prevent them from getting help before completely crashing out. It has the additional side effect of whatever portion of their lives they come out of it with being completely destroyed by the legal process. You know, because chronic illness obviously deserves punishment.
So I guess the real question is: what is the goal? Help chronic illness, or punish people that do things we don't like?
Also, don't we already have laws for literally all the bad things someone can do while addicted? If not, then why is it bad just because they are suffering from a chronic illness?
Agree with you. It is a collateral consequence of the War on Drugs™ that everything good and effective is getting locked behind a $50-$200 doctor's visit for a 'scrip. This scam medicine problem could be helped if a bunch of substances were moved out of Rx and back to OTC. The nanny state will continue to grow to meet people's definitions on how much others should be warded.
The article kinda glossed over it, but one fact under-appreciated by the general public is just how dangerous acetaminophen overdoses can be.
Scientists often talk about the "therapeutic index" or "safety ratio" of a drug. It's the LD50 (dose at which 50% of recipients die) divided by the effective dose. Common hard drugs like heroin or methamphetamine have a safety ratio of about 6-10 [1]. "Soft" drugs like marijuana or LSD often have safety ratios of about 1000.
The safety ratio of acetaminophen is under 4. A typical dosing schedule for an adult is 4-6 500mg tablets within a 24 hour period [2], for a total of no more than 3g. 7g of acetaminophen can kill you, and 12g is likely to [3]. Acetaminophen is the leading cause of liver failure in the U.S, causing 50% of cases and 20% of transplants.
When they tell you "don't exceed 6 doses daily", they really mean it, and it's across all acetaminophen-containing products. The margin for error is narrower than heroin.
[1] http://politicsofsin.50megs.com/risk/Toxicity.Comparison_Add...
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC3585765/
[3] https://www.ncbi.nlm.nih.gov/books/NBK441917/
Thank you - this is correct and cannot be repeated enough, especially in the context of infant and child doses.
In most countries 4g is the upper limit and it is considered perfectly safe within that limit. So 8 500mg pills in 24 hours.
Yes. 4g is generally considered perfectly safe and is fairly commonplace dosing. 7g can kill you. Hence a therapeutic index of < 2.
This is why you have to be very, very careful. If you're doing 8 500mg Tylenol pills and then you also do 6 doses of DayQuil or Mucinex without realizing it's also acetaminophen, you can end up needing a liver transplant.
I wonder why it is not a more commonplace useage for suicides. Females seem to enjoy overdoes more, and men seem to enjoy violent ways. But female sucicides often "fails", seems like eating a box of Tylenols (here they come in 20 packs) would solve the "being alive" issue quite quick, no? Better not tip people off... :)
>end up needing a liver transplant
You won't get one nor should you get one if the reason is this.
Probably because most people realize that it’s a horribly unpleasant way to go about it?
It's a pretty terrible way to go. Death doesn't come immediately; you seem fine at first, and then about 3 days later you suffer intense abdominal pain and vomiting. At about 4 days you realize your liver is irreversibly shot and you're a dead man walking unless you can get a liver transplant. Then you enter multi-organ failure as your body and brain shuts down.
Acetaminophen poisoning actually featured on two episodes of House, and one of them had the suicide plotline. In S05E11, "Joy to the World" they suspected an overweight teen OD'd on acetaminophen trying to kill herself, but the actual diagnosis was eclampsia from an undisclosed pregnancy. In S06E10, "Wilson", a friend of Wilson's suffers acetaminophen poisoning while trying to manage his back pain.
https://house.fandom.com/wiki/Joy_to_the_World
https://house.fandom.com/wiki/Wilson_(episode)
Calling women females and men men in the same sentence is really something. Same with the smiley face in a comment about suicide.
Intentionally overdosing on Tylenol gives you a day or so afterwards to panic and seek medical attention and probably live instead of dying a horrible death. More violent means do not give you any time to retroactively back out of it.
And, yes, in America at least, some lucky people do get liver transplants after acetaminophen overdoses, occasionally even intentional ones.
Acetaminophen should be treated with more caution in general. So many people have reacted with shock and upset when I told them that taking Tylenol (or anything with acetaminophen in it like Dayquil/Nyquil) while drinking can cause immediate liver damage.
Indeed.
I like beer quite a lot and have for a very long time, so acetaminophen is banned from my medicine cabinet.
Seems like the logical thing to ban from your stomach for the time periods you need acetaminophen is the beer, unless I'm missing something.
For a lot of us, Ibuprofen works just as well or better than Acetaminophen, so banning Acetaminophen is not much of a problem.
I am on a medication that's contraindicated with NSAIDs, but I made sure that a low dose of Ibuprofen was acceptable.
Ibuprofen is hard on the kidneys and stomach too. And bleeding/clotting issues.
Sooo ya :)
Better just stay off the beer hubby.
Remember, beer makes you fat also.
Wow, that's a really weird tone for a hackernews comment.
You don't know us, nor the scale of anything we do in our lives.
But thanks for the input, sweetlips!
No.
Even in the absence of beer, I'm not choosing acetaminophen. The juice isn't worth the squeeze.
Alcoholism, you're missing alcoholism.
>reacted with shock and upset when I told them that taking Tylenol (or anything with acetaminophen in it like Dayquil/Nyquil) while drinking can cause immediate liver damage.
Maybe your package needs to be clearer but here in Sweden it says to avoid taking with alcohol.
Or people cannot read anymore?
Most people grew up taking Tylenol as kids for various things and it was never a new medicine to them that they felt the need to read. Also, there's a huge difference between "don't take this with alcohol, it will make you more drowsy" and "even one beer with this will start fucking your liver up don't even think about it". I think people associate the latter with more intense medication than some OTC mild pain meds.
I didn’t know this until recently either. I grew up on a family where if there was pain, you just take tylenol to deal with it. We always followed the dosage timing and never had issues. So recently when my wife had some chronic pain I suggested taking tylenol but even after two days the pain would not go away and she went to ER. They did a blood check to see if they could find anything. They didn’t find the cause, just suspected food poisoning, but they found her liver enzymes were near dangerous levels. This was even with timing the dosages absed on instructions. Now I am super careful wtih Tylenol.
Not to chastise you or your wife, there is an actual "Liver Warning" on Tylenol Product labels. They warn against 4000mg/day or with alcohol consumption. It's not an on/off switch, the damage occurs on a ramp that achieves a critical point after so much consumption.
Saying this to encourage label reading and to refute those who might try to characterize your wife's experience as anecdotal. And for those who stop reading a page like this one, after the first paragraph that touts "no evidence": https://www.tylenolprofessional.com/safety-and-efficacy/safe... when at the bottom it reveals the Liver Warning.
It appears his wife took under that threshold and only for a few days. 4000mg is roughly 8-10 otc painkillers in a day (depending on the brand).
That said, everyone's physical ability to metabolise drugs is different. I might worry something else was wrong, or at least get a followup test done later, if her liver tox screen showed that, just to rule out another cause.
>or with alcohol consumption
This part is what a lot of people miss IME
People take alcohol and tylenol???
People need to read and think... I begin to wonder if I am some elite IQ intellect?
Here's one list of medicines containing alcohol: https://www.hpspmonitoring.com/Content/Oregon/Resources/Medi...
You don't have to be a special kind of dumbass to take, let's see, NyQuil when you're sick.
It doesn’t have to be concurrent to be harmful. You need decent spacing between the two. How do you think many people ride out hangovers?
Alcohol can actually be protective in a paracetamol overdose. Paracetamol itself isn't relatively dangerous, the metabolic product created by the liver is.
Alcohol use acutely reduces the levels of these enzymes which convert paracetamol into it's toxic byproduct as ethanol preferentially binds to the same enzyme for it's own metabolism. Therefore, acute alcohol consumption can reduce the harmful effects of paracetamol.
The reverse is true for overdose in the context of chronic alcohol use, when the liver adapts to long-term alcohol exposure by increasing the levels of enzymes, therefore rapidly metabolising paracetamol into it's toxic byproduct and worsening harm.
Source: doctor
As a side comment, the lack of medical knowledge displayed in HN threads paired with the absolute confidence some verdicts are delivered with is worrying, and something I thought this forum would be better at than other sites (looking at you, reddit). Paracetamol and NSAIDs (including ibuprofens) are safe drugs if taken to the package directions. Some of the ideas shared in this thread about taking one over the other, or not taking one ever etc, are not rational. Please consult your doctor if you are worried about your particular situation, but generally OTC medicines are not dangerous if taken to the package instructions.
Accidental overdoses of paracetamol are exceeding rare, but intentional ones are common.
Yup, did some digging on Tylenol/acetaminophen before I had some surgery, and it's a real danger. Oddly enough, it seems downing a whole bottle won't (usually) end your life as it gets mostly directly eliminated rather than metabolized, but taking just around 2-3X the high-strength dose sustained over 3-4 days can destroy your liver — at that point, you have about six weeks unless they find a new liver for you (obviously, there's wide variance in actual dosages and reactions, but that was the general median). For someone with serious acute pain, who doesn't know this hazard, it'd be pretty easy to self-medicate and load up and lose track...
OTOH Ibuprofein, doesn't have anything like that deadly profile, but enough gut and other issues.
Ibuprofen isn’t much better, unfortunately.
The index for ibuprofen is waaaaay better than DayQuil
Would appreciate it if you could elaborate. Someone close to me takes a lot of ibuprofen.
Not a doctor, this is how it was explained to me by my doctor.
Paracetamol/acetaminophen has a therapeutic dose that is uncomfortably close to the fatal dose, but is otherwise as safe as any drug can possibly be. So long as you don’t take too much.
Ibuprofen is also relatively safe, but it has a number of ways that it can do damage even at the therapeutic dose, if you are taking it all the time.
The main one is that it depletes your mucus lining in your stomach, which can lead to bleeding and death (used to be a big problem here in Aus when codeine combined pills were available without prescription). It’s also harder on your kidneys and liver.
