7 ms·

I feel like I'm living under a rock, how is everyone in these comments so intimately familiar with this subject? I've never heard the word "phenylephrine" in my

I feel like I'm living under a rock, how is everyone in these comments so intimately familiar with this subject? I've never heard the word "phenylephrine" in my life.

booleandilemma 3y ago
It's the internet. I have a feeling a lot of people are not. One tab for HN, another tab for wikipedia.
- HumblyTossed 3y ago
  That might define you, but not the rest of us. Think about it, most people likely to reply on this subject probably know something about it.
- jannyfer 3y ago
  I strongly agree that non-experts in HN comments write as if they are experts. Without some sort of upvote counter, it becomes hard to distinguish confident bullshit from expertise. Certain individuals are prolific bullshitters too. I’d read a questionable comment and notice it’s the same person. (My observation is general, not specific to this topic)
  - BobaFloutist 3y ago
    As someone who also browses Reddit, I assure you that an upvote counter does little to prevent confident bullshit.
- singleshot_ 3y ago
  It’s pretty handy to know the names of all these drugs because frequently there is a nineteen dollar package of Advil and a nine dollar package of Walgreens Ibuprofen. It’s pretty easy to figure out all the names of these drugs because all the generics say things like “compare with Claratin.” And it’s smart to use the generic because the active ingredients are molecule for molecule the same. I guess the generics could be using cheap corn starch…
  - lazide 3y ago
    Some medications, the adjuvants/buffering compounds help a lot to alleviate issues or maximize the effectiveness of the drug. Things like PH buffers to do less damage to stomach linings, etc. Same with pesticides - the brand name products often include things like better surfactants that make them much more effective. At least based on the papers I’ve read. Not always of course.
alteriority 3y ago
https://xkcd.com/2501/ https://xkcd.com/2501/
kridsdale1 3y ago
Many of us have severe allergies. I came to the conclusion about these drugs on my own years ago.
willcipriano 3y ago
When I'm sick I "do my own research". If you are similar you are familiar with over the counter remedies and their purported effects. Not that many 'effective' medicines are available over the counter in the US and this was a very popular one.
orev 3y ago
If you take any kind of OTC medicine, it’s assumed that you’ll read the directions (which includes the list of ingredients). Clearly most people don’t, and they just rely on the marketing material printed on the box/bottle to understand what the medicine does. If they did read the ingredient list, people would realize that all those products in the pharmacy are mostly remixes of the same handful of chemicals sold at different prices.
- burkaman 3y ago
  I do know to always buy the generic version of a medicine when it's available, but I also generally rely on the FDA to not let companies lie about what a drug does. Apparently that has failed in this case. I guess I only buy decongestants like once a year at most though, I would probably pay more attention if I needed them more often.
- dessimus 3y ago
  Sure, but one hopes that a national brand takes care to avoid any type of contamination that might cause a scare on the level of the Tylenol scandal in the 80s. A generic making 20-some store brands might be more lax.
- AnthonyMouse 3y ago
  > If they did read the ingredient list, people would realize that all those products in the pharmacy are mostly remixes of the same handful of chemicals sold at different prices. This is one of the major problems with putting pseudoephedrine behind the counter. It had been an ingredient in many of these combination products -- after all, if you have a cold, you have the combination of symptoms that come with a cold and want to take the corresponding combination of drugs. But the combination products are convenience products. You could just as well buy the ingredients individually and take them together. People buy the combination product to be saved the trouble, which isn't compatible with the trouble of getting something from behind the counter. So there generally isn't a combination product available with the decongestant that actually works in them. And phenylephrine, in addition to not working, has more dangerous side effects (e.g. larger increase in blood pressure) than pseudoephedrine. But now it's the thing in the bottle grandma gets when she has a cold.
stephen_g 3y ago
Well for me I remember the big news about gangs buying up cold tablets for the pseudoephedrine that they had in them to make meth, so the pharmacies making it harder to buy them. Then the new ones on the shelves (which are marketed as ‘PE’ here) just plain don’t work at all, unlike the real ones (which you can still get but you have to ask the pharmacist for). So I read the ingredient list and googled it, and was annoyed to find my experience confirmed and that they’d replaced a really useful medication with one that basically everyone reported didn’t work.
