How Two Pharmacists Figured Out That Decongestants Don't Work (scientificamerican.com) 143
In 2005, the reclassification of pseudoephedrine to behind-the-counter status led to widespread use of oral phenylephrine in OTC decongestants, despite evidence of its ineffectiveness. Randy Hatton, a clinical professor in the College of Pharmacy at the University of Florida, and his colleague worked to bring this issue to the FDA's attention, revealing loopholes in the regulatory process for older OTC drugs. Hatton writes in an opinion piece for Scientific American: Before the FDA required that drugs had to be proven effective, it determined whether OTC drugs were effective through expert panels that reviewed existing data. These OTC monographs establish what older OTC ingredients can be marketed without FDA approval. The oral decongestant monograph panel reviewed a few published studies and multiple unpublished studies for phenylephrine. Of the unpublished studies, only four studies showed oral phenylephrine was effective, while seven showed it was no better than placebo. We requested copies of all evidence used by the nasal decongestant review panel via a Freedom of Information Act request and performed a systematic review and meta-analysis ourselves. [...]
The FDA has multiple regulatory processes for different types of medicinal compounds. People are perhaps most familiar with the New Drug Application process, which leads to clinical trials for prescription drug approvals. However, many OTC or nonprescription drugs are regulated differently. In fact, a law passed in 1951, the Durham-Humphrey Amendment to the 1938 Food, Drug, and Cosmetic Act, created the categories of prescription and nonprescription drugs. In 1962, the act was amended again so that drugs had to be shown to be effective, hence the requirement for well-done clinical trials. But what about the drugs that were approved before 1962? This is the loophole that some OTC drugs fall through. For prescription drugs, FDA tried to address pre-1962 approvals through a review of over 3,000 prescription drugs. Most of those drugs have now been reviewed and addressed, but there are still unapproved prescription drugs on the market today, such as an extended-release form of oral nitroglycerin. For nonprescription drugs, FDA established the OTC monograph process 10 years after the 1962 amendment to the Food, Drug, and Cosmetic Act, which required products not proven effective to be reconsidered. FDA formed advisory panels grouping hundreds of ingredients into 26 categories based on the products' uses. After gathering all available information, both published and unpublished, from manufacturers, the advisory panels issued final reports to FDA about whether these ingredients were GRASE (generally recognized as safe and effective), not GRASE, or inconclusive. GRASE ingredients can be used in nonprescription drugs without FDA approval if the use matches the monograph. "The oral phenylephrine example shows that FDA needs more funding to look at these old drugs," concludes Hatton. "We need public funds to support independent researchers who want to examine these products objectively. The government should be able to spend millions to save consumers billions on ineffective products. Companies that market these products have no incentive to prove they don't work. Nonprescription drugs must be effective -- not just safe."
The FDA has multiple regulatory processes for different types of medicinal compounds. People are perhaps most familiar with the New Drug Application process, which leads to clinical trials for prescription drug approvals. However, many OTC or nonprescription drugs are regulated differently. In fact, a law passed in 1951, the Durham-Humphrey Amendment to the 1938 Food, Drug, and Cosmetic Act, created the categories of prescription and nonprescription drugs. In 1962, the act was amended again so that drugs had to be shown to be effective, hence the requirement for well-done clinical trials. But what about the drugs that were approved before 1962? This is the loophole that some OTC drugs fall through. For prescription drugs, FDA tried to address pre-1962 approvals through a review of over 3,000 prescription drugs. Most of those drugs have now been reviewed and addressed, but there are still unapproved prescription drugs on the market today, such as an extended-release form of oral nitroglycerin. For nonprescription drugs, FDA established the OTC monograph process 10 years after the 1962 amendment to the Food, Drug, and Cosmetic Act, which required products not proven effective to be reconsidered. FDA formed advisory panels grouping hundreds of ingredients into 26 categories based on the products' uses. After gathering all available information, both published and unpublished, from manufacturers, the advisory panels issued final reports to FDA about whether these ingredients were GRASE (generally recognized as safe and effective), not GRASE, or inconclusive. GRASE ingredients can be used in nonprescription drugs without FDA approval if the use matches the monograph. "The oral phenylephrine example shows that FDA needs more funding to look at these old drugs," concludes Hatton. "We need public funds to support independent researchers who want to examine these products objectively. The government should be able to spend millions to save consumers billions on ineffective products. Companies that market these products have no incentive to prove they don't work. Nonprescription drugs must be effective -- not just safe."