Completely fine at therapeutic doses taken as per instructions and not mixed with alcohol. But having it every day is going to be much worse for you than the paracetamol and almost certainly lead to health problems.
https://asteriskmag.com/issues/14/the-mystery-in-the-medicin...
The therapeutic index for ibuprofen is considerably better: it's around 10, fairly similar to alcohol. Accidental overdoses of ibuprofen are rare.
The main issue with ibuprofen is that it can have fairly annoying (but non-life-threatening) side effects like stomach upset and GI bleeds even with normal dosing.
It can also cause kidney damage which can be life threatening, especially when you’re dehydrated (which is pretty common after drinking); tylenol is a lot safer than ibuprofin when used as directed, it only becomes dangerous when glutathione is depleted (at which point it becomes a lot more dangerous, which is why you should never drink while taking Tylenol)
> The main issue with ibuprofen is that it can have fairly annoying (but non-life-threatening) side effects like stomach upset and GI bleeds even with normal dosing.
Those side effects are more problematic when used chronically. This is when acetaminophen shines, because it has virtually no side effects at all when used as directed.
I simply do not take acetaminophen because of this risk.
Ibuprofen isn't easy on the kidneys either so I'd keep an eye on that if you don't
>4-6 500mg tablets within a 24 hour period
On top of that daily use brings it down to 3-5, preferably 4 or less of those a day. And they last less than 6 hours.
The 8h extended release is 650mg a tablet, and you can have 3-4 a day daily. And if you have any experience taking them you can feel the first half of the extended dose wear off before the extended one kicks in, which leads to basically NEEDING 4 a day, and staggered start times.
Therapeutic index of fentanyl is much higher than heroin or morphine, but I don’t think people really think that it makes it safer.
The folks I know who've been prescribed fentanyl weren't particularly upset about it. It is very potent, and thus measuring the dose properly is very important, but it's not particularly fussy beyond that.
The people you know may be obtaining it from less reliable apothecaries; that can be a real issue.
Reminds me of a comment I saw on a drug chemist's blog decades ago where they were talking about ACE inhibitors for Parkinsons' Disease - by dicking around with nerve conductivity and acetylcholine reuptake you could "boost" the failing nerves a bit, presumably until they fail altogether.
Anyway much of the discussion was on how hard it is to make suitable drugs, and someone said "We actually have some fairly inexpensive, reliable, and well-characterised ACE inhibitors with a nice long half-life and known efficacy, but the therapeutic window of nerve gas is pretty narrow..."
I'm grateful for you mentioning this. I grew up with ibuprofen as my default painkiller without really thinking of it too much but am about to do PRP which requires no NSAIDs for a week prior and 3 months after - but they do allow/recommend Tylenol as an alternative, especially for the post-procedure pain. I just would've assumed it was a sufficiently good substitute that I could treat them equivalently but now i know to be very careful about tracking how many I'm taking each day
Nsaids are dangerous in all sorts of other ways, kidney, gut lining. Pain medications that work and are safe seem to all be highly addictive.
I was in the hospital on Thanksgiving Day last year. I received 8 diagnoses at that time, including "Diabetic Hypertension" and "Metabolic Acidosis" and E. coli infection, and Hyponatremia.
They treated me with an antibiotic, a potassium-rich saline drip and acetaminophen. Yeah that's all they put in my orders.
The thing that pissed me off so much, firstly they insisted on calling it "Tylenol" when it was not, in fact, brand-name Tylenol but generic acetaminophen (even if they could charge $$$ per pill on it) and also that they basically refused to administer it at a rate that would keep my exquisite headache pain at bay. I was literally screaming and moaning through the entire night and day. (Actually, I was wearing one of those radio-transmitting heart monitors, and mostly the screams happened when I moved suddenly, and the electrodes tore at my chest hair...) But my head was also constantly throbbing, and that's how I knew to go to the hospital in the first place.
The nurses could tell me how long to wait between doses, but they couldn't explain to me how to know that interval, given no clocks and no written-down time of dosing. So basically I had to keep guessing throughout my sleepless nights. And they didn't really inform me of a way to just put it on automatic dosing like a normal hospital would have a schedule for.
I really didn't want acetaminophen at all; I don't like it much, and it really hasn't ever relieved any pain I've ever taken it for. My parents chomped so much of it, made me sick just watching them. I lived through the cyanide adulteration episodes and though unsolved, that guy wasn't wrong.
When I finally got to visit a sane PCP after all this madness, I told him I was taking big doses of Bayer Aspirin, and he said that's fine; just follow instructions and heed warnings, and he also warned me: for Heaven's sake don't ever take any acetaminophen, because it would seriously harm my liver!!!
It's not under appreciated in the UK and Ireland where you can only buy tiny quantities of it at a time. Cash registers will literally refuse to process a sale if there is more than one pack of acetaminophen in your groceries.
On the plus side you can still buy psuedo OTC.
Safety ratio as you present it is a bit misleading, numbers for hard/soft drugs are usually for a single dose.
It's a good darwin effect clearer/cleaner I think.
Can't read or follow simple instructions? Well maybe modern society is not for you anymore.
Replacing Aspirin with Acetaminophen/Paracetamol was absurd. Reyes’s syndrome was nowhere as prevalent as acetaminophen overdoses, which are a horrible way to go.
There is an antidote available for acetaminophen overdose, but it's only available in the hospital. So if you think you took too much, get to a hospital quickly before your liver suffers permanent damage.
Untreated acetaminophen overdose is an extremely unpleasant way to die.
Huh, looked this up as Acetaminophen is one of the only OTC painkillers I can take. I thought NAC (N-Acetyl Cysteine) sounded familiar and low and behold I already have some I've purchased as a supplement.
Anyone can buy this stuff, no need to make it sound like it's some controlled substance. I will say if I take to much Acetaminophen I'll just head to the hospital instead of winging it!
I was trying to keep it simple. Yes you can buy n-acetylcysteine but OTC versions can vary in purity and dosage and it's not the only treatment you might need. With an acetaminophen OD you really want to be in a hospital.
The safety ratios listed in reference [1] are exaggerated, as can be determined by the following qualification: "The majority of published reports of acute lethal toxicity indicate that the decedent used a co-intoxicant (most often alcohol)."
The vast majority of so-called drug overdoses are due to polydrug intoxication. It's much harder to die by consuming a single substance. This is clear from the statistics of the few jurisdictions that report all substances in the blood in coroner's reports. See, for example, the Scottish data from 2020 (https://www.drugsandalcohol.ie/34642/7/ndrdd_report.pdf ): "In 2020, almost all (96%) [drug-related deaths] occurred after the consumption of multiple substances."
I imagine painkillers are fairly commonly used for hangover headaches, and it’s surprisingly difficult to get guidance on how long after drinking it’s ok to take painkillers (presumably as it’s complicated) - perhaps instructions should be updated to not just say don’t take with alcohol, but don’t take within a day of alcohol?
Liver failure is the worst way to go, it's slow and painful. if someone accidentally takes too much you can give them activated charcoal before you get them to the ER to give them a better chance of not going through liver failure
Perhaps it's useful to know that NAC is the treatment for acetaminophen toxicity, should you happen to find yourself in the middle of a zombie apocalypse with a Tylenol ODed friend and a supplements isle handy but no readily available medical support. :D
There has been some suggestions that acetaminophen products should contain NAC to offset some of the toxic effects, but I dunno where they've gone-- there probably isn't any money in it to study it formally.
I try to make an effort to know what the treatment/antidote is for any hazardous substance in my home... things you hope you never need to know but are glad if you do.
This article uses the trick where you pick studies that support your argument and ignore all of the studies that disagree with it.
There are other studies where Dextromethorphan improves both objective and subjective measures of coughing: https://pubmed.ncbi.nlm.nih.gov/37232330/
They also picked a study that shows honey outperforming Dextromethorphan but ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.
There are so many studies and papers published now that you can find both positive and negative results for just about anything. When someone starts pulling up singular random links to papers you should be suspicious. Be even more suspicious when someone is calling for bans or regulations based on those individually selected papers
> There are so many studies and papers published now that you can find both positive and negative results for just about anything.
Doesn’t that suggest that the effect overall is neutral?
You can find positive and negative results for everything.
If that implies the effect is neutral, then by extension that means nothing works at all.
No, you can't just "average" different studies and I'm not sure what "neutral" means in the context of some studies showing a benefit and others not showing a benefit.
Only if you assume that all studies are valid and accurate. And even then you are drawing the wrong conclusion -- if everything is "neutral" then that means that all the positive studies are wrong and all the negative studies are correct. (You seem to have erroneously assumed that a negative study means that something is bad for you.)
Also, the very claim that there are positive and negative studies for everything is handwavy nonsense. There might 100 studies, all of which agree except for one outlier ... what does that "suggest" to you?
> ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.
To be fair, you're doing pretty much the same by claiming these studies exist without proof.
An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself, and similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.
> An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself,
Auvelity is interesting, but the exact mechanism of action is not very clear.
Auvelity is a combination of two drugs: Dextromethorphan and Bupropion. Bupropion, aka Wellbutrin, is an antidepressant by itself. In Auvelity it helps alter how Dextromethorphan is processed by the body, but we can't rule out that it contributes to the antidpressant effect. I mean it's literally an antidepressant.
Dextromethorphan has a lot of interactions and gets a lot of comparisons to ketamine because it has NMDA affinity, but if you look at the table of receptors it interacts with the serotonin receptor is one of the strongest interactions. It is a potent serotonin reuptake inhibitor, which is also known to have antidepressant effects. It also has some sigma receptor interactions which might be doing something significant.
The NMDA interactions get all of the attention because if you put "ketamine" in the headline you get a lot more attention, but NMDA may be much lower on the list or even negligible for this combo.
This is straying a bit from the original post, but agreed, NMDA antagonists and related compounds effecting glutaminergic tone are showing promising directions.
N=1, I've had very positive experiences with DIY Auvelity, using 150mg Buproprion XR that I'm RX'ed with 60mg OTC DXM-only tablets.
> … similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.
Should read “NMDA receptor antagonists _may_ give rise to treatments that _may help prevent or ameliorate the symptoms_ of Alzheimer’s.
Nobody even knows how Alzheimer’s works at all — like most diseases it’s a description of some detectable symptoms, some of which could even turn out to be the body defending itself.
Thus compounds that may have a mechanism of action that affects some concomitant, visible symptoms might potentially be useful.
The use of definitive sentences about unknown results is how we end up with wellness and some “biohacking” nonsense.
They're referring to Memantine, an NMDA antagonist that has been approved for treating symptoms of Alzheimer's for over 20 years.
Haven't heard of Alzheimer's. What kind of use is necessary ? I would assume something like an ultra low dose but daily thing ?
Memantine https://medlineplus.gov/druginfo/meds/a604006.html
In my subjective experience, Dextromethorphan (DXM, as the robo-trippers call it) does almost nothing for me, in the 1-5% range
The only cold and cough medicine that really truly works is the over-the-counter stuff, pseudoephedrine, works amazing for me. I usually pick up a box of the stuff when school starts in the fall and I go through half a box of it by the following summer.
Pseudoephedrine is a decongestant to relieve the nasal/sinus congestion.
If it helps with your coughing, it’s because it’s stopping the postnasal drip, not suppressing the cough as DXM would by shutting down the cough reflex.
Two different, but very similar use cases. DXM is a god-send in the appropriate time.
DXM may or may not suppress coughing relative to placebo - the study cited here appears to be have been written entirely by authors from drug companies, so perhaps there is some bias. Here's a meta analysis that favors honey over DXM https://pubmed.ncbi.nlm.nih.gov/32817011/, the original study that kicked off this idea that also favors honey https://pubmed.ncbi.nlm.nih.gov/18056558/, and a different meta analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC6513626/ which found little or no difference between honey and DXM. Whether its effective or not, to me there doesn't seem to be compelling evidence that it is more effective than honey.
It's funny that TFA seems to use the comparison to honey as disparagement, rather than interpret the same information as an endorsement of the helpfulness of honey.
I think the point is honey is known as a home remedy, may already be in your house and is available at a much lower price (farmer’s markets and woo merchants possibly excepted).
Honey is also well established in medicine, especially in wound and infection management. I'm not sure of how much clinical evidence supports cough suppression, but it not huge leap to suspect that it could be a second order effect of its antibacterial properties, like in bacterial bronchitis.
It's worth nothing that all of the studies you linked were performed only on children. It is entirely plausible that DXM is effective in adults but not children because of the difference in dosage or measurement (studies on children often rely on parental surveys).
Are you sure you posted the right paper? That paper appears to present a clinically insignificant outcome for DXM in children.
I think it's perfectly reasonable to contest the research summary this article is providing. All science-based articles on interesting topics are going to be like that. But you're writing your comment as if they took a flyer on DXM, and the research consensus is in fact that DXM is not effective. It's not as bad as phenylephrine (it has detectable, if immaterial, impact in adults), but it's pretty bad.
The point of the article, of course, isn't that Dayquil should be illegal because it's dangerous; it's that it doesn't work. Having spent an unreasonable amount of time in HN pseudoephedrine threads, I think the broad consensus of this site is that phenylephrine should be taken off the shelves.
Phenylephrine was the replacement that doesn't really work but is non (or less) stimulating right ?
From what I remember it was actually quite effective topically but not through pill form. Could be wrong.
Also makes me wonder if there's an alternative function to DXM for people with colds (maybe it makes them feel better in other ways). Or it's just good marketing and associated with NyQuil having other drugs and people assuming DayQuil works
It's not that it's less stimulating, it's that pseudoephedrine basically is methamphetamine (the chemistry to reduce it to meth is truck-stop straightforward). But oral phenylephrine doesn't work at all.
The case against DXM is nowhere nearly as good as the case against phenylephrine; phenylephrine is a scam, and DXM is a drug everyone thought was the gold standard cough suppressant, but then serious studies knocked down its effectiveness.
I don't know if OP changed their link but the one currently in their post (https://pubmed.ncbi.nlm.nih.gov/37232330/) did find DXM to be effective:
"Using objective and subject assessment tools validated in pediatric populations, this study provided evidence of the antitussive efficacy of DXM in children, aged 6–11 years, at the current OTC monograph dose and labeled indication. Compared with placebo, DXM treatment reduced cough rates 21.0% over 24 h (primary endpoint) and 25.5% during daytime/awake hours. In addition, children treated with DXM reported greater reductions in cough severity and frequency in the mornings and afternoons over 3 days than children treated with placebo. These treatment effects were statistically significant despite the study not reaching its planned sample size and are medically relevant."
Also as I mentioned in another comment, the author of original article misrepresents the findings of their own citation. DXM was found to be effective in adults, just not children.
I work for a large agricultural company, in my part of it we sell fertilizer, chemical, and agronomic services. As part of this, we end up putting out a lot of trials so we can actually say something true instead of “buy our stuff it’s great I promise ;)”
One of my favorite slides is when we compiled dozens of trials on something that’s basically a nitrogen fertilizer, which as much of a guaranteed positive effect as you can get in agriculture. When compared in a graph most of the trials show an overwhelming effect on increasing yield over an untreated check, however there’s always a portion of the trials where the yield decreases compared to the (untreated) check.
Real life is extremely noisy for a multitude of circumstantial reasons that are either not practical or possible to control for, so a single trial is generally worth fuckall. It takes a lot of testing to see a consistent trend across them.
And, all of this, to avoid selling a little bit of the narcotic codeine. Which was technically permitted to be sold "behind the counter" without prescription, but was made Schedule II as part of cough syrup in the US not long ago. (It used to be Schedule III or IV when combined with homoatropine or promethazine).
100%
I wonder if the cost benefit analysis would show that this is still the best policy - I.e. are more people dying because of overdose of acetaminophen than would have from “behind the counter” + controlled acquisition of codeine products.
I would also imagine that the compliance / nationwide tracking is now much easier than when the legislation was initially conceived.
I think it was a mostly innocent bystander, because they decided to put codeine-combination painkillers (Vicodin, etc.) in schedule 2 but wrote it as just opiate combination medicines.
Codeine is still sold in many countries otc, as part of weak pain killer combination or as part of cough medicine.
Isn't it a bad sign that there are such varied results? Perhaps that's only a bad sign for the state of science, but I suspect it's also a bad sign for the effectiveness of the drug.
> This article uses the trick where you pick studies that support your argument and ignore all of the studies that disagree with it.
It's even worse than that, they appear not to have actually read the analysis they cited because two of the three studies on DXM found it was effective in adults. The same efficacy was not found in children but there are other very plausible explanations for this (difference in dosage and measurement techniques).
I was wondering about that. I've taken a number of different cold medications over the years, one active ingredient at a time, to check their effectiveness while sick. Phenylephrine, as widely reported, had zero effect. But Dextromethorphan seemed to work for my kids - give it to them, stopped coughing. Started coughing again 6 hours later, etc. n=1 and it's a 4 year old, but in one of those cases my results clearly matched the studies, and in the other it didn't, at least as reported by this article.
They wouldn't be selling the placebos if the real stuff were accessible. That's the real answer. The article mentions this but just accepts the inaccessiblity of the real thing as a given.
You used to be able to get Nyquil with real sudafed in it. That was the gold standard. It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos.
As an aside:
> In January 2011, the FDA set a maximum amount of acetaminophen that could be packaged in combination opioids like Vicodin or Percocet. The odds of hospitalization due to opioid-related acetaminophen toxicity plummeted.
Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.
> you'd overdose on the acetaminophen first
which is a much, much worse way to go, apparently
I’m not sure. Another explanation is that it is accessible, with a small amount of friction.
But then drug makers realize they can get more sales by selling a placebo that won’t have the friction.
> It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos.
What do you mean "morons"? Say I'm a normal person who doesn't habitually read magazine articles about drug effectiveness. How am I supposed to know that phenylephrine doesn't work? It's in the drug store and they're selling it as a decongestant; I have good reason to believe it will decongest my nose.
They also sell homeopathic drugs at that same store. So that at least should tip you off that not everything for sale can be trusted to be effective.
You don't need to know anything about the new stuff. You used to be able to get Sudafed; it worked. It was moved behind the counter for $REASONS. You've got enough to guess that the new stuff is some kind of inferior substitute and that you're only going to be able to get the real thing during pharmacy hours.
That was 20 years ago. Plenty of people never experienced the good Sudafed and have no idea it moved.
Then it's also been enough time to think about bringing it back again. That's my whole complaint about this article, is that it fails to reach the correct conclusion.
> The article mentions this but just accepts the inaccessiblity of the real thing as a given.
Reality is in fact a given. If you mean that the author is just fine with that reality, that's patently false.
> presumably because they can make more money from morons buying the placebos.
If that's your evaluation of everyone who lacks perfect information then you need to look in the mirror.
> You used to be able to get Sudafed; it worked. It was moved behind the counter for $REASONS. You've got enough to guess that the new stuff is some kind of inferior substitute and that you're only going to be able to get the real thing during pharmacy hours.
Grossly intellectually dishonest and downright unintelligent nonsense. Here's a fact that is inconvenient for this moronic argument: acetaminephen is readily available on the aisle. Things not being locked away does not imply that they have no effect. The more complex reality is actually discussed in TFA.
> Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.
The misspelling of "its" is the least egregious part of this nonsense.
"DXM does nothing", proceeds to link a study whose contents describe significant decreases in cough severity versus placebo.
I am convinced that many people ask LLM's "give me a citation URL" and don't bother to read it.
It's the same people who just googled a couple keywords and used that as a citation without reading the link, pre-AI.
I read the main section of the lit review linked by OP, and it didn't seem to come to any real conclusions.
> The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. [...] There is no good evidence for or against the effectiveness of OTC medicines in acute cough.
