4 ms·

This strikes me as an example of a larger phenomenon. Take for example the counter-insurgency wars that have become normalized since 9/11. In these conflicts,

This strikes me as an example of a larger phenomenon. Take for example the counter-insurgency wars that have become normalized since 9/11. In these conflicts, there is enormous pressure to minimize casualties because these directly undermine the political will to conduct military operations. As such, the strategic objectives eventually degenerate to mere "presence", and commanders are effectively unable to pursue the kinds of operations that might actually translate into military success. Similarly, we've collectively decided that selling an OTC drug that is effectively inert is somehow preferable to selling a useful-but-abusable substance, at which point one might argue that it's even safer to sell nothing at all.

tptacek 3y ago
(1) I think there's pretty wide agreement that selling Sudafed PE is worse than selling nothing at all, and I'd sort of expect it to be off the shelves sometime soon (it should have been much earlier than this). (2) "Selling nothing at all" is actually not the policy. Real Sudafed is simply a behind-the-pharmacy-counter drug. You don't need a script to get it (plenty of non-abusable drugs do require scripts, a much higher bar). Real Sudafed is to a first approximation available to everybody.
- omginternets 3y ago
  > Real Sudafed is to a first approximation available to everybody. I didn't actually know this, and it's good to know. That said, I'm not certain that most people are aware that it is available without a script. Maybe I'm wrong.
  - tptacek 3y ago
    If you walk up to the pharmacy counter at any Walgreens or CVS, literally the first thing you're going to see is a shelf of decongestants.
    - clipsy 3y ago
      I can’t speak for your Walgreens or CVS, but at mine you’ll see a shelf full of phenylephrine-based decongestants only, because the pseudoephedrine-based ones are behind the counter and out of sight.
      - idlewords 3y ago
        Lots of pharmacies display cards in the regular decongestant section that you can take up to the counter to get the ID-required OTC pills. It adds an annoying step, but they are hardly out of sight.
      - schrodinger 3y ago
        Not trying to be condescending, but are you sure you're referring to "behind the pharmacy counter (i.e. where the pharmacist stands)" rather than on the regular shelves? That's where it's prominent—although as someone else noted there are often "see the pharmacist for the real stuff" cards on regular shelves too.
        clipsy 3y ago
        Yes.
    - jgalt212 3y ago
      you need to provide a government ID. so probably not an option available to illegal aliens (in many states).
- skipkey 3y ago
  Not sure if it’s still the case, but a few years ago I was traveling and staying overnight near St Louis, and was shocked to find that it actually required a prescription there, but only in the county that St Louis was in.
orangepurple 3y ago
The Dutch take this to the extreme, where the actually effective anti-cough medication dextromethorphan is completely unavailable, but complete bullshit herbal mixes which claim to help are a dime a dozen on every store shelf. I can't even imagine the amount of needless suffering people with chronic cough go through in the Netherlands.
- rscho 3y ago
  The effectiveness of dextrometorphan is... underwhelming in most people. But you are correct that no effective cough suppressant is available OTC in Europe.
  - wrs 3y ago
    Dextromethorphan is one of the other “scientifically proven ineffective” OTC products mentioned by the authors. Once when I had a quite severe cough I did some (highly motivated) research and my conclusion was that there is no such thing as an effective cough suppressant. At least, none that isn’t also a consciousness suppressant.
    - pitaj 3y ago
      As a consciousness suppressant I wonder if DXM is safer than diphenhydramine. When I'm sick, being able to essentially sedate myself is honestly pretty valuable.
      - cmrdporcupine 3y ago
        DXM is crappy as a consciousness suppressant. At low doses it doesn't do much. At higher doses it's likely to do the opposite: make you dissociate and hallucinate. It doesn't help you sleep.
    - rscho 3y ago
      Low dose codeine is notoriously efficient.

tptacek 3y ago

(1) I think there's pretty wide agreement that selling Sudafed PE is worse than selling nothing at all, and I'd sort of expect it to be off the shelves sometime soon (it should have been much earlier than this). (2) "Selling nothing at all" is actually not the policy. Real Sudafed is simply a behind-the-pharmacy-counter drug. You don't need a script to get it (plenty of non-abusable drugs do require scripts, a much higher bar). Real Sudafed is to a first approximation available to everybody.

omginternets 3y ago
> Real Sudafed is to a first approximation available to everybody. I didn't actually know this, and it's good to know. That said, I'm not certain that most people are aware that it is available without a script. Maybe I'm wrong.
- tptacek 3y ago
  If you walk up to the pharmacy counter at any Walgreens or CVS, literally the first thing you're going to see is a shelf of decongestants.
  - clipsy 3y ago
    I can’t speak for your Walgreens or CVS, but at mine you’ll see a shelf full of phenylephrine-based decongestants only, because the pseudoephedrine-based ones are behind the counter and out of sight.
    - idlewords 3y ago
      Lots of pharmacies display cards in the regular decongestant section that you can take up to the counter to get the ID-required OTC pills. It adds an annoying step, but they are hardly out of sight.
    - schrodinger 3y ago
      Not trying to be condescending, but are you sure you're referring to "behind the pharmacy counter (i.e. where the pharmacist stands)" rather than on the regular shelves? That's where it's prominent—although as someone else noted there are often "see the pharmacist for the real stuff" cards on regular shelves too.
      - clipsy 3y ago
        Yes.
  - jgalt212 3y ago
    you need to provide a government ID. so probably not an option available to illegal aliens (in many states).
skipkey 3y ago
Not sure if it’s still the case, but a few years ago I was traveling and staying overnight near St Louis, and was shocked to find that it actually required a prescription there, but only in the county that St Louis was in.

orangepurple 3y ago

The Dutch take this to the extreme, where the actually effective anti-cough medication dextromethorphan is completely unavailable, but complete bullshit herbal mixes which claim to help are a dime a dozen on every store shelf. I can't even imagine the amount of needless suffering people with chronic cough go through in the Netherlands.

rscho 3y ago
The effectiveness of dextrometorphan is... underwhelming in most people. But you are correct that no effective cough suppressant is available OTC in Europe.
- wrs 3y ago
  Dextromethorphan is one of the other “scientifically proven ineffective” OTC products mentioned by the authors. Once when I had a quite severe cough I did some (highly motivated) research and my conclusion was that there is no such thing as an effective cough suppressant. At least, none that isn’t also a consciousness suppressant.
  - pitaj 3y ago
    As a consciousness suppressant I wonder if DXM is safer than diphenhydramine. When I'm sick, being able to essentially sedate myself is honestly pretty valuable.
    - cmrdporcupine 3y ago
      DXM is crappy as a consciousness suppressant. At low doses it doesn't do much. At higher doses it's likely to do the opposite: make you dissociate and hallucinate. It doesn't help you sleep.
  - rscho 3y ago
    Low dose codeine is notoriously efficient.