8 ms·

Should DayQuil Be Legal?

241 points by paulpauper 4mo ago

daft_pink 4mo ago
I think it’s outrageous that pseudoephedrine has become difficult and annoying to purchase while they put that ineffective garbage out through all these combo drugs.
nekusar 4mo ago
All drugs should be legal, full stop. And I should be able to get medical drugs on my own, without a permission slip from a doctor I have to convince. Drug prohibition has caused magnitudes more harm than decriminalization and legalization. And part of this article is about claims from what is likely inert or mild effect at best. Remember, we used to have amphetamines, pseudoephedrine, and much more potent drugs to alleviate colds and such. But because of the forever-drug-war , we're stuck with substandard crap, and everything good gatekept by doctors.
- antonkochubey 4mo ago
  Are you sure you have read the article, not just its title?
  - nekusar 4mo ago
    Yes, and the question lends itself to control (or lack of) by relevant medical "authorities". I honestly do not trust somebody with a doctor license who I talked to for 7 minutes out of 259200 minutes (6 months). For example, when I went on a camping trip, I got bit by 15 ticks. After I got back, went to doc for 15 day doxycyclene, gold standard. And its cheap, like $15. NOPE, fucker wanted the ticks in a bag to grind up and waste a $400 Lyme test. And that test is only 60% accurate, tons of false negatives. If I could have, I would have bought doxy, scaled it to my weight, and did the 15 day run. But nope. I ended up getting the second recommended, amoxicilian as "fish antibiotics".
    - bigfishrunning 4mo ago
      One of the reasons doxycyclene is so effective is because it's less overprescribed. Antibiotic resistance is a real thing, and the day we run out of viable ones is going to be ugly. Having a gatekeeper isn't a bad idea.
      - Sohcahtoa82 4mo ago
        To add to this, despite all efforts to educate people, many STILL don't know that antibiotics don't work against viruses and will want one when dealing with a cold or other viral infection. If we let antibiotics be over-the-counter, every damn infectious bacteria will be a super-strain in a year.
        nekusar 4mo ago
        Antibiotics are routinely given to all of their farm animals as part of their food, for prophylaxis. But allowing humans to buy when they're sick is somehow the super-strain-end-of-times?? Antibiotics stop bacteria. Antivirals stop viruses. Except bacteria can be attacked whenever, the sooner the better. Antivirals need a rapid and early timeframe to work. Getting a fucking doctor to say yes is almost always too long, and you missed your treatment window. That is unless you go the ER, and lucky to not get shoved aside. Then pay $$$$$
        Melatonic 4mo ago
        Those are two separate issues and we obviously should not be just giving feedstock and animals antibiotics constantly. That's no good for anyone. Maybe the better solution is that the government should be paying for the Lyme test as a public health measure. Knowing which areas it is spreading too is extremely important. And on the flip side I know someone whose father got Lyme but didn't know it for years - he was not very symptomatic at first and ended up with major nerve damage. Not one to mess around with
        bigfishrunning 4mo ago
        > Antibiotics are routinely given to all of their farm animals as part of their food, for prophylaxis. That's also a problem [0]; and it's one that can't be solved by creating a second, somewhat related problem. 0: https://pmc.ncbi.nlm.nih.gov/articles/PMC11200672/ https://pmc.ncbi.nlm.nih.gov/articles/PMC11200672/
  - stickfigure 4mo ago
    When an article has a misleading clickbait title, I think it's fair game to redirect the conversation to the subject of the title.
- robertpateii 4mo ago
  Read the article. It doesn’t even ask if dextromethorphan and phenylephrine should be illegal. It asks if intentionally misleading consumers about their efficacy should be.
- CommieBobDole 4mo ago
  The article is not about "should people be allowed to buy this product because it's potentially dangerous/addictive/etc" but "Should the company be allowed to sell this product because it consists of acetaminophen plus two useless ingredients and is basically a scam".
- techbro92 4mo ago
  What is the argument for legalizing drugs that are contraindicated for all medical purposes, are toxic, and have a high addictive potential? How does it benefit me or society if my neighbor is permitted to choose to basically roll the dice on afflicting themselves with a debilitating chronic illness (severe addiction)? If I don’t want to do illegal drugs why would I ant to support this?
  - tyami94 4mo ago
    [dead]
  - yomismoaqui 4mo ago
    - People that want to do drugs already can buy them, with worse quality and the with the side-effect of funding crime at a planetary scale. - Alcohol, tobacco & weed are already legal... why them and no other drugs? Check how many deaths do alcohol & tobacco provoke. - Taxes, lots of taxes, literal mountains of money... a small percentage of which can be redirected to treating addicts.