- Scoundreller 3y ago
  > Well for me I remember the big news about gangs buying up cold tablets for the pseudoephedrine that they had in them to make meth, so the pharmacies making it harder to buy them. You missed the step where cartel super-producers (that didn’t depend on small qtys of feedstock from pharmacies) just started producing 5% more to make up for it. The organized producers appreciated the government shutting down their nibbling competitors. Sucks for the public though, paying the price for an ineffective measure.
  - tptacek 3y ago
    It's not that simple. Industrial-scale meth production (obviously) doesn't use Sudafed; amateur small-scale production does. But small-scale meth production has its own distinct externalities: it sites "meth labs" in residential areas, which catch fire, create hazardous waste problems (some of which require specialist cleaning crews), and attract additional crime. The policy doesn't have to cut off the meth supply to be successful on its own terms.
    - alwa 3y ago
      And for that matter, small-scale meth enthusiasts, wisely or not, were in fact robbing stores for it at the time. Meth access aside, there’s probably some social benefit to tamping down on robberies in these places where sick and vulnerable people need to go for their meds.
    - 3y ago
jfengel 3y ago
You may not know the word "phenylephrine", but you almost certainly know Sudafed (and perhaps its generic name, pseudoephedrine). If you live in the US or several other places, you probably know that the "good" Sudafed is kept behind the counter, and you have to sign for it. You may have also noticed that there is another version, called "Sudafed PE", that you can just pick up off the shelf. A lot of people have done that and concluded for themselves that the PE version didn't work. That's why there are so many people commenting that they already knew the thing the article is about. So... a lot of people were familiar with "PE", and apparently a lot of them knew that it stood for "phenylephrine". And it all touches on a bunch of existing controversy about why the effective medication is locked up. It wasn't always. People knew that Sudafed was an pretty effective drug. (It was even used, under a different brand, on Apollo missions -- there was a TV ad with an astronaut endorsing it.) A lot of people are grumpy that a well-known effective medicine was made hard to get, and something else sneakily substituted. The point being, it's not entirely a surprise that people are aware of the phenylephrine -- especially if they're older than, say, 40, and live in the United States. They remember, sniffily, when cold medicine started to suck.
- burkaman 3y ago
  Thanks this is helpful, I'm aware of the Sudafed/meth issue but I didn't realize the alternatives were all clearly labeled PE. That explains why it's so obvious to a lot of people.
  - deleted 3y ago
    [deleted]
  - gambiting 3y ago
    It isn't labeled as such in the UK. Both the "full fat" version and the placebo worthless one are just called Sudafed - but the proper one is kept behind counter and you have to ask for it.
- 6stringmerc 3y ago
  This is a fantastic write up and as for anecdotal confirmation, an award winning career journalist cited his “on deadline” setup was a box of Sudafed and a pot of Coffee, then a bottle of Jack Daniels once it was all in. Very effective compound and I also didn’t know the PE longhand…only went to the counter…
mdasen 3y ago
I think it'll depend on who you are. If you have allergies or often suffer from nasal congestion, you'll likely know it. If you're someone whose nose just kinda works, there's no reason you'd be aware of it.
pfranz 3y ago
Hard-won experience? I vaguely remember when Sudafed got put behind counters because it was used to make meth. I don't frequently get sick. Often, the last medication I bought is expired by the time I need it again. One year, I found something that worked for me. Another year, I thought I bought the same thing, but it just didn't work. The one I had originally bought (same brand) had a behind-the-counter version that worked. It's annoying to catch the pharmacy when it's open, but now I just ask the pharmacist for generic Sudafed with the smallest-lasting dose (so I can decide if I want to take more). I've found with most medications looking for an active ingredient and an amount is helpful. You can search for effectiveness or side-effects. The brand I got last time isn't always available and they'll have 3-hour or 12-hour versions with warnings about exceeding recommended dosages (or mixing medications). Or company annoyingly package similarly-branded things that just aren't the same.
- samtho 3y ago
