5 ms·

As someone who has worked in healthcare for 20+ years now, at least in those circles it was widely known that phenylephrine was a placebo at best, when it was m

As someone who has worked in healthcare for 20+ years now, at least in those circles it was widely known that phenylephrine was a placebo at best, when it was mandated as the on the shelf replacement for psuedoephedrine (Sudafed) nasal decongestant. Again in healthcare circles there was a clear understanding of this being a DEA driven policy to replace an effective medicine that could be abused to create methamphetamine with a different medicine that was ineffective but could not be turned into street drugs. As best as I can tell the policy resulted in harm to millions of people while not reducing the spread and availability of methamphetime one bit and ancillary costs to the healthcare system in the billions of dollars. Off the top of my head, https://pubmed.ncbi.nlm.nih.gov/19230461 https://pubmed.ncbi.nlm.nih.gov/19230461 from 2009 but there are many earlier studies as I recall.

tobinfricke 3y ago
I often wondered why German pharmacies continue to stock homeopathic remedies. Maybe phenylephrine was our equivalent? As someone who suffered chronic congestion, and had experienced the effectiveness of pseudoephederine, it was immediately obvious that phenylephrine did nothing. It's just surprising that this "open secret" has taken 20+ years to be publicly confronted.
- bitwize 3y ago
  Zinc gluconate is often promoted as "homeopathic", but the formulations sold e.g. as Zicam do contain the active ingredient in significant amounts and, apparently, are effective at shortening or mitigating colds if taken early enough.
  - tobinfricke 3y ago
    Zinc is literally the only pharmaceutical intervention that has been shown to possibly have efficacy in reducing the length of the common cold. But it's not homeopathic -- the defining property of "homeopathic" remedies is that they have been progressively diluted until they consist of only pure water.
- RCitronsBroker 3y ago
  fellow german and medical student here. the reason is twofold. The first part is pretty obvious, it’s a great way to make money for pharmacists and physicians, it’s pretty much unregulated, has huge margins and is often paid by the patient instead of the gesetzliche Krankenkassen. The second part, why they are getting away with it, is that naturalistic and pseudoscientific healing BS has a long, long history in Germany. Schulmedizin, at least somewhat, had the image of being perverted by Jewish influences. "Völkische Medizin" the OG Heilpraktiker in some sense, started most of the Quack stuff you see today. The same circles are also still infested with nationalist and anti-jewish sentiments á la "the globalists" to this very day. It’s a crazy, crazy world if you take a closer look.
  - deleted 3y ago
    [deleted]
  - tobinfricke 3y ago
    Yikes! I did not know this.
tjohns 3y ago
Even outside of healthcare circles, most folks I know were aware from anecdotal experience that the OTC phenylephrine was practically useless, and that the psuedoephedrine behind the counter was the way to go if you had a cold. Night and day difference between the two. The only problem is that the pharmacy always seems to be closed when you need it.
dan_quixote 3y ago
For the last 20+ years, I've lived in states where you had to show ID at the pharmacy counter to get your hands on the real thing. So I made it my (probably annoying) mission to ask every pharmacist if phenylephrine was effective for anyone. I don't recall a single time I got a "yes".
- whatshisface 3y ago
  It shows you something about the priorities of the system that the company got a similarly-named substitute to sell (that's what they need out of medicine), but we didn't get a substitute for what we needed out of the medicine.
tootie 3y ago
From what I've read there are basically no effective treatments for coughing. Dextromethorphan and guafenesin are equally useless. Or at least no better than staying hydrated.
- toast0 3y ago
  Dextromethorphan has some effect at least. Not sure that it helps much with coughing, but it does something. I've heard codine can help with coughing although again the primary effect seems to be sedation. IME, guafenesin can be helpful for making coughs more productive, hydration helps with that too, and again IME, so do spicy foods. Mixing cough suppresants and expectorants together makes no sense, but is common --- if I'm trying to clear the junk in my lungs with an expectorant, why am I supressing the coughs that are needed?
  - tootie 3y ago
    Guafensin is the only one I've been recommended to use by a doctor but that was a few years ago. I think it hasn't stood up to scrutiny based on what I've read more recently.
  - kube-system 3y ago
    > I'm trying to clear the junk in my lungs with an expectorant, why am I supressing the coughs that are needed? Because you need sleep too. And if a cough isn’t productive, having more of them doesn’t help, it only hurts. The ideal case is to have a minimal number of coughs that are productive.
    - toast0 3y ago
      Well, expectorant in the morning, and suppressant before bed?
      - kube-system 3y ago
        I usually just take a cough suppressant anytime it feels like I am coughing unnecessarily, and take an expectorant if I feel like I have phlegm stuck in me. No matter the time of day.
tehwebguy 3y ago
Incredible — DEA couldn’t harm enough people directly with their budget so they laundered the task out to CVS and Johnson & Johnson!
sfn42 3y ago
Welcome to the war on drugs - Ruining lives and wasting huge amounts of money for absolutely zero benefit since forever.