  - the_sleaze_ 4mo ago
    I went to a southeast asian country and got a staph infection. I walked down to the pharmacy, asked the pharmastst for a topical and an oral antibiotic. 3 days later i was healed, continued the course the rest of the week and that was it. $12 dollars american. I got another staph infection previously in the united states. Needed to go to a doc in the box who misdiagnosed it. A few days went by and i needed to go to another doc in the box who gave me topical and trued to give me a steroid shot. Needless to say it progressed and turned into fullblown MRSA which required admitance and a IV antibiotic. Extremely painful. I don't have the ability to add the costs but north of $10k easily. That's why drugs should be legalized.
    - ikesau 4mo ago
      I'm sorry that happened to you. Sincerely. That sounds incredibly frustrating, painful, and scary. I think your maximalist conclusion of "drugs should be legalized" might have some second-order effects that might be net worse for society, though. Addiction, misuse, MRSA, overdoses, etc.
- rustcleaner 4mo ago
  Agree with you. It is a collateral consequence of the War on Drugs™ that everything good and effective is getting locked behind a $50-$200 doctor's visit for a 'scrip. This scam medicine problem could be helped if a bunch of substances were moved out of Rx and back to OTC. The nanny state will continue to grow to meet people's definitions on how much others should be warded.
robobro 4mo ago
Dextromethorphan is definitely not a placebo. Take enough and you'll go to space and meet God. Smaller doses produce euphoria and dissociation, which, even if they don't make the cough go away, makes it easier to tolerate a cold -- same reason antitussives have historically contained alcohol, cannabis extract (which may incidentally work as bronchodilator but was not the reason I imagine it was in antitussives) Funny amphetamine used to be an over the counter cold medicine, which the article doesn't mention despite talking about the meth precursor? Fine article but these two details stuck out to me while reading it.
- jona-f 4mo ago
  Came here to say this, the author is hating on dextromethorphan like he never robotripped before. But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that.
  - MisterTea 4mo ago
    > But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that. Ketamine is neurotoxic itself and can cause permanent brain damage. I can't find the info but there was someone in the tech industry who accidentally overdosed and suffered a two year bout of severe debilitating depression culminating in suicide.
    - sph 4mo ago
      Sorry to say, we shouldn't really base our opinion on drug safety from people who accidentally overdose or are generally reckless with drugs. There's people who drink for the first time and end up in the hospital. If you want to do it the smart way, just consult erowid.org and use a little common sense. https://erowid.org/chemicals/ketamine/ketamine_faq.shtml https://erowid.org/chemicals/ketamine/ketamine_faq.shtml
      - MisterTea 4mo ago
        The post I replied to stated that a DXM OD is dangerous then mentions ketamine without stating its OD dangers giving it the appearance of a safe alternative.
robertpateii 4mo ago
Yeah, intentionally misleading consumers should always be at least somewhat illegal. Sure caveat emptor, but consumers having accurate information is implied and a cornerstone of a competitive market.
- ryandrake 4mo ago
  "Caveat Emptor" and "Do your own research" is not a basis for a functional society. Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level. And letting marketing decide what counts as "accurate information" is just letting the fox guard the henhouse.
  - ultrarunner 4mo ago
    Counterpoint: 54% of adults read below a sixth-grade level because a society has been created to facilitate (and encourage) just that. Encouraging a population to rely on the thought processes of others is exactly what leads to over reliance on marketing.
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  - mindslight 4mo ago
    > Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level This is obvious, but thank you for putting it so succinctly. One has to wonder how much support for "do your own research" is driven by people who want to remain proudly-in-denial about their own inabilities.
    - ryandrake 4mo ago
      It's no surprise that the political party/forces pushing on policies that result in worse education and literacy outcomes are the same ones who want "Buyer Beware" and "Do your own research" to be fundamental product regulatory principles.
mindslight 4mo ago
The more general deeply-entrenched golden goose here is branding, which applies to much more than OTC medicines. Make it so the active ingredients have to be listed prominently - the largest text on the front of the product package - and these concerns diminish greatly. It would also fix the homeopathic snake oil as well, which has started showing up as options in previously-reputable medicine aisles. So at any rate, be on guard if you don't want to end up accidentally buying a bottle of water plus flavoring in your cold-addled state.
- ryandrake 4mo ago
  Making the active ingredients prominent is a good start but not sufficient. As the article points out, the word "phenylephrine" looks/sounds similar enough to "pseudoephedrine" to broadly fool the population.