Make this apply everywhere... (Score:5, Interesting)
...and you will destroy the market for quackery like homeopathy, acupuncture, and other placebos.
Would that be a good thing or a bad thing? Serious question. One the one hand, people with actual illnesses should get actual, effective treatment. They shouldn't be deceived into thinking that sugar pills will cure their cancer.
On the other hand, placebos have a genuine role to play. They are great for hypochondriacs, and prevent them from taking care from people who actually need it. Placebos also (sometimes) have a role for actual illnesses. However, for placebos to work, the patient has to believe in them.
As a last note: I know a couple of "natural healer" types. They are incredibly nice people, and my bet is that they are functioning more as therapists than anything else. Whatever they claim to do, the real benefit to their patients probably comes from being taken seriously by a nice person who listens to them.
Re:Make this apply everywhere... (Score:5, Interesting)
That's what makes alternative medicine so popular: People feel like they're being taken seriously. The quack sits down with them, listens to their ailments, asks questions that they can answer, makes suggestions rather than prescriptions and the patient has the feeling that they are in charge.
This is actually a pretty powerful thing. There have been studies about how being involved in the "production" of the medication affects its efficacy. Headache medication where the patient had to first dissolve the powder in water, wait for a moment for it to dissolve and then drink the water was more effective than the same medication in the form of a pill that just had to be swallowed. Splitting up the medication into two bags that first had to be mixed increased the chance of resolving the headache even further, even though all the people did was to mix two powders that originally came in a single envelope.
Even the color of the medication has an impact on how effective it is. Heart medication pills work best with a red cover. Tranquilizer need to be blue. White is always a good color, especially for medication that is supposed to kill germs. And under no circumstances may a pill be black, so even activated charcoal gets a coating so it ain't.
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The second my doc prescribed acupuncture, I knew he wasn't serious and I got a new one.
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Are you sure you didn't just misunderstand him when he said he needed a lot of blood samples?
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No, but once a hospital took > 20 blood samples. Like, seriously, and they claimed they could not use the IV and needed to stick me again! Another nurse was so totally distracted and twisting/moving around that the needle came right out and spewed blood all over me. I passed out and the doc said seeing it did something to my blood pressure and I could have died.
It's a miracle I am not deathly afraid of needles by now!
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...and you will destroy the market for quackery like homeopathy, acupuncture, and other placebos.
Sadly no, people who evaluate evidence and effectiveness are already avoiding quackery like homeopathy, acupuncture, vitamin supplements, et al. People who buy this stuff are taken in by the nonsense and will ignore evidence to the contrary.
Would that be a good thing or a bad thing? Serious question. One the one hand, people with actual illnesses should get actual, effective treatment. They shouldn't be deceived into thinking that sugar pills will cure their cancer.
On the other hand, placebos have a genuine role to play. They are great for hypochondriacs, and prevent them from taking care from people who actually need it. Placebos also (sometimes) have a role for actual illnesses. However, for placebos to work, the patient has to believe in them.
As a last note: I know a couple of "natural healer" types. They are incredibly nice people, and my bet is that they are functioning more as therapists than anything else. Whatever they claim to do, the real benefit to their patients probably comes from being taken seriously by a nice person who listens to them.
Destroying the market for quackery would, beyond any shadow of a doubt, be a good thing. However to do this, you'd need to reduce demand below the critical mass that can support such a market. If a demand exists, someone will fill it. This is why when you illegalise vice
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I don't think you can destroy the market for quackery as long as there's something the medical establishment can't cure.
Plus not all quackery is actually quackery. Yoga and meditation used to be fringe practices in the west--in particular yoga was pretty woo woo. Not only has meditation been vindicated, but it has been adopted into more formal practices like CBT.
And don't get me started on supplements: they are an unregulated mess, but the effective ones get turned into prescribed medicines in 20 years, and
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...On the other hand, placebos have a genuine role to play. They are great for hypochondriacs, and prevent them from taking care from people who actually need it. Placebos also (sometimes) have a role for actual illnesses. However, for placebos to work, the patient has to believe in them.