tobinfricke 3y ago

I often wondered why German pharmacies continue to stock homeopathic remedies. Maybe phenylephrine was our equivalent? As someone who suffered chronic congestion, and had experienced the effectiveness of pseudoephederine, it was immediately obvious that phenylephrine did nothing. It's just surprising that this "open secret" has taken 20+ years to be publicly confronted.

bitwize 3y ago
Zinc gluconate is often promoted as "homeopathic", but the formulations sold e.g. as Zicam do contain the active ingredient in significant amounts and, apparently, are effective at shortening or mitigating colds if taken early enough.
- tobinfricke 3y ago
  Zinc is literally the only pharmaceutical intervention that has been shown to possibly have efficacy in reducing the length of the common cold. But it's not homeopathic -- the defining property of "homeopathic" remedies is that they have been progressively diluted until they consist of only pure water.
RCitronsBroker 3y ago
fellow german and medical student here. the reason is twofold. The first part is pretty obvious, it’s a great way to make money for pharmacists and physicians, it’s pretty much unregulated, has huge margins and is often paid by the patient instead of the gesetzliche Krankenkassen. The second part, why they are getting away with it, is that naturalistic and pseudoscientific healing BS has a long, long history in Germany. Schulmedizin, at least somewhat, had the image of being perverted by Jewish influences. "Völkische Medizin" the OG Heilpraktiker in some sense, started most of the Quack stuff you see today. The same circles are also still infested with nationalist and anti-jewish sentiments á la "the globalists" to this very day. It’s a crazy, crazy world if you take a closer look.
- deleted 3y ago
  [deleted]
- tobinfricke 3y ago
  Yikes! I did not know this.

tjohns 3y ago

Even outside of healthcare circles, most folks I know were aware from anecdotal experience that the OTC phenylephrine was practically useless, and that the psuedoephedrine behind the counter was the way to go if you had a cold. Night and day difference between the two. The only problem is that the pharmacy always seems to be closed when you need it.

dan_quixote 3y ago

For the last 20+ years, I've lived in states where you had to show ID at the pharmacy counter to get your hands on the real thing. So I made it my (probably annoying) mission to ask every pharmacist if phenylephrine was effective for anyone. I don't recall a single time I got a "yes".

whatshisface 3y ago
It shows you something about the priorities of the system that the company got a similarly-named substitute to sell (that's what they need out of medicine), but we didn't get a substitute for what we needed out of the medicine.

tootie 3y ago

From what I've read there are basically no effective treatments for coughing. Dextromethorphan and guafenesin are equally useless. Or at least no better than staying hydrated.

toast0 3y ago
Dextromethorphan has some effect at least. Not sure that it helps much with coughing, but it does something. I've heard codine can help with coughing although again the primary effect seems to be sedation. IME, guafenesin can be helpful for making coughs more productive, hydration helps with that too, and again IME, so do spicy foods. Mixing cough suppresants and expectorants together makes no sense, but is common --- if I'm trying to clear the junk in my lungs with an expectorant, why am I supressing the coughs that are needed?
- tootie 3y ago
  Guafensin is the only one I've been recommended to use by a doctor but that was a few years ago. I think it hasn't stood up to scrutiny based on what I've read more recently.
- kube-system 3y ago
  > I'm trying to clear the junk in my lungs with an expectorant, why am I supressing the coughs that are needed? Because you need sleep too. And if a cough isn’t productive, having more of them doesn’t help, it only hurts. The ideal case is to have a minimal number of coughs that are productive.
  - toast0 3y ago
    Well, expectorant in the morning, and suppressant before bed?
    - kube-system 3y ago
      I usually just take a cough suppressant anytime it feels like I am coughing unnecessarily, and take an expectorant if I feel like I have phlegm stuck in me. No matter the time of day.

tehwebguy 3y ago

Incredible — DEA couldn’t harm enough people directly with their budget so they laundered the task out to CVS and Johnson & Johnson!

sfn42 3y ago

Welcome to the war on drugs - Ruining lives and wasting huge amounts of money for absolutely zero benefit since forever.