I just can't get super upset about this. Sure, OTC companies are duping customers with marketing, but what's new about that? As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product. Or ask my doctor/nurse/pharmacist what to do, if I can't be bothered to make the effort myself.
When I want to get irrationally angry about something in a department store, I'll walk over to the shampoos, which for some reason always have a whole entire aisle dedicated to a single product, when they all do literally the same exact thing, just with different scents and advertising budgets baked into the sticker price.
The reason to take this seriously is mentioned in the article: It is possible to OD on Tylenol, and when consumers miss the fact that these drugs are all just Tylenol+junk, they might believe they need to take several of them together to get well.
It's similar to the shampoo example (a huge selection of borderline useless products that make money purely because of marketing) but with a minor safety consideration, too.
Especially when the phenylephrine they took doesn't fix the problems the box promised to fix.
You are ignoring the existence of consumer protection, which is not unusual as it seems like regulatory bodies around the world (but especially in Europe) have forgotten the existence of consumer protection as well.
You ask what is new about this, and the answer is, in 2026 context: nothing, but compared to the year 2000: plenty. Regulators used to issue fines for this behavior, and for worst offenders, regulators used to shut them down. Lying to customers is illegal in most jurisdiction, it used to have consequences, and it should do so again.
Not totally accurate - there are a handful of foaming agents and surfactants that are mixed and matched to make shampoos, so really it's nearly the same except that no one has ever overdosed on applying too much sodium lauryl sulfate to their scalp.
and, you know, smells and such
i don't need to smell like grandma
You won't OD from sulfates in shampoo, but there are serious pros and cons to using them at all:
Sulfate-containing shampoos give you a deeper clean, but can dry out your scalp and make the color in color-treated hair fade. They're ideal for most people, especially if you don't wash your hair every day.
Sulfate-free shampoos are more gentle, but if you're supremely oily and/or don't wash your hair every day, you might not feel like they clean your hair well enough. Almost all "color-safe" shampoos are sulfate-free. They're ideal if you wash your hair daily and/or have a dry scalp... and they're a must if you dye your hair and want to keep the color looking nice!
> As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product.
But I don't have time to do that. I would rather have a retailer do that curation for me and provide me with effective high value products, and stand behind returns when they miss the mark. Then as a customer I can reward them for that value added work.
That's why Costco is great most of the time. Although they sometimes miss the mark with certain products they stock.
Additionally, if I'm buying cold medicine there's a really good chance I have a cold, and my ability and inclination to carefully analyze the ingredient list on a box of medicine smear-printed in 3pt sans will likely be diminished.
> As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product
That ignores over a century of law regarding drug safety and efficacy, and false advertising.
Not to mention it ignores reality. Most consumers have neither the time now knowledge to research everything they buy. That's one of the roles of government.
That's one of the important reasons - I thought - that we have the FDA in the first place. But these days I'm really not so sure. So many promising treatments rejected (or just stalled forever) while pointless placebos and worse get or remain approved.
So - why again does the FDA exist?
> why again does the FDA exist?
Is the argument that because the FDA may not be perfect, the public would be better off if it didn’t exist?
The FDA handles many thousands of product categories, tens of thousands of prescription drugs, etc. Which items (and how many total) are you referring to? For many of them might there be a reason available as to why they didn’t end up as you recommended?
Is there any country on earth without an FDA where you think the result is better than the US’s FDA?
> As the person holding the money, it's my job to look at what is effective and what the act ingredients are in any given product.
I wish the industry, our health organizations, and most people in general acted as though this were true.
The environment we live in in general is increasingly hostile to people who ask those questions, do their own research, and take responsibility for their health in this way. I have first hand experience having reversed chronic health conditions myself by doing my own research. What have and do others say about it? Everything: every person on the sidelines watching who have formed opinions about how things are supposed to be, and how doctors and nurses and pharmacists are supposed to know better, attack and ridicule me and others like me and when we "look at what is effective and what the active ingredients are" we are gaslit and told we can't possible understand and know that and to leave it to the experts. Of course the definition of expert is only ever tribal and is a moving trojan horse for whatever best allows the agenda of an industry to establish its control over you.
"hostile" how?
> When I want to get irrationally angry about something in a department store, I'll walk over to the shampoos, which for some reason always have a whole entire aisle dedicated to a single product, when they all do literally the same exact thing, just with different scents and advertising budgets baked into the sticker price.
Somewhere on a shampoo forum people are complaining that all computers do the same damn thing. I guess they probably just don't know what they're talking about.
> all computers do the same damn thing
They're all Turing machines
I think I have two opinions on this, from different angles.
I think the phenylephrine stuff is absolutely messed up. I personally had no idea it was ineffective, and I've bought medicine with that included, believing it would do what it says it does in the active ingredients list. To me, this is criminal, and these companies should be taken to court for outright lying about their products. (And the FDA should be slapped, hard, for not having done something about this by now.)
But when it comes to the CVS brand of acetaminophen costing $5 and the NyQuil brand costing $10, that's just... the result of normal market forces. I'm not a big "free markets" guy (because we don't, and can't, have truly free markets, and if we could and did, it would be a disaster), but it's pretty normal and common for people to pay more for something just because some company did a better job advertising it than their competitor did. That's just life.
It's funny, because when I go to a pharmacy, the store brand is usually shelved right next to the big-name brand, and there's even often a little card next to the store brand (or even printing directly on its packaging) that says "Compare ingredients to $BIG_NAME_BRAND!" And yet, people still buy the big name brand. ::shrug::, that's life.
>Sure, OTC companies are duping customers with marketing, but what's new about that
Downvoting you isn't enough. How about we stop trying to take advantage of people and extra every dollar from them in every possible way?
If someone buys an overpriced shampoo, it only negatively affects them, but the are costs to overall society if people suffer health issues, addiction, etc.
In the past, a lot of people unknowingly ended up addicted to morphine, as it turned out both companies and individual doctors were happy to mislead them about the contents of medication.
That shampoo opinion is a sure tell that you're not a woman with long hair (men with long hair tend to be less picky). My hair behaves noticeably differently with different shampoos/conditioners even within the same brand, and depending on your specific porosity, oiliness, texture, and humidity of the local climate, different hair care products and routines make a big difference if you have hair past chin length and want it to look healthy.
While I can appreciate the principle of not blindly trusting OTC medicine marketing, it is not realistic to expect every person to be highly competent in fully understanding their medical choices. It is far more reasonable to expect the companies marketing healthcare products to be honest to their customers.
If anything, you need honesty from healthcare companies in the first place if you're even going to begin making an informed decision. You're putting the cart before the horse here: people absolutely should be doing their own research before medicating themselves, but it is the OTC companies that obstruct that.
And, secondary to all of this, your analogy about shampoo is misinformed. Still, it is fitting for this scenario, but not in the way you intended. There are lots of different hair types, including ethnic hairstyles that require specific treatments. There are also a number of lifestyle choices that can change your hair treatment needs. As a result, the shampoo aisle actually is stocked with a wildly varying assortment of haircare choices, but actually figuring out what product works best for your needs can be challenging because it is walled behind layers of marketing nonsense that don't inform the consumer adequately on what makes each product different. This isn't much different than the problems in the medicine aisle.
It took a lot of secondhand research to find the ideal hair care product for my thick, curly hair that would mitigate the damage of thrice-weekly swimming in a chlorinated pool. I can assure you, not everything in the shampoo aisle is exactly the same. It was especially hard figuring this out as a man, when so many products are arbitrarily marketed to specific genders.
Yeah, intentionally misleading consumers should always be at least somewhat illegal. Sure caveat emptor, but consumers having accurate information is implied and a cornerstone of a competitive market.
"Caveat Emptor" and "Do your own research" is not a basis for a functional society. Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level. And letting marketing decide what counts as "accurate information" is just letting the fox guard the henhouse.
Counterpoint: 54% of adults read below a sixth-grade level because a society has been created to facilitate (and encourage) just that. Encouraging a population to rely on the thought processes of others is exactly what leads to over reliance on marketing.
> Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level
This is obvious, but thank you for putting it so succinctly. One has to wonder how much support for "do your own research" is driven by people who want to remain proudly-in-denial about their own inabilities.
It's no surprise that the political party/forces pushing on policies that result in worse education and literacy outcomes are the same ones who want "Buyer Beware" and "Do your own research" to be fundamental product regulatory principles.
In the US at least, medicine is so highly regulated/gate-kept that I don't think caveat emptor really applies. What's happening here is more like deception of the public by the state, or by groups granted special status by the state. It's morally somewhere between fraud and treason.
> So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen
this argument makes very little sense. Plenty of very potent drugs are in the single digit mg range in a tablet that weights hundreds of mg.
More importantly, as always, it is a problem of incentives. There is no strong, commercial entity focused on removing ineffective drugs from the market, but plenty of commercial pressure to keep them. The FDA has zero incentive to clean house. The magic hand of the market is supposed to be consumers choosing not to buy these drugs because they are ineffective, but for many reasons (choice, placebo effect, basic scientific literacy) this does not happen.
I don't know what the most effective entity is. I cannot personally imagine a commercial structure to support this, but perhaps one could be built.
The other ingredients would be doing other things: making the pill/drug easer to swallow/consume, extending shelf-life, etc. You need enough of the drug for it to be effective, but not too much to overdose or exhibit side-effects.
The mass of the acetominophen isn't really important, it's just vivid writing. The point is that 8g is obtainable for orders of magnitude less when it isn't wrapped in misleading marketing.
I think it’s outrageous that pseudoephedrine has become difficult and annoying to purchase while they put that ineffective garbage out through all these combo drugs.
In Canada if you go to a drug store, the shelves are literally filled with literal homeopathic medicine. You have to carefully confirm that what you’re buying isn’t water, and there is no signage or other differentiation between actual medicine and magic.