  > I've found with most medications looking for an active ingredient and an amount is helpful. You can search for effectiveness or side-effects. Is this not common practice? I would be uncomfortable taking an ambiguously labeled “cold medicine” pill, personally. I know which medicines are effective for me and which are a waste of time and money.
  - lazide 3y ago
    The vast majority of the population has zero interest in looking at what is in medicine, and even less interest in researching those long complicated names. They buy a brand that promises to fix what they don’t like, and if it works, they buy more next time.
    - jampekka 3y ago
      This is something quite striking in US where there is a full aisle of "cold medicines", "headache pills", "back pain reliefs", "muscle ache aides" etc, and they are all the same stuff (ibuprofen/"Advil" or paracetamol/acetaminophen/"Tylenol") in different packages. In Finnish pharmacies it's mostly just three or so "generic" paracetamols or ibuprofens in different brands.
josefresco 3y ago
You must not have allergies. Congratulations. Joking aside, I wouldn't know a single thing about these drugs if I didn't have crushing seasonal allergies.
- rvbissell 3y ago
  My reply is a bit off-topic, but: I'm beginning to personally notice a correlation with sugar intake and degree of my allergy symptoms. I can't say if I was just oblivious before, or the personally correlation is recent. I started noticing it when I began avoiding foods containing sugars or breads. My allergies aren't completely gone, but they very much spike up when I relapse on my voluntary diet restriction.
  - josefresco 3y ago
    While I can't say I have definitive proof, my allergies decreased significantly after I was diagnosed with an autoimmune disease, and as a result started consuming less sugar (among other things like dairy). I still get allergies, but much less severe than then first 3 decades of my life.
  - Projectiboga 3y ago
    Allergies are worsened by dehydration. To rehydrate, drink one cup of water every 45 min and after you finish one put a speck of salt at the back of your tongue. Don't go over 8 max 10 cups in a day. Unless you're under extreme conditions you don't really need more than 5 cups per day once you're properly hydrated. The Eight Cups was developed for military basic training, not every day life. The other thing that can help allergies is washing your nose out with Ocean Nasal Spray (actual product name). The key is to pull it through your nose and caught it into your mouth and spit it out a couple of times in a row w fresh sprays. That clears mold and breaks that immune resistant slime, whatever it's called.
- Nick87633 3y ago
  I have seasonal allergies and I found an effective method for myself: When I realize the allergies are kicking in (usually after 6 hours of watery eyes and sneezing) I take a claritin and a zyrtec together, as well as spraying my nose with Flonase. Usually this knocks it off and I will keep taking one of the once-a-day meds for a bit to prevent reoccurrence. Zyrtec and Flonase together is probably the best normal combo and is generally accepted to be ok. Disclaimers: I'm not a doctor. Combining a nose spray and a pill is generally accepted practice and studied in several peer review studies I've seen. Stacking claritin and zyrtec pills together is not generally accepted practice, so don't do it.
simonebrunozzi 3y ago
Please make room for me under there. Same feeling. :(
milofeynman 3y ago
I think a lot of people watched this Vox video about sudafed 2 months ago and became armchair experts tbh: https://youtu.be/ZlFF7A8nk0w https://youtu.be/ZlFF7A8nk0w
- inemesitaffia 3y ago
  Some of us have first hand knowledge and found alternatives too
schwartzworld 3y ago
It's the "active" ingredient in most cold medicine. There's real Sudafed behind the counter, and everything else is just varying amounts of phenylephrine, acetaminophen, guaifenesin, and dextromethorphan. If you read labels for otc medication, you see these same names over and over again.
quickthrower2 3y ago
Lol… I am more familiar with it via watching Breaking Bad than anything else. But in general for any HN topic the people who have something to say get attracted to the article.
annoyingnoob 3y ago
I have bad allergies and have at times relied on Sudafed so that I could breath through my nose. It was apparent to me the very first time I tried a product where phenylephrine had replaced Sudafed that phenylephrine does not work at all. I never purchased another product with phenylephrine. I've found that conservative and non-continuous use of Afrin is a better option for me.
JohnFen 3y ago
I'm extremely familiar because I suffer from severe hayfever. When they made pseudoephedrine unavailable, it was immediately obvious that the replacement, phenylephrine, didn't work at all. So I have a sore spot about this whole issue. I get made to suffer in order for lawmakers to have an empty gesture toward addressing the meth problem.