  - mindslight 4mo ago
    That's why I said "diminish greatly" rather than solve - by doing something basically everybody should be able to agree on regardless if you think a given product should be on the market or not. They should probably have to split up large words with dashes or even spaces "phenyl-ephrine" "psuedo-ephedrine". Maybe even "phenyl-eph-rine" "psuedo-eph-edrine". One authoritative list published by the FDA (they already keep a list of what's allowed to be sold OTC in the first place, right?) of how the active ingredient names have to be distinctly stylized to best inform.
    - ryandrake 4mo ago
      It just seems like a quick patch that doesn't acknowledge or address the root cause: that the FDA is supposed to be regulating both safety and effectiveness, but it is largely abdicating the "effectiveness" role over to companies' marketing departments. If corporate marketing can convince the public that the serpensoleum drug works, then that's enough to put it in a shiny box in the drug store.
      - 4mo ago
shin_lao 4mo ago
Oral phenylephrine is considered to be ineffective, phenylephrine in a nasal spray is considered effective.
- ursuscamp 4mo ago
  Nasal phenylephrine is a miracle when I am trying to sleep with a stopped up nose. A spray in each nostril and my nose is clearer than even normal within a few minutes.
- advisedwang 4mo ago
  BRB, spraying DayQuil up my nose
- dreamcompiler 4mo ago
  Absolutely true. Phenylephrine liquid applied directly to nasal mucosa is a quick and effective decongestant. It doesn't last as long as oxymetazoline (the other big nasal spray ingredient), but it also doesn't cause you to become dependent on it as much as oxymetazoline does.
delichon 4mo ago
Of course placebos should be legal, they're effective medications. https://www.health.harvard.edu/newsletter_article/the-power-of-the-placebo-effect https://www.health.harvard.edu/newsletter_article/the-power-...
- eli 4mo ago
  The placebo effect is not an excuse to allow drug companies to make false claims about the efficacy of the ingredients
Sohcahtoa82 4mo ago
> If you walk down the cold and flu aisle at CVS and start looking closely at labels, you will count about 100 products and around six active ingredients It's so utterly ridiculous how much space the Cold and Flu section of the medicine aisle takes for no reason at all. And the whole thing about combining so many medications is just silly, especially the marketing for it. "Why take 3 medications for your cold symptoms when you can take just this one?" then gets countered with "Why take a cold medication that has ingredients for symptoms you don't have?" IMO, DayQuil should never have existed simply for the reasons the article mentions: It leads to people being unaware of what they're taking. Yeah, the label is right there, but you gotta consider the lowest common denominator when selling things to the general public.
Aurornis 4mo ago
This article uses the trick where you pick studies that support your argument and ignore all of the studies that disagree with it. There are other studies where Dextromethorphan improves both objective and subjective measures of coughing: https://pubmed.ncbi.nlm.nih.gov/37232330/ https://pubmed.ncbi.nlm.nih.gov/37232330/ They also picked a study that shows honey outperforming Dextromethorphan but ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect. There are so many studies and papers published now that you can find both positive and negative results for just about anything. When someone starts pulling up singular random links to papers you should be suspicious. Be even more suspicious when someone is calling for bans or regulations based on those individually selected papers
- vlovich123 4mo ago
  > There are so many studies and papers published now that you can find both positive and negative results for just about anything. Doesn’t that suggest that the effect overall is neutral?
  - Aurornis 4mo ago
    You can find positive and negative results for everything. If that implies the effect is neutral, then by extension that means nothing works at all.
  - eli 4mo ago
    No, you can't just "average" different studies and I'm not sure what "neutral" means in the context of some studies showing a benefit and others not showing a benefit.
  - jibal 4mo ago
    Only if you assume that all studies are valid and accurate. And even then you are drawing the wrong conclusion -- if everything is "neutral" then that means that all the positive studies are wrong and all the negative studies are correct. (You seem to have erroneously assumed that a negative study means that something is bad for you.) Also, the very claim that there are positive and negative studies for everything is handwavy nonsense. There might 100 studies, all of which agree except for one outlier ... what does that "suggest" to you?
icodestuff 4mo ago
I only know one person who has ever found phenylephrine effective. It's definitely not for me, but they've done single-blinded self-studies (with help) to see if it's a placebo effect, and it's pretty clearly not. DXM is also not a placebo, although it might be specifically for cough. I don't especially want the FDA to ban them, but requiring separating out the acetaminophen might not be the worst idea.
- QuercusMax 4mo ago
  Phenylephrine only works as a nasal spray. It doesn't do anything when taken orally, because it is broken down in the digestive tract.
bityard 4mo ago
I just can't get super upset about this. Sure, OTC companies are duping customers with marketing, but what's new about that? As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product. Or ask my doctor/nurse/pharmacist what to do, if I can't be bothered to make the effort myself. When I want to get irrationally angry about something in a department store, I'll walk over to the shampoos, which for some reason always have a whole entire aisle dedicated to a single product, when they all do literally the same exact thing, just with different scents and advertising budgets baked into the sticker price.