Completely unrelated, I noticed recently that tire detailing spray that makes your tires look black, and the recommended lubricant for my garage door weather stripping, which both cost $15 or more for a little bottle, are just silicon oil that costs pennies for that amount. I have no moral problem with charging higher prices for convenience plus clarity of what the use is. I do think it’s amoral, obviously, to be involved in snake oil sales and unbelievable that the government allows it.
Edit: this is the first result from a Canadian pharmacy searching for cough medicine. Worse it’s for kids: https://well.ca/products/homeocan-kids-0-9-cough-cold-day_88...
Ugh yup. My regular pharmacy is a pharmaprix (shoppers drug mart), which is one of the biggest chain pharmacies in canada. The cold and flu isle is right in front of the pick up counter, so when I was sick a few months ago one of the pharmacists flagged me down when they noticed me hovering around the cough drop/coldfx/oscillococcinum part of the isle. The amount of proverbial snake oil on the shelves is bad enough that she was apologizing for how confusing it was. Got me set up with OTC pseudoephedrine instead! (There's some combo PSE/acetaminophen meds they sell in front of the counter, but they're mixed in with the sugar pills.)
It's really worth talking to your pharmacist even if you know what you're buying. There's so many more options behind the counter and they're really knowledgable.
Silicone oil can actually vary a lot. Some are safe for certain plastics or rubber materials and not great for others.
The tire stuff might be the cheap shit that's not so safe just because tires are so thick and robust. Or maybe it's actually designed for tires.
In Canada all homeopathic medicine must clearly identify itself as such and must also state that it's based on traditional form of medicine and not based on any kind of scientific evidence.
The very "medicine" you linked to in fact displays it right on the cover.
To be fair, they are clearly following that rule, yes. But also, if I went to a clinic, and got told it was my fault something didn't get treated because I spoke to the person dressed as a doctor wearing the "Aspiring Dr. Soandso (Untrained but did watch House MD all the way through)" nametag instead of the one that said "Dr. Soandso", I would be pretty pissed. They were still in the clinic, dressed like a doctor.
I think there's one thing most people agree on: drugs should be safe and effective.
DXM is fine but oral phenylephrine should be banned. The only reason it's in any of these drugs is because they don't want to lose sales when the real version that works is locked behind the pharmacy counter after hours. It's a scam to keep sales up.
I had a cold a year or two ago, I had used the last of a bottle of actually working cough medicine, attempting to buy a replacement failing to do so, I found it had been banned. Turns out the active ingredient was morphine, which is apparently quite an effective decongestant in very low doses(and variants have been used as such for thousands of years)
That started me on a quest for a good cough medicine. My research turned up some interesting results.
Different countries have their own go-to medications for decongestants. Actual different drugs, not just the same thing under a different name.
None of them work.
Anything that does work is banned unless the people making it have been doing so for a couple of hundred years, then it seems that they just pretend it's not there.
When challenged the industry defended their sale of ineffective products by saying if they didn't work, people wouldn't buy them.
Anecdotal evidence is taken as gospel in many public health circles. When an attempt to have a substance banned was rejected on the basis of no evidence of abuse, it appears that means 'try again later', not gather evidence. You only have to wait for someone who shares your ideology once and it gets done and getting it undone is too much work for anyone to consider.
It's almost enough to send you off to a music festival to gather your own supplies for home remedies.
Adderall (amphetamine) is a very effective decongestant. And it helps you get more work done!
Well that's a bad sign. I'm managing the tail end of a cold again at the moment and I'm already taking dexamphetamine.
I get that the discussion here focuses on doubtful decongestants, but just the mention of acetaminophen makes me think of pharmaceuticals and people's relationship with them in the US. It's a strange world to me, especially how deeply ingrained the brand names are in people's minds - years of evidently successful marketing.
What, to me, should be illegal, is building expensive branding around a group of very basic analgesics - well and other groups like antihistamines.
In the UK I can buy an own-brand 16-pack (8 g) of paracetamol in a supermarket for £0.35 / $0.45. At the same time, I can buy a packet of Panadol (GSK), same substance, same content, same amount, for £2.35, nearly 7 times the price of generics.
How is THAT legal, and how are people so unaware as to actually buy it? "Unaware" may be the key here.
Same situation in the US. I can buy NyQuil/DayQuil, or I can buy the pharmacy-branded version for a lower price. Here it's usually not such a dramatic difference; probably the pharmacy brand is a a 30-40% discount off the big-name brand.
> How is THAT legal
Why shouldn't it be? Companies are free to set prices to whatever the market will bear. In this case it's based on customer ignorance, which makes it feel icky, but I don't think that's a reason to legislate this sort of thing.
> and how are people so unaware as to actually buy it?
Yeah, I don't know. I do remember that, many many years ago, I didn't know about this, and would always go for the big-name-brand version. At some point I learned to look at the active ingredients and just buy the cheapest one that had the same ingredients in the same dose, but I don't recall when or why I learned that, or why I didn't know that before.
I think there's also an implicit quality judgement sometimes, even if it's unfair. When it comes to groceries, say, canned tomatoes, and I see some fancy-looking Italian brand that I've heard of, my brain will automatically rate it much higher than the grocery store's own branded version of it. Maybe that's an effect of marketing/advertising, maybe it's something else, I don't know. And sometimes it's actually true: tomatoes are not all created equal. I think something similar happens with drugs, even if it's an entirely different kind of product.
People also often assume that something that costs more is automatically higher quality. For some types of things, that can be true (because yes, there is such a thing as a better tomato, and sometimes it costs more to cultivate said better tomato), but for drugs in a regulated environment, that doesn't really make sense. But people pattern match on what they know and what they feel.
We see this all over. Generic brands can be on-par with (or even 100% identical) to name-brands, and the name brands still make money. For example at my local grocery store, you can buy distilled white vinegar from Heinz or the generic brand. The generic brand costs half-price (or less if you get the bigger container), but the product should be chemically identical.
There can be some arguments made (maybe you think the generic cuts corners and it is only 4.5% vinegar instead of 5%), and the same arguments can be made for the drugs. But IMHO they come nowhere near to justifying the price gap.
The thing that is particularly frustrating in the case of the drugs is how the brand-name is (for many people) the vernacular name. I grew up in a family that called many drugs by their actual name (eg ibuprofen & acetaminophen), but when I go to the doctor, many of them insist on calling them Advil & Tylenol. Sometimes it seems to take them a second to recognize the generic name.
FWIW my guess is most people are aware, and do know that supermarket/drugstore acetaminophen / paracetamol is the same, in some relevant sense, as Tylenol / Panadol. It's not like the retailers lack marketing resources. But for these off-the-shelf drugs the total $/£ amounts are small for a lot of people.
Then, there _are_ arguments about whether generics face adequate testing to ensure the same quality as the originally-approved name brand drug. A lot of this is FUD - I'll happily buy generic acetaminophen in the US - but it's not a totally irrational concern. I doubt any regulator ensures generic equivalence to the same degree of conformity that a big pharma companies' own quality control does.
For example, I personally find real differences in the jankiness of different asthma inhalers, even amongst generics. Maybe that's because I don't shake/use/clean them exactly per the directions, but then that's real-world use for you. My personal experience says brand-name Ventolin has solved a "robustness against user error" problem in a way some alternatives often have not, suggesting the FDA does not enforce equivalence on this dimension. It's not enough of a difference for me to go name-brand, since out-of-pocket price differences can be egregious, but I do distinguish between otherwise-unknown generics.
Finally, you may trust the UK regulator and so do I, but traveling somewhere without good regulatory oversight, I'd probably reach for Panadol - assuming it seemed authentic - over a generic brand I'd never heard of. Brands have value and brand owners have a lot to lose, which is a kind of insurance (see 1982 Tylenol recall).
OTC decongestants that actually work, some useful info for those of us with bad sinuses.
- pseudoephedrine taken orally.
- phenylephrine, but only as nasal spray, not if you take it orally.
- Oxymetazoline (Afrin) nasal spray and others in this broad family
- propylhexedrine, sold OTC as Benzedrex as a vapor inhaler. Unfortunately people crack open the inhaler and swallow the whole thing as a drug of abuse, so often they are out of stock seemingly because of shoplifting, or not sold at all because the pharmacies don't want to deal with the hassle.
Anything that goes directly in your nose has the potential to cause rebound congestion after a couple days which can be pretty bad.
Calling Dextromethorphan a placebo is quite a stretch. Sure, I think the point is that it makes you intoxicated so that you don't really care that you're sick, but it is definitely active.
Oral phenylephrine is considered to be ineffective, phenylephrine in a nasal spray is considered effective.
Nasal phenylephrine is a miracle when I am trying to sleep with a stopped up nose. A spray in each nostril and my nose is clearer than even normal within a few minutes.
BRB, spraying DayQuil up my nose
Absolutely true. Phenylephrine liquid applied directly to nasal mucosa is a quick and effective decongestant. It doesn't last as long as oxymetazoline (the other big nasal spray ingredient), but it also doesn't cause you to become dependent on it as much as oxymetazoline does.
> Most studies have found that dextromethorphan performs the same as a placebo
The citation linked does not support this claim. In fact it suggests the opposite:
"Dextromethorphan was tested in three of the included studies (Lee 2000; Parvez 1996; Pavesi 2001). One report on a series of three successive studies on a total of 451 adults favoured dextromethorphan 30 mg given in a single dose to placebo in terms of cough counts (measured through cough acoustic signals using a microphone on the nose) and subjective visual analogue scales (Parvez 1996). Differences in mean changes of cough counts between active treatment and placebo varied from 19% to 36% (P value < 0.05) in the three studies (up to a net difference of eight to 10 coughing bouts every 30 minutes). This study did not report on side effects.
A study involving 44 participants tested a single 30 mg dose of dextromethorphan versus placebo (Lee 2000). Both treatment groups showed a decline in cough frequency (from 50 to 19 per 10‐minute period in the active treatment arm compared with 42 to 20.5 in the placebo arm, P value = 0.38 at 180 minutes follow‐up). Mean subjective cough scores showed a decline from 2.0 to 1.0 in the active treatment group compared to a decline from 2.0 to 1.5 in the placebo group (mean difference in decline in cough scores 0.5 at 180 minutes, P value = 0.08).