Surprisingly, this turns out not to be true. Here's an interesting study I heard about where people got relief from IBS even when they were told they were taking a placebo:
https://www.ncbi.nlm.nih.gov/p... [nih.gov]
At least one person got so much relief from the placebo that she had to keep taking it after the study (knowing it is a placebo) :D
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Open-label placebos seem to work for more than just IBS: https://www.nature.com/article... [nature.com]
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I had to chuckle (to myself) one day when I was in one of these natural grocery stores (to buy a specific brand and flavor of ice cream) and someone was trying to return some CBD product complaining that it didn't work. The manager said that the store doesn't take returns on products that don't work. Ah, ha, that's the secret to their business model: Barnum was right.
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Would that be a good thing or a bad thing? Serious question.
WTF is wrong with you? Serious question.
It's BAD, *obviously*. There is no way selling fake medicine to sick people instead of real medicine is a net positive for society.
This isn't one of those "well both sides have good points..." kind of thing. Selling snake oil is glaringly, obviously, wrong and immoral.
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Re: Make this apply everywhere... (Score:2)
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You might want to look into placebo a little more. You'll find that they can produce very real, measurable, physiological effects. They can be harmful as well, often called the nocebo effect.
Placebos work, which is why you need to subtract the placebo response in order to determine a drug's effectiveness. You might not like it, but that's reality.
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Acupuncture might not be 'placebo'. There's an effect. However, the tricky bit is, the effect is not necessarily related to centuries old folk practice, and complex charts of acupuncture points and flow were not created following any sort of rigorous procedure. Folk medicine may or may not work, and when it does work it's not scientifically tested for proper dosage, which ailments it does work on, and so forth. The myth is that ancient people were godlike in their wisdom, but even if that were improbabl
Re: Make this apply everywhere... (Score:2)
Broken window fallacy isn't a great basis for an economy. We can retrain acupuncturist to be feng shui decorators for example.
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The other way around would be sensible, i.e. if you claim your product has a particular effect, you have to demonstrate it does.
But if we did that, religions could get into mighty hot water...
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The other way around would be sensible, i.e. if you claim your product has a particular effect, you have to demonstrate it does.
Shouldn't' the market quickly sort that out? If you buy a product that does not work, would you continue to buy it? If I bought ibuprofen and it did not actually help with pain I would look for something else.
And sure, there is the placebo effect, but if the placebo effect works for whatever ails you then the product is actually effective isn't it. Keep using it then so long as it is safe.
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The market's ability to solve such things has been castrated and disabled a long, long time ago.
The market is whatever corporations like it to be today.
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You do? Really?
Can you get the ISP you want? Or do you get to choose between two equally crappy ones?
Hell, do you get the crisps you want? Or do you get to choose between 5 brands all made by the same corporation?
You have fuck all to choose from. You are free to do as we tell you [youtube.com].
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Can you get the ISP you want? Or do you get to choose between two equally crappy ones?
I'm actually quite happy with my ISP, I've been with the same one for nearly 30 years, even though there are several others to choose from. I'm also quite happy with my cellular provider, and there are a few of those as well. Prices here in Canada are higher than many parts of the world to be sure, but the service is nonetheless fast and rock solid reliable.
Hell, do you get the crisps you want?
We call them chips here, but I can get crisps imported from Britain or by a couple local artisanal makers as well as the usual Frito-Lay. You do get
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History says the market fails at this type of stuff. Sure that mixture of morphine and arsenic might help your headache but it will kill you eventually, perhaps after you become addicted to it. There were a lot of problems with patent medicines, including people dying and is the reason we have Health Canada now.
Unluckily we now have the opposite problem, arsehole freedom pushers who will take your freedom to, lets say, buy an effective decongestant as people might miss use it. These are the same people that
Re:Make this apply everywhere... (Score:5, Interesting)
You just can't stop thinking about trans women, can you?
I almost feel bad for you.
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Hey!
No kinkshaming, please!
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Re: Make this apply everywhere... (Score:2, Troll)
Why are you mixing science and social conventions?
A biological reality is your body might produce more testosterone than a woman's, but that doesn't make being an angry asshole science, duuuuhhh. Acting masculine isn't a science, and you live in a world where you can have low T AND still throw empty beer cans at the monitor when someone embarrasses you. As you hyperventilate and flip your ashtray over, consider a world where you're only a man if you show me your T levels because I don't buy your performativ
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So that passes your science-y test? Putting on a costume and wishing transforms basic biological reality?