- ryandrake 4mo ago
  The reason to take this seriously is mentioned in the article: It is possible to OD on Tylenol, and when consumers miss the fact that these drugs are all just Tylenol+junk, they might believe they need to take several of them together to get well. It's similar to the shampoo example (a huge selection of borderline useless products that make money purely because of marketing) but with a minor safety consideration, too.
  - kube-system 4mo ago
    Especially when the phenylephrine they took doesn't fix the problems the box promised to fix.
- runarberg 4mo ago
  You are ignoring the existence of consumer protection, which is not unusual as it seems like regulatory bodies around the world (but especially in Europe) have forgotten the existence of consumer protection as well. You ask what is new about this, and the answer is, in 2026 context: nothing, but compared to the year 2000: plenty. Regulators used to issue fines for this behavior, and for worst offenders, regulators used to shut them down. Lying to customers is illegal in most jurisdiction, it used to have consequences, and it should do so again.
- robmccoll 4mo ago
  Not totally accurate - there are a handful of foaming agents and surfactants that are mixed and matched to make shampoos, so really it's nearly the same except that no one has ever overdosed on applying too much sodium lauryl sulfate to their scalp.
Hasz 4mo ago
> So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen this argument makes very little sense. Plenty of very potent drugs are in the single digit mg range in a tablet that weights hundreds of mg. More importantly, as always, it is a problem of incentives. There is no strong, commercial entity focused on removing ineffective drugs from the market, but plenty of commercial pressure to keep them. The FDA has zero incentive to clean house. The magic hand of the market is supposed to be consumers choosing not to buy these drugs because they are ineffective, but for many reasons (choice, placebo effect, basic scientific literacy) this does not happen. I don't know what the most effective entity is. I cannot personally imagine a commercial structure to support this, but perhaps one could be built.
- rhdunn 4mo ago
  The other ingredients would be doing other things: making the pill/drug easer to swallow/consume, extending shelf-life, etc. You need enough of the drug for it to be effective, but not too much to overdose or exhibit side-effects.
- tptacek 4mo ago
  The mass of the acetominophen isn't really important, it's just vivid writing. The point is that 8g is obtainable for orders of magnitude less when it isn't wrapped in misleading marketing.
christina97 4mo ago
This should be divided into three parts: marketing and selling people questionable combo drugs at insane cost (bad), the case of oral phenylephrine (idiotic + bad), and the efficacy of the other drugs in the mix (guaifanesin, etc) (unclear).
deaton 4mo ago
No it should not be, but not because of the dextromethorphan or the phenylephrine being ineffective. By far the biggest issue is the acetaminophen it contains, which it isn't super obvious about, and frequently leads to acetaminophen overdoses. The vast majority of acetaminophen overdoses occur because people combined different medicines containing it (like DayQuil and Tylenol) without realizing they were taking the same thing multiple times. Its a completely preventable cause of liver failure and we should not be making cocktails with it that don't clearly show exactly what they are.
- jmalicki 4mo ago
  Acetaminophen (Tylenol) is probably the OTC drug that is at the top of the list to be made RX-only due to its dangers.
  - rustcleaner 4mo ago
    Please no. We need to be going the other way on that trend: converting things which won't easily outright kill/maim you (and dare I say, even potentially addictive ones) at normal doses from Rx to OTC! Acetaminophen is one of the few cheap, easy, and working products on the shelf!
    - kube-system 4mo ago
      A concern with OTC drugs is specifically that they won't be taken at normal doses. People confuse brand names and drug names, and don't realize they are taking more than the reccomended amount. This is especially problematic with combination drugs.
      - Melatonic 4mo ago
        Doesn't OTC specifically mean the ones that can't just be on the shelf ? Where you do not need a prescription but a pharmacist still has to be asked to hand it to you "over the counter" ?
petesergeant 4mo ago
> Why do we even have combination over-the-counter products at all? In America? No idea. In the UK it's because they sell codeine+tylenol OTC, and they want it to poison you if you try and get a codeine buzz from it. Incredibly this is true.
- deleted 4mo ago
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- Latty 4mo ago
  “Incredibly”? The US does exactly the same thing in another case: denatured alcohol.
gavinray 4mo ago
"DXM does nothing", proceeds to link a study whose contents describe significant decreases in cough severity versus placebo. I am convinced that many people ask LLM's "give me a citation URL" and don't bother to read it.