Pavesi and colleagues also tested a single 30 mg dose of dextromethorphan versus placebo (Pavesi 2001). Outcomes were measured through a three‐hour continuous cough recording, measuring cough bouts, cough components, cough effort, cough intensity and cough latency. Average treatment difference was 12% to 17% in favour of dextromethorphan for cough bouts (P value = 0.004), cough components (P value = 0.003) and cough effort (P value = 0.001), with an increase in cough latency (P value = 0.002)."</i>
Two out of the three studies found DXM was effective in adults. The studies did not find the same efficacy in children but that could be due to differences in dosage (adult dosage is 30mg, child doses vary based on body weight) or in measurement techniques (as far as I can tell the child studies measured results via parental survey as opposed to more objective techniques like cough recordings).
Btw, the cosmetics industry functions similarly, but worse. Although I suppose the health dangers are lower (the monetary ones are not).
For anti aging stuff, the workhorse ingredient is retinol (with a few formulation variations).
However, it is very difficult to buy _just_ retinol - most beauty brands bundle up retinol with a bunch of other ingredients. This has a couple of issues:
1. You won't know your retinol dosage. These creams almost never tell you the retinol proportion and concentration.
2. You're overpaying by _a lot_. The luxury name brand cream will cost maybe 10x more than the similarly sized $9 bottle of retinol from the ordinary, but it will only contain some fraction of retinol.
Tbf this has been slowly changing and I see even La Roche Posay sells retinol bottles for $50. Insane markup, but smaller than what was the case 5 years ago.
This is all compounded with the fact that it's very difficult to tell if your anti aging cream is actually working from your own experience:
- its effect is slow acting
- it's difficult to compare the result with the counterfactual, unless e.g. you only use it on half your face
> Historically, Sudafed has contained pseudoephedrine, the wonder drug equally good at clearing congestion and making crystal meth.
It's much better at clearing congestion than at making crystal meth. And, as the joke goes, it's easier to make an effective decongestant from meth than it is to buy it from a store.
I am still bothered that Australia limited the sale of small quantities of codeine in 2018. I had not realized it limited acetaminophen last year to limits similar to the UK.
At least in the States I can still economise.
On the record, I am 100% for making common painkillers, cold and flu remedies completely over the counter. It blows my mind people are making things that used to be prescription (for good reason) OTC, but limiting purchases for things like acetaminophen. I still find it burdensome to deal with the pseudoephedrine controls, and I don't even use it often.
Dextromethorphan is abused to get high. Not sure how it could be a placebo.
I'm not sure what it is in the Dayquil - the DXM or the "decongestant," but there is a stimulant effect that is half of what I buy it for. It is the most effective medication I have found for getting me off the couch and able to power through a workday with a moderate cold, and definitely does something that Acetaminophen alone doesn't do.
Interesting that in the US metamizole[0] (dipyrone, or Novalgin and Analgin comercially) is banned in the US due to agranulocytosis[1] risk. It's fairly common in Europe, Asia and South America.
[0] https://en.wikipedia.org/wiki/Metamizole
[1] https://en.wikipedia.org/wiki/Agranulocytosis
The FDA did this to us by outlawing effective but problematic products and replacing them with relatively safe but ineffective products. And then letting product makers off the hook on claims and pricing
I only know one person who has ever found phenylephrine effective. It's definitely not for me, but they've done single-blinded self-studies (with help) to see if it's a placebo effect, and it's pretty clearly not.
DXM is also not a placebo, although it might be specifically for cough.
I don't especially want the FDA to ban them, but requiring separating out the acetaminophen might not be the worst idea.
Phenylephrine only works as a nasal spray. It doesn't do anything when taken orally, because it is broken down in the digestive tract.
DayQuil: Because you're sick, and the rest of the office should be too.
I use DayQuil/NyQuil when I get a cold and in my case, it's always worked well. It suppresses the symptoms and lets me carry on with my day-to-day. I did try once going 1 week without it and it was hell.
When the hubbub about phenylephrine first started, I decided I still felt less miserable taking DayQuil/NyQuil, and switched to the "High Blood Pressure" formulation, which drops the phenylephrine, alcohol and sugar.
It takes it down to just the Tylenol, the DXM (, plus the antihistamine in the NyQuil), and the great slightly tearable taste for the ritual of "time to pretend I'm not sick for a little while".
I go with Alka Seltzer specifically because they have an Aspirin variant instead of Acetaminophen.
> Take your standard 12-ounce bottle of DayQuil, which costs around $15 at CVS.
...
> So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen, which separately would run you about 16 cents at Costco.
Why are they comparing the price of CVS DayQuil to Costco acetaminophen? Either compare CVS DayQuil to CVS acetaminophen or compare Costco DayQuil to Costco acetaminophen.
Yeah that seems odd. It's also a very different delivery mechanism. Might be easier to get a sick and snotty kid to drink some (maybe?) tasty liquid vs cheap pills.
that's why you have children's tylenol (or generic) that is $$$ but exactly that.
Of course placebos should be legal, they're effective medications.
https://www.health.harvard.edu/newsletter_article/the-power-...
The placebo effect is not an excuse to allow drug companies to make false claims about the efficacy of the ingredients
Dextromethorphan is definitely not a placebo. Take enough and you'll go to space and meet God. Smaller doses produce euphoria and dissociation, which, even if they don't make the cough go away, makes it easier to tolerate a cold -- same reason antitussives have historically contained alcohol, cannabis extract (which may incidentally work as bronchodilator but was not the reason I imagine it was in antitussives)
Funny amphetamine used to be an over the counter cold medicine, which the article doesn't mention despite talking about the meth precursor?
Fine article but these two details stuck out to me while reading it.
Came here to say this, the author is hating on dextromethorphan like he never robotripped before. But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that.
> But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that.
Ketamine is neurotoxic itself and can cause permanent brain damage. I can't find the info but there was someone in the tech industry who accidentally overdosed and suffered a two year bout of severe debilitating depression culminating in suicide.
Sorry to say, we shouldn't really base our opinion on drug safety from people who accidentally overdose or are generally reckless with drugs. There's people who drink for the first time and end up in the hospital.
If you want to do it the smart way, just consult erowid.org and use a little common sense.
https://erowid.org/chemicals/ketamine/ketamine_faq.shtml
The post I replied to stated that a DXM OD is dangerous then mentions ketamine without stating its OD dangers giving it the appearance of a safe alternative.
You need much higher doses of dxm to get the psychedelic effects compared to ketamine. Ketamine is a pretty safe drug when used responsibly and occasionally, especially because you can slowly dose to the required intensity and it wears off quickly. Like any drug there are risks involved. Most notably psychosis and addiction. Apart from the immediate toxicity, of course. And that is very much higher for dxm in my experience. It's also a very weird trip and it took me a while (2 weeks) for my brain to fully settle again, whereas with ketamine I would bounce right back feeling better than ever, which of course increases its addiction potential. What we didn't know back then is that ketamine is actual toxic to the kidneys in prolonged high doses, so yes, be careful.
one off experience of someone in a stressful job. are we gate keeping?
It is entirely reasonable to say that it should be RX-only to be monitored by a physician for these reasons.
>I can't find the info but there was someone in the tech industry who accidentally overdosed and suffered a two year bout of severe debilitating depression culminating in suicide.
i believe you are referring to Felix Hill.
https://docs.google.com/document/d/1-jBoSEVlryiX1IaSzV4vKuih...
"On mental health, psychedelics and life
This is a story about mental health, psychedelics, psychology and the mind. It is a story about the joy of family, the joy of friends, the joy of being in love, and the joy of doing scientific research. It is a story about life, the world, and how amazing they both are.
After 18 months of intolerable torture, and after many months of consideration I have decided to end my life.</i>"
The left enantiomer of methamphetamine (exact same chemical formula and structure, just mirror symmetry) is also an OTC decongestant.
Vicks
Only historically. No Vick's brand product has contained it since 2016. The only "brand" name I'm aware of currently is Benzedrex.
Benzedrex is not l-Methamphetamine, it is Propylhexedrine
Ah indeed, I misremembered. That is also a very similar compound, identical structure but more saturated carbon bonds (non-aromatic ring). It's always delightfully silly to get your own correction corrected!
https://www.vumc.org/poison-control/toxicology-question-week...
> Dextromethorphan is definitely not a placebo.
It definitely works for me. It'd be wild if for all 44 years of my life, it's only worked because of the placebo effect.
The article mentions phenylephrine, and that shit definitely doesn't work. Not even a placebo.
Very relevant username
Yup. The only upside to being sick is that I get to take NyQuil before going to sleep and have trippy as fuck dreams.
"Yes, legalize all drugs for adults"
Simple
> If you walk down the cold and flu aisle at CVS and start looking closely at labels, you will count about 100 products and around six active ingredients
It's so utterly ridiculous how much space the Cold and Flu section of the medicine aisle takes for no reason at all.
And the whole thing about combining so many medications is just silly, especially the marketing for it. "Why take 3 medications for your cold symptoms when you can take just this one?" then gets countered with "Why take a cold medication that has ingredients for symptoms you don't have?"
IMO, DayQuil should never have existed simply for the reasons the article mentions: It leads to people being unaware of what they're taking. Yeah, the label is right there, but you gotta consider the lowest common denominator when selling things to the general public.
Until the late 1960s, codeine was considered the definitive over-the-counter cough medicine. It worked well. Maybe a little too well, because it was easy to get addicted to it. So the FDA banned it from OTC sales and dextromethorphan was substituted. Which brings us to today.
In the pharmacy in the US there are about 1000 over the counter drugs made if varios combinaciones of about 50 ingredients. Many of them contain acetaminophen. I can see how accidental liver damage can occur.
On DayQuil specifically, the only time I took it I was about as useful as someone stoned. I would have been better off and less dangerous to society if I had just taken rest..