Won't answer, will you?
Of course it passes the science-y test. Gender has nothing to do with biology. You're confusing gender and sex, sociology and biology.
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Can we start with the people who claim that if a boy puts on a dress and wishes really hard, that he turns into a girl?
It is slightly more effective than the claim that whining and complaining about other people's behavior being "wrong" will prompt those people to be "normal."
Re:Make this apply everywhere... (Score:4)
Why'd I care? As long as they just want to put on a dress and not try to make me wear one, why the hell would I give a shit?
Let's talk again if they try to put it into law that I can't wear pants or get rid of a parasite inside my body, ok?
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If my kid wants that, who am I to disallow them? Their body, their rules.
Yes, I have to be consistent with that. Either it applies to everyone, or no one. Either I can accept that everyone, including me, can do with their body what they fucking please, or not. Who am I do dictate what my child can do with their body?
Sorry, but I don't feel entitled to tell ANYONE what they can or cannot do with their own, personal body. If they feel like punching holes into it or redo whatever they feel like it, it's their
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If they pay for the pony, it's not exactly my position to say that they should not have it.
I don't have to enjoy it. But it's also not my prerogative to tell them what to do. And I don't know about your government, but mine doesn't go around and tell people what to do.
That's what we have corporations for.
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You will care when your kid gets a sex reassignment procedure behind your back
No. I'll care before hand and support my kid in their choice. If you only start to care about something after your kid disobeys you (of course you never bothered to consider their point of view, that much is obvious), then you have no business being a parent.
I feel sorry for any kids you may have.
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I have several trans friends, and what they have to put with from you and others like you is just appalling. Why don't you just shut up about people you know nothing about.
Re: Make this apply everywhere... (Score:3)
Who knows, but you certainly don't pass the intelligence and knowledge of science tests. You've conflated three separate concepts into one and then argued on the basis of one of those concepts that the others don't exist. Way to use fallacious reasoning, there.
Now, I'll explain. There are three separate yet related concepts that you've smashed into: sex, gender identity, and gender appearance. Your sex is immutable, and by and large, a binary proposition. Not always though, there are genetic and physical co
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Anyone that sells a product that claims to do something when later it is proven that the claim is false should be sued to oblivion. Problem solved.
I'll agree, if we include for examination every law or program created by politicians.
Re:Make this apply everywhere... (Score:5, Insightful)
why shouldn't a person be allowed to select some medicine they think might work and use it
Because the usual result is bad things and when bad things happen those same people who knew more than the experts end up suing, or if they're dead, their family or estate sues and we have to listen to all the whining about how someone should have told them taking arsenic laced vanilla pudding wouldn't cure their cough.
We see from the pandemic response that doctors often 'shoot from the hip' with their professional opinion.
Yes, of course. That's what doctors do. Make wild-assed guesses. They in no way use their training, experience, or the evidence to determie a course of action. They just pull something out of their ass.
If people were allowed to make these decisions themselves, they wouldn't be so quick to blame companies for false claims.
See above.
We let people 'self medicate' or whatever you want to call it with smoking cigarettes, drinking alcohol etc.
You have no idea what self-medicate means, do you?
Alcohol seems to have no beneficial properties.
Yes, it does [harvard.edu].
More than 100 prospective studies show an inverse association between light to moderate drinking and risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes. [20] The effect is fairly consistent, corresponding to a 25-40% reduction in risk.
. . .
The idea that moderate drinking protects against cardiovascular disease makes sense biologically and scientifically. Moderate amounts of alcohol raise levels of high-density lipoprotein (HDL, or “good” cholesterol), [37] and higher HDL levels are associated with greater protection against heart disease. Moderate alcohol consumption has also been linked with beneficial changes ranging from better sensitivity to insulin to improvements in factors that influence blood clotting, such as tissue type plasminogen activator, fibrinogen, clotting factor VII, and von Willebrand factor. [37] Such changes would tend to prevent the formation of small blood clots that can block arteries in the heart, neck, and brain, the ultimate cause of many heart attacks and the most common kind of stroke.
. . .