I feel like I'm living under a rock, how is everyone in these comments so intimately familiar with this subject? I've never heard the word "phenylephrine" in my life.

booleandilemma 3y ago

It's the internet. I have a feeling a lot of people are not. One tab for HN, another tab for wikipedia.

HumblyTossed 3y ago
That might define you, but not the rest of us. Think about it, most people likely to reply on this subject probably know something about it.
jannyfer 3y ago
I strongly agree that non-experts in HN comments write as if they are experts. Without some sort of upvote counter, it becomes hard to distinguish confident bullshit from expertise. Certain individuals are prolific bullshitters too. I’d read a questionable comment and notice it’s the same person. (My observation is general, not specific to this topic)
- BobaFloutist 3y ago
  As someone who also browses Reddit, I assure you that an upvote counter does little to prevent confident bullshit.
singleshot_ 3y ago
It’s pretty handy to know the names of all these drugs because frequently there is a nineteen dollar package of Advil and a nine dollar package of Walgreens Ibuprofen. It’s pretty easy to figure out all the names of these drugs because all the generics say things like “compare with Claratin.” And it’s smart to use the generic because the active ingredients are molecule for molecule the same. I guess the generics could be using cheap corn starch…
- lazide 3y ago
  Some medications, the adjuvants/buffering compounds help a lot to alleviate issues or maximize the effectiveness of the drug. Things like PH buffers to do less damage to stomach linings, etc. Same with pesticides - the brand name products often include things like better surfactants that make them much more effective. At least based on the papers I’ve read. Not always of course.

alteriority 3y ago

https://xkcd.com/2501/ https://xkcd.com/2501/

kridsdale1 3y ago

Many of us have severe allergies. I came to the conclusion about these drugs on my own years ago.

willcipriano 3y ago

When I'm sick I "do my own research". If you are similar you are familiar with over the counter remedies and their purported effects. Not that many 'effective' medicines are available over the counter in the US and this was a very popular one.

orev 3y ago

If you take any kind of OTC medicine, it’s assumed that you’ll read the directions (which includes the list of ingredients). Clearly most people don’t, and they just rely on the marketing material printed on the box/bottle to understand what the medicine does. If they did read the ingredient list, people would realize that all those products in the pharmacy are mostly remixes of the same handful of chemicals sold at different prices.

burkaman 3y ago
I do know to always buy the generic version of a medicine when it's available, but I also generally rely on the FDA to not let companies lie about what a drug does. Apparently that has failed in this case. I guess I only buy decongestants like once a year at most though, I would probably pay more attention if I needed them more often.
dessimus 3y ago
Sure, but one hopes that a national brand takes care to avoid any type of contamination that might cause a scare on the level of the Tylenol scandal in the 80s. A generic making 20-some store brands might be more lax.
AnthonyMouse 3y ago
> If they did read the ingredient list, people would realize that all those products in the pharmacy are mostly remixes of the same handful of chemicals sold at different prices. This is one of the major problems with putting pseudoephedrine behind the counter. It had been an ingredient in many of these combination products -- after all, if you have a cold, you have the combination of symptoms that come with a cold and want to take the corresponding combination of drugs. But the combination products are convenience products. You could just as well buy the ingredients individually and take them together. People buy the combination product to be saved the trouble, which isn't compatible with the trouble of getting something from behind the counter. So there generally isn't a combination product available with the decongestant that actually works in them. And phenylephrine, in addition to not working, has more dangerous side effects (e.g. larger increase in blood pressure) than pseudoephedrine. But now it's the thing in the bottle grandma gets when she has a cold.

stephen_g 3y ago

Well for me I remember the big news about gangs buying up cold tablets for the pseudoephedrine that they had in them to make meth, so the pharmacies making it harder to buy them. Then the new ones on the shelves (which are marketed as ‘PE’ here) just plain don’t work at all, unlike the real ones (which you can still get but you have to ask the pharmacist for). So I read the ingredient list and googled it, and was annoyed to find my experience confirmed and that they’d replaced a really useful medication with one that basically everyone reported didn’t work.