As far as pain management I personally find acetaminophen does nothing for pain and only helps with fever. Similar ibuprofen only helps me with sever muscle pain associated with over exertion or bruising.
Having unfortunately suffered from nerve pain I can say the pain relief opiates provide, even at low levels, is on a whole different level. My experience is that taking them only for pain, when it is unbearable, was not addictive and made pain on the level of I need to go to the hospital bearable.
Just my experience.
Just bring back ephedrine and pseudoephedrine! Nobody cares if a few enterprising nerds could cook it into methamphetamine! Oh my gawd someone might experience some unapproved, unrentiered joy! Send in the SWAT teams! This is what the War on Drugs™ gets us.
It should be legal. Caveat Emptor applies always. to everything. I'd rather have choices available in a marketplace rather than a nanny state stifling innovation through its own incompetence.
in the specific case of this article, "innovation" and "choice" are exactly the problem here. we know what works well - they're well-studied generic compounds. there's no social reason whatsoever that "dayquil" or "tylenol" or "sudafed" should exist when generics are readily available and clearly labeled.
With computerized registers and loyalty programs, it is way too easy to profile. I am not too worried about looking like I chug too much aspirin; it's the further out assumptions or speculations that models (like I myself once designed or otherwise) might make that I worry about, that would not require proof, and would not be documented somewhere. I mean there is also stuff "like" congestion pricing to worry about, and maybe that would work better to make people think about liberties and tech. Dunno.
This should be divided into three parts: marketing and selling people questionable combo drugs at insane cost (bad), the case of oral phenylephrine (idiotic + bad), and the efficacy of the other drugs in the mix (guaifanesin, etc) (unclear).
The more general deeply-entrenched golden goose here is branding, which applies to much more than OTC medicines. Make it so the active ingredients have to be listed prominently - the largest text on the front of the product package - and these concerns diminish greatly.
It would also fix the homeopathic snake oil as well, which has started showing up as options in previously-reputable medicine aisles. So at any rate, be on guard if you don't want to end up accidentally buying a bottle of water plus flavoring in your cold-addled state.
Making the active ingredients prominent is a good start but not sufficient. As the article points out, the word "phenylephrine" looks/sounds similar enough to "pseudoephedrine" to broadly fool the population.
That's why I said "diminish greatly" rather than solve - by doing something basically everybody should be able to agree on regardless if you think a given product should be on the market or not.
They should probably have to split up large words with dashes or even spaces "phenyl-ephrine" "psuedo-ephedrine". Maybe even "phenyl-eph-rine" "psuedo-eph-edrine". One authoritative list published by the FDA (they already keep a list of what's allowed to be sold OTC in the first place, right?) of how the active ingredient names have to be distinctly stylized to best inform.
It just seems like a quick patch that doesn't acknowledge or address the root cause: that the FDA is supposed to be regulating both safety and effectiveness, but it is largely abdicating the "effectiveness" role over to companies' marketing departments. If corporate marketing can convince the public that the serpensoleum drug works, then that's enough to put it in a shiny box in the drug store.
The problem is that you're butting up against the highly profitable cult of ignorance. For instance if something isn't intended to actually treat a disease, then it's basically exempt from FDA regulation as it's a "supplement". Then the seller is free to imply whatever they want, regardless of efficacy.
I'm advocating something that ideally can sit in the middle of the two philosophical/regulatory regimes with more people on board - being able to buy whatever you want, but regulation aimed at preventing companies "innovating" by simply confusing the market. And while I'm sympathetic to extending the scientific-maximalist approach onto the "supplement" industry that is currently harboring copious amounts of straight up fraud, I would also say that throwing down such a gauntlet doesn't seem like a great idea at the moment!
Yea don't even get me started on the "supplements" loophole. There are so many problems to solve. Making even small amount of progress towards fixing anything would be miraculous, given the economic forces wanting to make the problems even worse.
The author has a point about dextromethorphan and phenylephrine. However, he does guaifenisin dirty:
>You’ll also find lots of cough medication with guaifenesin, which has similarly thin scientific backing.
He links ( https://pubmed.ncbi.nlm.nih.gov/24003241/ ) which shows that guaifenisin had no measurable effect on sputum volume or consistency (p = 0.12 for volume). But there are other studies with broader outcome measures which show positive effects:
https://link.springer.com/article/10.1186/1465-9921-13-118
>The pilot study was a randomized, double-blind study where patients were dosed with either 1200 mg extended-release guaifenesin (n = 188) or placebo (n = 190), every 12 hours for 7 days [...]
>Subjective measures of efficacy at Day 4 showed the most prominent difference between treatment groups, in favor of guaifenesin.
>The DCPD assessment of symptoms also indicated advantages for ER guaifenesin over placebo for the between-day changes from baseline in response to the questions “Over the last 24 hours how often did your phlegm prevent you from going to public places?” (Day 2; p = 0.0016) and “Over the last 24 hours, how difficult was it for you to bring up phlegm?” (Day 5; p = 0.0070).
G tends to do well in subjective (symptomatic) assessments, even when subjects are blinded, but poorly in objective assessments. However, this isn't enough to condemn it.
The real reason that all these drugs are mixed together seemingly willy-nilly is actually to prevent people from overdosing and going wild with a singular drug, or cooking up more potent mixtures from it. Guaifenesin in particular has been mixed with decongestants, for the primary purpose of preventing use as a precursor.
If they sold these chemicals as singular treatments then the abuse would go through the roof. The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this.
I injured my legs, then on top of it, had a minor cold recently, and finally grabbed a bottle of Coricidin HBP out of desperation. I have also been stocking up on 0.0% beers. Between doses of the former and bottles of the latter, I managed to get some great-quality sleep and rest.
The other thing to notice about the Cold and Flu section of your pharmacy is that most all the treatments are supposed to relieve congestion, clear phlegm, and serve as an expectorant, such as all the cough drops with lemon, or menthol. If you are a lifelong smoker with a productive cough, this is great. That includes habitual pharmacy patrons who've always purchased their cigarettes and cigarilloes right there at CVS, next to the candy aisle and the booze aisle.
If you live in a desert and/or suffer from chronic E-N-T dryness and dry coughs, then these treatments will make your life a living hell and must be avoided at all costs. Think about it.
> The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this.
I think we need to do more around accidental overdoses than suggest that everyone should be a "shrewd consumer".
All you need to do is read the warnings and follow the instructions. It is not difficult. It does require literacy and intelligence, but a caregiver or the patient themselves should not have difficulty with the terminating the drug type and the dosage limits. If they do have difficulty, just see a nurse or a PCP. It's not rocket science!
All these overdoses are happening because people do not read the warnings and they do not follow the instructions; and if they cannot understand the warnings and if they cannot follow the instructions, nor even consult a professional, then perhaps they deserve an overdose?
Dextromethorphan is useful. The problem is solely with oral phenylephrine being sold for something that it does not work for. The precise suggestion then is for oral phenylephrine to not be sold for such indications.
> Why do we even have combination over-the-counter products at all?
In America? No idea. In the UK it's because they sell codeine+tylenol OTC, and they want it to poison you if you try and get a codeine buzz from it. Incredibly this is true.
“Incredibly”? The US does exactly the same thing in another case: denatured alcohol.
No it should not be, but not because of the dextromethorphan or the phenylephrine being ineffective. By far the biggest issue is the acetaminophen it contains, which it isn't super obvious about, and frequently leads to acetaminophen overdoses. The vast majority of acetaminophen overdoses occur because people combined different medicines containing it (like DayQuil and Tylenol) without realizing they were taking the same thing multiple times. Its a completely preventable cause of liver failure and we should not be making cocktails with it that don't clearly show exactly what they are.
Acetaminophen (Tylenol) is probably the OTC drug that is at the top of the list to be made RX-only due to its dangers.
Please no. We need to be going the other way on that trend: converting things which won't easily outright kill/maim you (and dare I say, even potentially addictive ones) at normal doses from Rx to OTC! Acetaminophen is one of the few cheap, easy, and working products on the shelf!
A concern with OTC drugs is specifically that they won't be taken at normal doses. People confuse brand names and drug names, and don't realize they are taking more than the reccomended amount. This is especially problematic with combination drugs.
Doesn't OTC specifically mean the ones that can't just be on the shelf ? Where you do not need a prescription but a pharmacist still has to be asked to hand it to you "over the counter" ?
No, OTC means a drug available on the shelf, that people can buy without a prescription.
It's funny, I never thought about it, but you're right, it does sound backwards.
In the US, OTC means the drugs available on the shelf.
The ones you have to ask a pharmacist for are “BTC”: behind the counter. e.g. pseudoephedrine.
There are people who don't know that Tylenol and acetaminophen are the same thing. That is not a reason for us to make everyone's quality of life and access to healthcare worse because some people are ignorant.
The desire to nanny-state things to the lowest common denominator is ruining everything, and it's a major driver for various problems all the way to the housing crisis and the cost of healthcare in the first place.
OTC drugs should be both available and regulated to be sold in such a way to minimize harm to people who use it.
Honestly, combination drugs are out of fucking control. Some people don't know Advil is ibuprofin. Some people think all Advil is ibuprofin. Both are wrong!
It used to be true that doctors could tell people that it was okay to take [X] brand drug with [Y] brand drug but anymore, there are a half dozen formulations of each in varying combinations on the shelf and half of them have some of the same ingredients. Basically every brand has a "fuck it lets just mix everything together, flu" version on the shelf now.
I agree that drugs should be regulated, but that regulation should be primarily about ensuring that they are effective, safe when taken as instructed, and that they contain the ingredients they say that they do and don't contain ingredients that aren't listed.
It is not the government's responsibility, nor should it be, to try to solve the fact that someone can do something stupid with medication and harm themselves. Medication, by its very nature, interacts with and changes your body: that's the entire point. There is no way for something to be effective and also impossible to abuse or misuse. Regulating drug safety should always be based on following the instructions for how to use that drug.