A review of alcohol consumption in women from the Nurses’ Health Study I and II found that smaller amounts of alcohol (about 1 drink per day) spread out over four or more days per week had the lowest death rates from any cause, compared with women who drank the same amount of alcohol but in one or two days. [39]
. . .
The benefits of moderate drinking aren’t limited to the heart. In the Nurses’ Health Study, the Health Professionals Follow-up Study, and other studies, gallstones [40, 41] and type 2 diabetes [32, 42, 43] were less likely to occur in moderate drinkers than in non-drinkers. The emphasis here, as elsewhere, is on moderate drinking.
Yet if you want to buy some cancer medication from a pharmacy... sorry you need a doctor's permission.
Huh, imagine that. A potent drug designed to help kill cancer which can also ruin your body, can't be bought from your corner store without permission. Wonder why that is.
With all your nonsensical rambling, is this something you read [imgur.com]?
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Sure, with my particular rare, incurable disease, I am probably more of an expert that 99% of doctors in the specialty, but, as far as I ca
Re: Make this apply everywhere... (Score:2)
Homeopathic "doctors" with mod points huh? Shit show ftw
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Saw a study where people who used homeopathics were actually healthier then average, it was conjectured due to the advice to exercise and eat healthy that came along with the homeopathy. Things are not so simple.
Re: Make this apply everywhere... (Score:2)
All doctors say you should eat right, not just quacks.
Cochrane confirms ... (Score:2)
Are there enough meta analysis of meta analysis papers yet to do a meta analysis on them?
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That is one of the problems with modern scholarship. The original data can be dangerously poor, or incomplete, but the layers of meta-analysis are astonishingly vulnerable to bias. I'm afraid it's not merely a problem in the soft sciences: the "dark matter" proofs seem vulnerable to similar over-complex analysis of what is quite limited raw data.
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Are there enough meta analysis of meta analysis papers yet to do a meta analysis on them?
ooh!!!
I know a nifty technique would could use to make a model to analyze the numbers and find out!
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>Are there enough meta analysis of meta analysis papers yet to do a meta analysis on them?
metabe, metabe not. :)
Phenylephrine HCl works great for me (Score:2)
Phenylephrine HCl works great for me, which makes me wonder whether these studies showing its ineffectiveness were done in a population that did not follow the dosage guidelines and took more than the recommended dosage, which feeds into a positive feedback loop of increasing doses vs increasing dose tolerance. Anyone who falls into this pattern will quickly find that the drug has little or no effect due to tolerance. This is a very well-known characteristic of decongestants, which is why I try to avoid th
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You're one of the few people it works for.
For most of us, it's as useful as a sugar pill. I tried it once, many years ago when they first put the real stuff behind the counter. It did absolutely nothing, I had to go back and be treated like a criminal to buy the (suddenly more expensive) pseudoephedrine.
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Interesting. I've noticed another feedback thing in pseudoephedrine, more congestion than I started with after going off it. And it has minor side effects systemically, some good, some bad. Low-key weird drug. So I use it sparingly. What I like to call psuedo-pseudoephedrine (phenylephrine) sounds like a good solution for you.
Pseudoephedrine is still fairly easy to buy. You just show your license. You don't need a prescription, but can only buy x amount every three months. Some pharmacies have stopped carry
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I wonder if it's not just the acidic effect which helps, with the difference in PH and titratable acidity being the determining factor rather than the supposed active compounds.
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Oops, that stuff is not topical. Nevermind.
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Phenylephrine HCl doesn't work for me as a decongestant but as an antihistamine. To that end, it doesn't work as well as Benadryl (diphenhydramine HCl) or Nyquil, but it doesn't make me drowsy, and it plus a nasal rinse (Neti pot) works better than pseudoephedrine alone ever did.
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I use RO water heated for a few seconds in an electric kettle because running the tap until the water warms up takes much longer. So safety and convenience coincide nicely for me.
Hah! You made a funny! [youtube.com]
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It's classic Actifed for me. I don't think they even make it any more because of the scare storm about making meth from PE (very much not the best way to make it), bit you can still get generics.
Start with two Sudafeds worth of PE, then add some stuff called Triprolidine. [wikipedia.org] What you get will put me the fuck to sleep for four hours solid (after half an hour start delay), so I normally have to break them in half, which only makes my supply last longer. Lately I've started breaking the halves in half to see if
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Re: Phenylephrine HCl works great for me (Score:2)
Actually, you are a dumbass, anonymous shitbag.