Scoundreller 3y ago
> Well for me I remember the big news about gangs buying up cold tablets for the pseudoephedrine that they had in them to make meth, so the pharmacies making it harder to buy them. You missed the step where cartel super-producers (that didn’t depend on small qtys of feedstock from pharmacies) just started producing 5% more to make up for it. The organized producers appreciated the government shutting down their nibbling competitors. Sucks for the public though, paying the price for an ineffective measure.
- tptacek 3y ago
  It's not that simple. Industrial-scale meth production (obviously) doesn't use Sudafed; amateur small-scale production does. But small-scale meth production has its own distinct externalities: it sites "meth labs" in residential areas, which catch fire, create hazardous waste problems (some of which require specialist cleaning crews), and attract additional crime. The policy doesn't have to cut off the meth supply to be successful on its own terms.
  - alwa 3y ago
    And for that matter, small-scale meth enthusiasts, wisely or not, were in fact robbing stores for it at the time. Meth access aside, there’s probably some social benefit to tamping down on robberies in these places where sick and vulnerable people need to go for their meds.
  - 3y ago

jfengel 3y ago

You may not know the word "phenylephrine", but you almost certainly know Sudafed (and perhaps its generic name, pseudoephedrine). If you live in the US or several other places, you probably know that the "good" Sudafed is kept behind the counter, and you have to sign for it. You may have also noticed that there is another version, called "Sudafed PE", that you can just pick up off the shelf. A lot of people have done that and concluded for themselves that the PE version didn't work. That's why there are so many people commenting that they already knew the thing the article is about. So... a lot of people were familiar with "PE", and apparently a lot of them knew that it stood for "phenylephrine". And it all touches on a bunch of existing controversy about why the effective medication is locked up. It wasn't always. People knew that Sudafed was an pretty effective drug. (It was even used, under a different brand, on Apollo missions -- there was a TV ad with an astronaut endorsing it.) A lot of people are grumpy that a well-known effective medicine was made hard to get, and something else sneakily substituted. The point being, it's not entirely a surprise that people are aware of the phenylephrine -- especially if they're older than, say, 40, and live in the United States. They remember, sniffily, when cold medicine started to suck.

burkaman 3y ago
Thanks this is helpful, I'm aware of the Sudafed/meth issue but I didn't realize the alternatives were all clearly labeled PE. That explains why it's so obvious to a lot of people.
- deleted 3y ago
  [deleted]
- gambiting 3y ago
  It isn't labeled as such in the UK. Both the "full fat" version and the placebo worthless one are just called Sudafed - but the proper one is kept behind counter and you have to ask for it.
6stringmerc 3y ago
This is a fantastic write up and as for anecdotal confirmation, an award winning career journalist cited his “on deadline” setup was a box of Sudafed and a pot of Coffee, then a bottle of Jack Daniels once it was all in. Very effective compound and I also didn’t know the PE longhand…only went to the counter…

mdasen 3y ago

I think it'll depend on who you are. If you have allergies or often suffer from nasal congestion, you'll likely know it. If you're someone whose nose just kinda works, there's no reason you'd be aware of it.

pfranz 3y ago

Hard-won experience? I vaguely remember when Sudafed got put behind counters because it was used to make meth. I don't frequently get sick. Often, the last medication I bought is expired by the time I need it again. One year, I found something that worked for me. Another year, I thought I bought the same thing, but it just didn't work. The one I had originally bought (same brand) had a behind-the-counter version that worked. It's annoying to catch the pharmacy when it's open, but now I just ask the pharmacist for generic Sudafed with the smallest-lasting dose (so I can decide if I want to take more). I've found with most medications looking for an active ingredient and an amount is helpful. You can search for effectiveness or side-effects. The brand I got last time isn't always available and they'll have 3-hour or 12-hour versions with warnings about exceeding recommended dosages (or mixing medications). Or company annoyingly package similarly-branded things that just aren't the same.