- QuercusMax 4mo ago
  It's the same people who just googled a couple keywords and used that as a citation without reading the link, pre-AI.
- MichaelDickens 4mo ago
  I read the main section of the lit review linked by OP, and it didn't seem to come to any real conclusions. > The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. [...] There is no good evidence for or against the effectiveness of OTC medicines in acute cough.
- deleted 4mo ago
  [deleted]
rustcleaner 4mo ago
Just bring back ephedrine and pseudoephedrine! Nobody cares if a few enterprising nerds could cook it into methamphetamine! Oh my gawd someone might experience some unapproved, unrentiered joy! Send in the SWAT teams! This is what the War on Drugs™ gets us.
breck 4mo ago
[dead]
OutOfHere 4mo ago
Dextromethorphan is useful. The problem is solely with oral phenylephrine being sold for something that it does not work for. The precise suggestion then is for oral phenylephrine to not be sold for such indications.
ButlerianJihad 4mo ago
The real reason that all these drugs are mixed together seemingly willy-nilly is actually to prevent people from overdosing and going wild with a singular drug, or cooking up more potent mixtures from it. Guaifenesin in particular has been mixed with decongestants, for the primary purpose of preventing use as a precursor. If they sold these chemicals as singular treatments then the abuse would go through the roof. The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this. I injured my legs, then on top of it, had a minor cold recently, and finally grabbed a bottle of Coricidin HBP out of desperation. I have also been stocking up on 0.0% beers. Between doses of the former and bottles of the latter, I managed to get some great-quality sleep and rest. The other thing to notice about the Cold and Flu section of your pharmacy is that most all the treatments are supposed to relieve congestion, clear phlegm, and serve as an expectorant, such as all the cough drops with lemon, or menthol. If you are a lifelong smoker with a productive cough, this is great. That includes habitual pharmacy patrons who've always purchased their cigarettes and cigarilloes right there at CVS, next to the candy aisle and the booze aisle. If you live in a desert and/or suffer from chronic E-N-T dryness and dry coughs, then these treatments will make your life a living hell and must be avoided at all costs. Think about it.
- kelnos 4mo ago
  > The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this. I think we need to do more around accidental overdoses than suggest that everyone should be a "shrewd consumer".
  - ButlerianJihad 4mo ago
    All you need to do is read the warnings and follow the instructions. It is not difficult. It does require literacy and intelligence, but a caregiver or the patient themselves should not have difficulty with the terminating the drug type and the dosage limits. If they do have difficulty, just see a nurse or a PCP. It's not rocket science! All these overdoses are happening because people do not read the warnings and they do not follow the instructions; and if they cannot understand the warnings and if they cannot follow the instructions, nor even consult a professional, then perhaps they deserve an overdose?
jollyllama 4mo ago
They wouldn't be selling the placebos if the real stuff were accessible. That's the real answer. The article mentions this but just accepts the inaccessiblity of the real thing as a given. You used to be able to get Nyquil with real sudafed in it. That was the gold standard. It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos. As an aside: > In January 2011, the FDA set a maximum amount of acetaminophen that could be packaged in combination opioids like Vicodin or Percocet. The odds of hospitalization due to opioid-related acetaminophen toxicity plummeted. Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.
- stronglikedan 4mo ago
  > you'd overdose on the acetaminophen first which is a much, much worse way to go, apparently
  - krispyfi 4mo ago
    User takes a large dose and dies -> "they should have used as directed" User takes a large dose and gets high -> "why does big pharma condone drug abuse???"
- lokar 4mo ago
  I’m not sure. Another explanation is that it is accessible, with a small amount of friction. But then drug makers realize they can get more sales by selling a placebo that won’t have the friction.
- MichaelDickens 4mo ago
  > It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos. What do you mean "morons"? Say I'm a normal person who doesn't habitually read magazine articles about drug effectiveness. How am I supposed to know that phenylephrine doesn't work? It's in the drug store and they're selling it as a decongestant; I have good reason to believe it will decongest my nose.
andy99 4mo ago
In Canada if you go to a drug store, the shelves are literally filled with literal homeopathic medicine. You have to carefully confirm that what you’re buying isn’t water, and there is no signage or other differentiation between actual medicine and magic. Completely unrelated, I noticed recently that tire detailing spray that makes your tires look black, and the recommended lubricant for my garage door weather stripping, which both cost $15 or more for a little bottle, are just silicon oil that costs pennies for that amount. I have no moral problem with charging higher prices for convenience plus clarity of what the use is. I do think it’s amoral, obviously, to be involved in snake oil sales and unbelievable that the government allows it. Edit: this is the first result from a Canadian pharmacy searching for cough medicine. Worse it’s for kids: https://well.ca/products/homeocan-kids-0-9-cough-cold-day_88807.html https://well.ca/products/homeocan-kids-0-9-cough-cold-day_88...