Hereâ(TM)s a link to a letter that better explains the situation:
https://college.acaai.org/wp-c... [acaai.org]
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DEA shouldn't have a hand in healthcare (Score:5, Insightful)
This is what happens when law enforcement gets to interfere with our country's healthcare. The idea that an entire society has to suffer poorer healthcare because a minuscule fraction of the population will use a drug to have fun is something only authoritarian goons could dream up.
The same situation is currently playing out with several ADHD drugs as we speak (mass shortages based on arbitrary DEA-imposed restrictions). It has also held back research into various psychedelic drugs as effective treatments for PTSD, treatment-resistant depression, and others.
The DEA has got to go, but a good first start would be keeping them far away from our medicines and healthcare. The idea that we have to have an entire office of armed police with the sole aim of making sure that a small subset of the population can't get high or self-medicate is asinine.
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It reminds me of being in grade school. First or second grade. Long time ago... Anyway, one of the kids did something stupid, the teacher got angry, and said that we would all be punished until the person who did the thing came forward. And I sat there thinking, "Why should I be punished because some other kid is being the problem?"
Anyway, can pseudo be used to make meth or whatever? Sure. I'm sure it can. But I'm not making meth. I want to be able to breathe. Don't make life any harder on me, I'm not the p
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Someone has never had to live in a trailer park or weekly stay hotel with a few meth labs. Once they get to cooking, it's nonstop noxious fumes and jankers with bad teeth stealing everything in sight for another fix. No copper wires or cabling will be safe! If that's your idea of people "using a drug to have fun" then no thank you.
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It doesn’t sound like fun to me, but what do you think is responsible for these jankers having to go to such lengths to get what would amount to a few bucks worth of product if it wasn’t illegal. It sounds like a medical problem, honestly. Once you get the cops involved, now you have two problems.
Color me unconvinced (Score:3)
Sure, could be true.
But we've had mass "THING doesn't work at all!!" hysterias before.
You may have noticed, for example, that antidepressants still exist. That's because they work. Ask the man on the street though, and he'll believe that they don't work, because oh noes meta analysis and lots of news stories.
Re:Color me unconvinced (Score:5, Interesting)
Except that phenylephrine doesn't work.
It was pushed on us during the meth panic. I only ever bought it once, because once was all I needed to know taking it was pointless.
And big pharma knew it didn't work many years ago, a friend is a research scientist with one of them, and he not only agreed with me that it was useless, he knew why it didn't work. (I don't remember the explanation, I'm not that good with organic chemistry.) But of course they were making money with it, so there was no incentive for them to tell the FDA.
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Nasally it works. (Any why flood the whole body with a drug that's only needed in a bit of the nasal passages?)
But I've read comments here that it works but the current dosage recommendation is wrong. I plan to test that later, but nasal decongestants work so well and quickly that pills are more for when you can't get the good stuff. (Warnings: you need to limit your usage to avoid rebound congestion, and oxymetazoline works but is a stimulant that may cause insomnia.)
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>I only ever bought it once, because once was all I needed to know taking it was pointless.
this.
pseudoephedrine is my idea of "wonder drug". It's generally their *only* relief available for either my allergies or sinus headaches.
my wife bought the phenyl wannabe once, not knowing better--and it, quite spectacularly, did nothing.
OK, it's actually #3 in effectiveness.
#2. hot arid air. A car that's been sitting in the sun all day on a 110 degree day in vegas. Hop in and close the door quickly. Also the
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Glucosamine is sold as a dietary supplement. The corp selling it can't make any health claims about it.
It's just supposed to be mostly harmless.
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The fact that phenylephrine doesn't work as a decongestant has been known since long before the pseudoephedrine ban. That's why it wasn't used as a decongestant! It's not a new drug.
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Ask the man on the street though
No thanks. I don't ask random people on the street about medical advice. That would be dumb.
FDA (Score:2)
The FDA doesn't want to be responsible for anything any more.