samtho 3y ago
> I've found with most medications looking for an active ingredient and an amount is helpful. You can search for effectiveness or side-effects. Is this not common practice? I would be uncomfortable taking an ambiguously labeled “cold medicine” pill, personally. I know which medicines are effective for me and which are a waste of time and money.
- lazide 3y ago
  The vast majority of the population has zero interest in looking at what is in medicine, and even less interest in researching those long complicated names. They buy a brand that promises to fix what they don’t like, and if it works, they buy more next time.
  - jampekka 3y ago
    This is something quite striking in US where there is a full aisle of "cold medicines", "headache pills", "back pain reliefs", "muscle ache aides" etc, and they are all the same stuff (ibuprofen/"Advil" or paracetamol/acetaminophen/"Tylenol") in different packages. In Finnish pharmacies it's mostly just three or so "generic" paracetamols or ibuprofens in different brands.

josefresco 3y ago

You must not have allergies. Congratulations. Joking aside, I wouldn't know a single thing about these drugs if I didn't have crushing seasonal allergies.

rvbissell 3y ago
My reply is a bit off-topic, but: I'm beginning to personally notice a correlation with sugar intake and degree of my allergy symptoms. I can't say if I was just oblivious before, or the personally correlation is recent. I started noticing it when I began avoiding foods containing sugars or breads. My allergies aren't completely gone, but they very much spike up when I relapse on my voluntary diet restriction.
- josefresco 3y ago
  While I can't say I have definitive proof, my allergies decreased significantly after I was diagnosed with an autoimmune disease, and as a result started consuming less sugar (among other things like dairy). I still get allergies, but much less severe than then first 3 decades of my life.
- Projectiboga 3y ago
  Allergies are worsened by dehydration. To rehydrate, drink one cup of water every 45 min and after you finish one put a speck of salt at the back of your tongue. Don't go over 8 max 10 cups in a day. Unless you're under extreme conditions you don't really need more than 5 cups per day once you're properly hydrated. The Eight Cups was developed for military basic training, not every day life. The other thing that can help allergies is washing your nose out with Ocean Nasal Spray (actual product name). The key is to pull it through your nose and caught it into your mouth and spit it out a couple of times in a row w fresh sprays. That clears mold and breaks that immune resistant slime, whatever it's called.
Nick87633 3y ago
I have seasonal allergies and I found an effective method for myself: When I realize the allergies are kicking in (usually after 6 hours of watery eyes and sneezing) I take a claritin and a zyrtec together, as well as spraying my nose with Flonase. Usually this knocks it off and I will keep taking one of the once-a-day meds for a bit to prevent reoccurrence. Zyrtec and Flonase together is probably the best normal combo and is generally accepted to be ok. Disclaimers: I'm not a doctor. Combining a nose spray and a pill is generally accepted practice and studied in several peer review studies I've seen. Stacking claritin and zyrtec pills together is not generally accepted practice, so don't do it.

simonebrunozzi 3y ago

Please make room for me under there. Same feeling. :(

milofeynman 3y ago

I think a lot of people watched this Vox video about sudafed 2 months ago and became armchair experts tbh: https://youtu.be/ZlFF7A8nk0w https://youtu.be/ZlFF7A8nk0w

inemesitaffia 3y ago
Some of us have first hand knowledge and found alternatives too

schwartzworld 3y ago

It's the "active" ingredient in most cold medicine. There's real Sudafed behind the counter, and everything else is just varying amounts of phenylephrine, acetaminophen, guaifenesin, and dextromethorphan. If you read labels for otc medication, you see these same names over and over again.

quickthrower2 3y ago

Lol… I am more familiar with it via watching Breaking Bad than anything else. But in general for any HN topic the people who have something to say get attracted to the article.

annoyingnoob 3y ago

I have bad allergies and have at times relied on Sudafed so that I could breath through my nose. It was apparent to me the very first time I tried a product where phenylephrine had replaced Sudafed that phenylephrine does not work at all. I never purchased another product with phenylephrine. I've found that conservative and non-continuous use of Afrin is a better option for me.

JohnFen 3y ago

I'm extremely familiar because I suffer from severe hayfever. When they made pseudoephedrine unavailable, it was immediately obvious that the replacement, phenylephrine, didn't work at all. So I have a sore spot about this whole issue. I get made to suffer in order for lawmakers to have an empty gesture toward addressing the meth problem.