- graypegg 4mo ago
  Ugh yup. My regular pharmacy is a pharmaprix (shoppers drug mart), which is one of the biggest chain pharmacies in canada. The cold and flu isle is right in front of the pick up counter, so when I was sick a few months ago one of the pharmacists flagged me down when they noticed me hovering around the cough drop/coldfx/oscillococcinum part of the isle. The amount of proverbial snake oil on the shelves is bad enough that she was apologizing for how confusing it was. Got me set up with OTC pseudoephedrine instead! (There's some combo PSE/acetaminophen meds they sell in front of the counter, but they're mixed in with the sugar pills.) It's really worth talking to your pharmacist even if you know what you're buying. There's so many more options behind the counter and they're really knowledgable.
- Melatonic 4mo ago
  Silicone oil can actually vary a lot. Some are safe for certain plastics or rubber materials and not great for others. The tire stuff might be the cheap shit that's not so safe just because tires are so thick and robust. Or maybe it's actually designed for tires.
- Maxatar 4mo ago
  In Canada all homeopathic medicine must clearly identify itself as such and must also state that it's based on traditional form of medicine and not based on any kind of scientific evidence. The very "medicine" you linked to in fact displays it right on the cover.
thallavajhula 4mo ago
I use DayQuil/NyQuil when I get a cold and in my case, it's always worked well. It suppresses the symptoms and lets me carry on with my day-to-day. I did try once going 1 week without it and it was hell.
- saalweachter 4mo ago
  When the hubbub about phenylephrine first started, I decided I still felt less miserable taking DayQuil/NyQuil, and switched to the "High Blood Pressure" formulation, which drops the phenylephrine, alcohol and sugar. It takes it down to just the Tylenol, the DXM (, plus the antihistamine in the NyQuil), and the great slightly tearable taste for the ritual of "time to pretend I'm not sick for a little while".
kube-system 4mo ago
I think there's one thing most people agree on: drugs should be safe and effective. DXM is fine but oral phenylephrine should be banned. The only reason it's in any of these drugs is because they don't want to lose sales when the real version that works is locked behind the pharmacy counter after hours. It's a scam to keep sales up.
tzs 4mo ago
> Take your standard 12-ounce bottle of DayQuil, which costs around $15 at CVS. ... > So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen, which separately would run you about 16 cents at Costco. Why are they comparing the price of CVS DayQuil to Costco acetaminophen? Either compare CVS DayQuil to CVS acetaminophen or compare Costco DayQuil to Costco acetaminophen.
- Melatonic 4mo ago
  Yeah that seems odd. It's also a very different delivery mechanism. Might be easier to get a sick and snotty kid to drink some (maybe?) tasty liquid vs cheap pills.
  - cozzyd 4mo ago
    that's why you have children's tylenol (or generic) that is $$$ but exactly that.
nostrademons 4mo ago
The article kinda glossed over it, but one fact under-appreciated by the general public is just how dangerous acetaminophen overdoses can be. Scientists often talk about the "therapeutic index" or "safety ratio" of a drug. It's the LD50 (dose at which 50% of recipients die) divided by the effective dose. Common hard drugs like heroin or methamphetamine have a safety ratio of about 6-10 [1]. "Soft" drugs like marijuana or LSD often have safety ratios of about 1000. The safety ratio of acetaminophen is under 4. A typical dosing schedule for an adult is 4-6 500mg tablets within a 24 hour period [2], for a total of no more than 3g. 7g of acetaminophen can kill you, and 12g is likely to [3]. Acetaminophen is the leading cause of liver failure in the U.S, causing 50% of cases and 20% of transplants. When they tell you "don't exceed 6 doses daily", they really mean it, and it's across all acetaminophen-containing products. The margin for error is narrower than heroin. [1] http://politicsofsin.50megs.com/risk/Toxicity.Comparison_Addiction.99,p686_2004.html http://politicsofsin.50megs.com/risk/Toxicity.Comparison_Add... [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC3585765/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3585765/ [3] https://www.ncbi.nlm.nih.gov/books/NBK441917/ https://www.ncbi.nlm.nih.gov/books/NBK441917/
- unparagoned 4mo ago
  Therapeutic index of fentanyl is much higher than heroin or morphine, but I don’t think people really think that it makes it safer.
  - Shog9 4mo ago
    The folks I know who've been prescribed fentanyl weren't particularly upset about it. It is very potent, and thus measuring the dose properly is very important, but it's not particularly fussy beyond that. The people you know may be obtaining it from less reliable apothecaries; that can be a real issue.