That's not to say we can't do more the educate people, but ignorance should not lead to inaccessibility. There are tens of millions of people in this country that are fully capable of reading a box and following instructions and they should not have to live a worse quality of life because some people are not willing or able to do so.
We don't have to prevent people from being stupid, but we do want to mitigate it, because medicine is supposed to be accessible to everyone, and part of the safety profile of a medication plainly is the ability for it to be administered safely.
> safe when taken as instructed
Part of that means that instructions and ingredients should be clear.
I am educated and knowledgeable and a trip to the pharmacy is more complicated than it needs to be. You damn near have to pick up every damn box to see what is actually in things, if your pharmacy doesn't have things locked up, and half of the time I ask a pharmacist for pseudoephedrine even they give me combination drugs instead.
I don't think we should take anything off the shelf (except oral phenylephrine). If anything, I think we should make more drugs available OTC.
I blame doctors and nurses. At least the ones I personally know tell patients "Advil" and "Tylenol" and never mention ibuprofen or acetaminophen. Actually, it's true for pretty much all OTC medications - they just use the branded names Immodium, not loperamide. Claritin. Zyrtec. Benadryl. Dramamine (drowsy/non-drowsy). The list goes on.
When asked, they always tell me one of two things:
1. They were trained on these names instead of the ingredient (scary!)
2. They want the "easiest" thing for the patients (i.e. so they don't have to look at the label).
Eh, from what I gather from the healthcare professionals I know, I think that is mostly doctors adapting to the language accessible to their clientele. I don’t think it’s about being “easy” as much as it is “doable”. I’ve heard that it’s often hard to even get an accurate list of current medications out of a person, brand name or not.
Now I suppose ibuprofen/acetaminophen is common enough that people may be familiar with it, but I could see how in a clinical setting defaulting to brand names is the only reasonable default for accessibility.
I’ve had multiple doctors remark specifically about my use of generic drug name in discussion. “So I presume you’re a little bit familiar already”, etc.
We can do both - and already do. Ibuprofen is perfectly fine for non prescription. Super dose ibuprofen pills are prescription.
And then there's OTC drugs which are sort of in a weird middle area - and where some of these I feel personally might work best. Make them easily accessible to anyone without a prescription but at least a pharmacist has to hand it to you. They are the experts at dosing and what combinations of drugs are safe after all !
Tylenol is one of the things on the shelf most likely to kill you from liver failure. It is way more dangerous than many prescription drugs.
It should be replaced with Dipyrone, which is much safer and more effective, but was restricted in the 70s in the US and parts of Europe.
In fact, it’s so effective against pain and fever, it keeps doctors from having to resort to prescribing opioids. Countries that haven’t restricted its use do not have nearly the same problem with opioid abuse.
It makes me wonder if its continued restriction is motivated by profits off the opioid crisis, rather than patient safety.
All drugs should be legal, full stop. And I should be able to get medical drugs on my own, without a permission slip from a doctor I have to convince.
Drug prohibition has caused magnitudes more harm than decriminalization and legalization.
And part of this article is about claims from what is likely inert or mild effect at best. Remember, we used to have amphetamines, pseudoephedrine, and much more potent drugs to alleviate colds and such. But because of the forever-drug-war , we're stuck with substandard crap, and everything good gatekept by doctors.
Are you sure you have read the article, not just its title?
Yes, and the question lends itself to control (or lack of) by relevant medical "authorities".
I honestly do not trust somebody with a doctor license who I talked to for 7 minutes out of 259200 minutes (6 months).
For example, when I went on a camping trip, I got bit by 15 ticks. After I got back, went to doc for 15 day doxycyclene, gold standard. And its cheap, like $15. NOPE, fucker wanted the ticks in a bag to grind up and waste a $400 Lyme test. And that test is only 60% accurate, tons of false negatives.
If I could have, I would have bought doxy, scaled it to my weight, and did the 15 day run.
But nope. I ended up getting the second recommended, amoxicilian as "fish antibiotics".
One of the reasons doxycyclene is so effective is because it's less overprescribed. Antibiotic resistance is a real thing, and the day we run out of viable ones is going to be ugly. Having a gatekeeper isn't a bad idea.
To add to this, despite all efforts to educate people, many STILL don't know that antibiotics don't work against viruses and will want one when dealing with a cold or other viral infection.
If we let antibiotics be over-the-counter, every damn infectious bacteria will be a super-strain in a year.
Antibiotics are routinely given to all of their farm animals as part of their food, for prophylaxis. But allowing humans to buy when they're sick is somehow the super-strain-end-of-times??
Antibiotics stop bacteria. Antivirals stop viruses.
Except bacteria can be attacked whenever, the sooner the better.
Antivirals need a rapid and early timeframe to work. Getting a fucking doctor to say yes is almost always too long, and you missed your treatment window. That is unless you go the ER, and lucky to not get shoved aside. Then pay $$$$$
Those are two separate issues and we obviously should not be just giving feedstock and animals antibiotics constantly. That's no good for anyone.
Maybe the better solution is that the government should be paying for the Lyme test as a public health measure. Knowing which areas it is spreading too is extremely important.
And on the flip side I know someone whose father got Lyme but didn't know it for years - he was not very symptomatic at first and ended up with major nerve damage. Not one to mess around with
> Antibiotics are routinely given to all of their farm animals as part of their food, for prophylaxis.
That's also a problem [0]; and it's one that can't be solved by creating a second, somewhat related problem.
0: https://pmc.ncbi.nlm.nih.gov/articles/PMC11200672/
That's why I went amoxycillan. I can buy medical grade as "fish antibiotics".
Alpha-gal wasn't prevalent then. It was primarily Lyme and rocky mountain spotted fever. Doxy and amox is the gold/silver standard for both.
I don't need a fucking doctor to tell me I was bitten by 15 ticks. I removed them myself with a tick puller. I don't need to he told that I probably got a disease from at least 1 of them. So yeah, its either going to cure the infection before it starts up, or is a prophylactic to prevent it.
And in more sane countries, I can go in a pharmacy, tell the pharmacist and reasonablely and cheaply treat myself. US? Not so much.
But, I can smoke delta8, tobacco, and drink until my lungs and liver give out. But how dare I take some antibiotics when I need them.
You make a good argument for expanded use for true "OTC" meds (Over the Counter - as in can't be sold on the shelf in bulk but has to be given by an actual Pharmacist).
I generally agree, but it seems darkly comical to be worried about gatekeeping antibiotics as a tick disease prophylactic when the vast majority of antibiotics are applied non-therapeutically to farm animals.
So what you're saying (and I agree with) is that antibiotics aren't gate kept *enough*
When an article has a misleading clickbait title, I think it's fair game to redirect the conversation to the subject of the title.
Read the article. It doesn’t even ask if dextromethorphan and phenylephrine should be illegal. It asks if intentionally misleading consumers about their efficacy should be.
The article is not about "should people be allowed to buy this product because it's potentially dangerous/addictive/etc" but "Should the company be allowed to sell this product because it consists of acetaminophen plus two useless ingredients and is basically a scam".
What is the argument for legalizing drugs that are contraindicated for all medical purposes, are toxic, and have a high addictive potential? How does it benefit me or society if my neighbor is permitted to choose to basically roll the dice on afflicting themselves with a debilitating chronic illness (severe addiction)? If I don’t want to do illegal drugs why would I ant to support this?
- People that want to do drugs already can buy them, with worse quality and the with the side-effect of funding crime at a planetary scale.
- Alcohol, tobacco & weed are already legal... why them and no other drugs? Check how many deaths do alcohol & tobacco provoke.
- Taxes, lots of taxes, literal mountains of money... a small percentage of which can be redirected to treating addicts.
I went to a southeast asian country and got a staph infection. I walked down to the pharmacy, asked the pharmastst for a topical and an oral antibiotic. 3 days later i was healed, continued the course the rest of the week and that was it. $12 dollars american.
I got another staph infection previously in the united states. Needed to go to a doc in the box who misdiagnosed it. A few days went by and i needed to go to another doc in the box who gave me topical and trued to give me a steroid shot. Needless to say it progressed and turned into fullblown MRSA which required admitance and a IV antibiotic. Extremely painful. I don't have the ability to add the costs but north of $10k easily.
That's why drugs should be legalized.
I'm sorry that happened to you. Sincerely. That sounds incredibly frustrating, painful, and scary.
I think your maximalist conclusion of "drugs should be legalized" might have some second-order effects that might be net worse for society, though. Addiction, misuse, MRSA, overdoses, etc.
But it's part of this world. Who is to say who can participate in aspects of the world?
How do you contrast this stance with say, Vietnam, where drug prescriptions are not required? Is their society collapsing?
It’s almost like there are other factors at play, and our system is an inadequate band-aid on those issues that has its own side effects.
Okay question was about drugs that are contraindicated for all medical purposes like heroin.
Also do you see any ironic connection between your two examples: easily accessible antibiotics and a medically resistant infection?
>"What is the argument for legalizing drugs that are contraindicated for all medical purposes, are toxic, and have a high addictive potential?
> That's why drugs should be legalized.
And dead men tell no tales.
Particularly the tales on why they shouldn't be legalized.
Legal status of these chemicals is not going to prevent your neighbor from getting them and becoming addicted.
Legal status (along with stigma associated with it) does prevent them from getting help before completely crashing out. It has the additional side effect of whatever portion of their lives they come out of it with being completely destroyed by the legal process. You know, because chronic illness obviously deserves punishment.
So I guess the real question is: what is the goal? Help chronic illness, or punish people that do things we don't like?
Also, don't we already have laws for literally all the bad things someone can do while addicted? If not, then why is it bad just because they are suffering from a chronic illness?
Agree with you. It is a collateral consequence of the War on Drugs™ that everything good and effective is getting locked behind a $50-$200 doctor's visit for a 'scrip. This scam medicine problem could be helped if a bunch of substances were moved out of Rx and back to OTC. The nanny state will continue to grow to meet people's definitions on how much others should be warded.