About 20 years ago they changed the way they monitor the safety of medical devices. Now, the onus of evaluating if a medical device is safe in the wild is on the manufacturer. The manufacturer has to collect all the data, interview doctors, and evaluate health care trends to see if their devices are safe. They have to file this paperwork with the FDA and, if the FDA decides they didn't do a good job or come to the correct conclusion, the manufactu
Not really news. (Score:2)
We've long known that phenylepherine doesn't work. It does a great job at raising some blood pressure in some people. As a decongestant? No. Aside from being one of the more onerous examples of drug panic stupidity, this kind of thing causes other problems. By stigmatizing pseudoephedrine, which is a safe and effective medication, people went off to using all sorts of other crap which wasn't. They silently replaced the active ingredient in medications across the board and kept the same product names, so mos
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Pseudoephedrine gave me heart palpitations, so I don't know why everyone seems to think it's so safe we don't need alternatives.
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...so I don't know why everyone seems to think it's so safe we don't need alternatives.
That's because that ISN'T what "everyone seems to think". You've got that wrong and have not properly understood the complaint.
Literally *NOBODY* said: "there should be no other decongestant options than pseudoephedrine" - that's just something you've made up.
What people ARE saying is: "please don't replace actually effective medicines with ones we know DON'T work, especially for BS reasons".
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I'm sorry I didn't read all of your comment, and was operating on some different assumptions. I see how the situation with the branded medications must be frustrating and feels almost predatory. And if it's only 1% bioavailable orally, the replacement will do pretty much nothing. But I may be out of touch since I don't take combination drugs, but in my area I went to several pharmacies and couldn't buy phenylephrine. It seems that as a plain pill, it's already been supplanted (in my area, but presumably not
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Doctor shopping is real. Addicts would prefer the medical version rather than the street fentanyl or alternatively emptying veterinary fentanyl patches with a needle.
I'm not suggesting the DEA methodology actually gets results - most doctor shoppers go unpunished except for wrecking their bodies, and most also ultimately end up on the street drugs anyway. The prescription databases aren't even nationally unified, so the whole regimen has little point in the end if you have multiple states available to you
Oh man - you know how I figured it out? (Score:2)
Geniuses! (Score:2)
I've known for decades that oral phenylephrine does nothing. Anyone not susceptible to hypnotic suggestibility who has tried it has found the same thing.
Thanks a lot, Meth heads (Score:2)
Galling to think that people would be encouraged to sell the public drugs not known to work at all. Also, why are homeopathic things still being sold?
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Re:can't wait.... (Score:5, Insightful)
I'll start. The headline contains two wrong statement. 1) "Decongestants don't work" is not true. The correct statement is that decongestants **based on phenylephrine** don't work. 2) The two pharmacists did not "figure out" phenylephrine does not work. What they did is the effort to raise the previously known facts (known to the literature) to the FDA.
In practical terms we can all continue to ask get decongestants that contain pseudoephedrine and are known effective.
Ugh, just give me some pseudoephedrine. (Score:5, Interesting)
I'll start. The headline contains two wrong statement. 1) "Decongestants don't work" is not true. The correct statement is that decongestants **based on phenylephrine** don't work. 2) The two pharmacists did not "figure out" phenylephrine does not work. What they did is the effort to raise the previously known facts (known to the literature) to the FDA.
In practical terms we can all continue to ask get decongestants that contain pseudoephedrine and are known effective.
It's getting harder and harder to find cold/flu treatments with pseudoephedrine, even in the UK. A lot of other countries have banned it wholesale and replaced it with drugs like phenylephrine that don't work. Sure I can buy a phenylephrine solution off the shelf instead of behind the counter, but when I've got cold/flu symptoms bad enough I'm going to suck it up and talk to an actual person to get something that works.
All of this because a few people abuse the system and use it for recreational purposes, now that pseudoephedrine is hard to get they've moved onto other forms that doctors give out prescriptions for. Further more, people are doing this because we've made the safe production and distribution of less harmful recreational drugs (I.E. marijuana) highly illegal.
I don't care if the pharmacist collects my drivers license for a national database, I'm not going around to every chemist in the tri-county area to get enough pseudoephedrine for a home drug lab. I want something that will clear my symptoms up enough so I can function in daytime and sleep at night rather than having to cough up a lung and drain my sinuses every 20 mins.
Re: Ugh, just give me some pseudoephedrine. (Score:2)
I'm in the UK and have no problem getting pseudoephedrine; you just have to ask for it at the pharmacy, and insist you want pseudoephedrine and not the "equivalent" phenylephrine.