  - ErroneousBosh 4mo ago
    Reminds me of a comment I saw on a drug chemist's blog decades ago where they were talking about ACE inhibitors for Parkinsons' Disease - by dicking around with nerve conductivity and acetylcholine reuptake you could "boost" the failing nerves a bit, presumably until they fail altogether. Anyway much of the discussion was on how hard it is to make suitable drugs, and someone said "We actually have some fairly inexpensive, reliable, and well-characterised ACE inhibitors with a nice long half-life and known efficacy, but the therapeutic window of nerve gas is pretty narrow..."
wowczarek 4mo ago
I get that the discussion here focuses on doubtful decongestants, but just the mention of acetaminophen makes me think of pharmaceuticals and people's relationship with them in the US. It's a strange world to me, especially how deeply ingrained the brand names are in people's minds - years of evidently successful marketing. What, to me, should be illegal, is building expensive branding around a group of very basic analgesics - well and other groups like antihistamines. In the UK I can buy an own-brand 16-pack (8 g) of paracetamol in a supermarket for £0.35 / $0.45. At the same time, I can buy a packet of Panadol (GSK), same substance, same content, same amount, for £2.35, nearly 7 times the price of generics. How is THAT legal, and how are people so unaware as to actually buy it? "Unaware" may be the key here.
- kelnos 4mo ago
  Same situation in the US. I can buy NyQuil/DayQuil, or I can buy the pharmacy-branded version for a lower price. Here it's usually not such a dramatic difference; probably the pharmacy brand is a a 30-40% discount off the big-name brand. > How is THAT legal Why shouldn't it be? Companies are free to set prices to whatever the market will bear. In this case it's based on customer ignorance, which makes it feel icky, but I don't think that's a reason to legislate this sort of thing. > and how are people so unaware as to actually buy it? Yeah, I don't know. I do remember that, many many years ago, I didn't know about this, and would always go for the big-name-brand version. At some point I learned to look at the active ingredients and just buy the cheapest one that had the same ingredients in the same dose, but I don't recall when or why I learned that, or why I didn't know that before. I think there's also an implicit quality judgement sometimes, even if it's unfair. When it comes to groceries, say, canned tomatoes, and I see some fancy-looking Italian brand that I've heard of, my brain will automatically rate it much higher than the grocery store's own branded version of it. Maybe that's an effect of marketing/advertising, maybe it's something else, I don't know. And sometimes it's actually true: tomatoes are not all created equal. I think something similar happens with drugs, even if it's an entirely different kind of product. People also often assume that something that costs more is automatically higher quality. For some types of things, that can be true (because yes, there is such a thing as a better tomato, and sometimes it costs more to cultivate said better tomato), but for drugs in a regulated environment, that doesn't really make sense. But people pattern match on what they know and what they feel.
maest 4mo ago
Btw, the cosmetics industry functions similarly, but worse. Although I suppose the health dangers are lower (the monetary ones are not). For anti aging stuff, the workhorse ingredient is retinol (with a few formulation variations). However, it is very difficult to buy _just_ retinol - most beauty brands bundle up retinol with a bunch of other ingredients. This has a couple of issues: 1. You won't know your retinol dosage. These creams almost never tell you the retinol proportion and concentration. 2. You're overpaying by _a lot_. The luxury name brand cream will cost maybe 10x more than the similarly sized $9 bottle of retinol from the ordinary, but it will only contain some fraction of retinol. Tbf this has been slowly changing and I see even La Roche Posay sells retinol bottles for $50. Insane markup, but smaller than what was the case 5 years ago. This is all compounded with the fact that it's very difficult to tell if your anti aging cream is actually working from your own experience: - its effect is slow acting - it's difficult to compare the result with the counterfactual, unless e.g. you only use it on half your face
chem83 4mo ago
Interesting that in the US metamizole[0] (dipyrone, or Novalgin and Analgin comercially) is banned in the US due to agranulocytosis[1] risk. It's fairly common in Europe, Asia and South America. [0] https://en.wikipedia.org/wiki/Metamizole https://en.wikipedia.org/wiki/Metamizole [1] https://en.wikipedia.org/wiki/Agranulocytosis https://en.wikipedia.org/wiki/Agranulocytosis
scythe 4mo ago
The author has a point about dextromethorphan and phenylephrine. However, he does guaifenisin dirty: >You’ll also find lots of cough medication with guaifenesin, which has similarly thin scientific backing. He links ( https://pubmed.ncbi.nlm.nih.gov/24003241/ https://pubmed.ncbi.nlm.nih.gov/24003241/ ) which shows that guaifenisin had no measurable effect on sputum volume or consistency (p = 0.12 for volume). But there are other studies with broader outcome measures which show positive effects: https://link.springer.com/article/10.1186/1465-9921-13-118 https://link.springer.com/article/10.1186/1465-9921-13-118 >The pilot study was a randomized, double-blind study where patients were dosed with either 1200 mg extended-release guaifenesin (n = 188) or placebo (n = 190), every 12 hours for 7 days [...] >Subjective measures of efficacy at Day 4 showed the most prominent difference between treatment groups, in favor of guaifenesin. >The DCPD assessment of symptoms also indicated advantages for ER guaifenesin over placebo for the between-day changes from baseline in response to the questions “Over the last 24 hours how often did your phlegm prevent you from going to public places?” (Day 2; p = 0.0016) and “Over the last 24 hours, how difficult was it for you to bring up phlegm?” (Day 5; p = 0.0070). G tends to do well in subjective (symptomatic) assessments, even when subjects are blinded, but poorly in objective assessments. However, this isn't enough to condemn it.