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I am also in the USA and this process is a hassle.
Also, living in Austin, TX we're now entering Cedar fever season [austinregionalclinic.com] (it's really "juniper [kxan.com] but I digress), and the amount of pseudoephedrine that they'll let you buy is insufficient for some who really suffer from this, and if one person is buying for a whole family it's pretty much impossible to get enough.
It's bad enough that some people have to plan months ahead -- they'll start "hoarding" (not that there's any shortage) pseudoephedrine months in advance so t
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I find it kind of hard to believe that a pharmacist would break the law on that, even a rural one -- I mean, the government will take their license over stuff like that with a quickness.
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The legal limits per individual [usdoj.gov] are (1) 3.6 g / day, (2) 7.5 g / 30 days via mail order, and (3) 9 g / 30 days via any method. A single 24-hour Claritan-D pill contains 240 mg of pseudoephedrine sulfate, and taking one pill per day over 30 days is 7.2 g, which is under the limit via mail order.
These limits are more than enough for occasional short-term use. For prolonged use and for use for children, doctors should be consulted, in which case, I imagine they can issue a prescription for any amounts that
Re: Ugh, just give me some pseudoephedrine. (Score:2)
There is always a line of 10+ elderly people at the pharmacy window. Or the pharmacy is closed but the rest of the store is open. Sometimes buying only what is accessible to the public is the only option for those of us that aren't retired.
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I'm in the UK and have no problem getting pseudoephedrine; you just have to ask for it at the pharmacy, and insist you want pseudoephedrine and not the "equivalent" phenylephrine.
Not around my area, (central berks), you've got to ask for the product by name otherwise they try to direct you to the phenylephrine.
I do ask for it but think having to insist upon it is utter nonsense.
Plus I was talking on an international scale, I believe Australia has banned it outright along with OTC codeine pain killers (you can still get ibuprofen + codeine OTC at boots fortunately).
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2) The two pharmacists did not "figure out" phenylephrine does not work. What they did is the effort to raise the previously known facts (known to the literature) to the FDA.
Right after they moved pseudoephedrine behind the counter there were grumblings that phenylephrine didn't work. [go.com] It just took 18 years for the FDA to take the complaints seriously.
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Way more important to stop people from cooking meth. Except it didn't stop them.
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Yup. I couldn't figure out why my cheap Walmart off-brand knockoff of Sudafed stopped working on my crippling sinus headaches, so I spent the extra cash and started getting name-brand Sudafed... which also didn't do a thing for those headaches. Only afterwards did I look closely at the ingredients and realized they had pulled a bait-and-switch on me. "PE" no longer stands for "pseudoephedrine" which works great; it stands for "phenylephrine" which, as anyone who has tried the stuff already knows, doesn't wo
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It's not just PE, some countries have also restricted DXM (for coughs) to have it replaced with some alternative that's known not to work. I checked our national database that records hospital admissions for drug/med misuse and over a 20-year period there were three cases from DXM. So they've withdrawn the one cough suppressant you could still get that actually works because of less misuse cases than the number of people who get stuck by lightning every year.
Re: can't wait.... (Score:2)
Look, it's rare that I get to say "I told you so". So don't take that away from me. But phenylephrine is crap. It doesn't work, and I have had better results spending my money on herbal tea than on that garbage.
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The body's immune system seems like it should be able to handle problems like congestion.
congestion is an immune response.
it's not a disease, it won't kill you, it's normal and it's just a qol thing. you definitely don't need a placebo for it. my recommendations are nasal showers, preferably with salty or sea water or a steam bath, or just a little bit of self control and patience, fss ... people these days ...
you can use a decongestant (better one of those which do actually work) in case of emergency (say, you have a hard time breathing in your high intensity exercise session) but they tend to
Re: Root of congestion (Score:2)
Decongestants help my eustachian tubes clear.
The "farm issue" (Score:2)
The data suggests that because agricultural people evolved around farm animals, the body evolved to expect to be exposed to farm germs early in life. Most don't get that now, and it throws off the immune system.
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The war on drugs is going about as well as the last war Nixon was involved in. It's long-past time we put an end to this nonsense. The war on drugs has ruined more lives and caused more harm than drugs have without netting us any benefits in exchange for all that suffering.
End the stupid drug war and bring back cold medicine that actually does something.