tshaddox 4mo ago
> Historically, Sudafed has contained pseudoephedrine, the wonder drug equally good at clearing congestion and making crystal meth. It's much better at clearing congestion than at making crystal meth. And, as the joke goes, it's easier to make an effective decongestant from meth than it is to buy it from a store.
CodeWriter23 4mo ago
It should be legal. Caveat Emptor applies always. to everything. I'd rather have choices available in a marketplace rather than a nanny state stifling innovation through its own incompetence.
- GuinansEyebrows 4mo ago
  in the specific case of this article, "innovation" and "choice" are exactly the problem here. we know what works well - they're well-studied generic compounds. there's no social reason whatsoever that "dayquil" or "tylenol" or "sudafed" should exist when generics are readily available and clearly labeled.
- jambalaya8 4mo ago
  With computerized registers and loyalty programs, it is way too easy to profile. I am not too worried about looking like I chug too much aspirin; it's the further out assumptions or speculations that models (like I myself once designed or otherwise) might make that I worry about, that would not require proof, and would not be documented somewhere. I mean there is also stuff "like" congestion pricing to worry about, and maybe that would work better to make people think about liberties and tech. Dunno.
watchdarkly 4mo ago
Dextromethorphan is abused to get high. Not sure how it could be a placebo.
currymj 4mo ago
OTC decongestants that actually work, some useful info for those of us with bad sinuses. - pseudoephedrine taken orally. - phenylephrine, but only as nasal spray, not if you take it orally. - Oxymetazoline (Afrin) nasal spray and others in this broad family - propylhexedrine, sold OTC as Benzedrex as a vapor inhaler. Unfortunately people crack open the inhaler and swallow the whole thing as a drug of abuse, so often they are out of stock seemingly because of shoplifting, or not sold at all because the pharmacies don't want to deal with the hassle. Anything that goes directly in your nose has the potential to cause rebound congestion after a couple days which can be pretty bad.
dec0dedab0de 4mo ago
Calling Dextromethorphan a placebo is quite a stretch. Sure, I think the point is that it makes you intoxicated so that you don't really care that you're sick, but it is definitely active.
PetaTech-News 4mo ago
[flagged]
chao- 4mo ago
I go with Alka Seltzer specifically because they have an Aspirin variant instead of Acetaminophen.
jambalaya8 4mo ago
I am still bothered that Australia limited the sale of small quantities of codeine in 2018. I had not realized it limited acetaminophen last year to limits similar to the UK. At least in the States I can still economise. On the record, I am 100% for making common painkillers, cold and flu remedies completely over the counter. It blows my mind people are making things that used to be prescription (for good reason) OTC, but limiting purchases for things like acetaminophen. I still find it burdensome to deal with the pseudoephedrine controls, and I don't even use it often.
pkilgore 4mo ago
DayQuil: Because you're sick, and the rest of the office should be too.
erelong 4mo ago
"Yes, legalize all drugs for adults" Simple
annzabelle 4mo ago
I'm not sure what it is in the Dayquil - the DXM or the "decongestant," but there is a stimulant effect that is half of what I buy it for. It is the most effective medication I have found for getting me off the couch and able to power through a workday with a moderate cold, and definitely does something that Acetaminophen alone doesn't do.
Lerc 4mo ago
I had a cold a year or two ago, I had used the last of a bottle of actually working cough medicine, attempting to buy a replacement failing to do so, I found it had been banned. Turns out the active ingredient was morphine, which is apparently quite an effective decongestant in very low doses(and variants have been used as such for thousands of years) That started me on a quest for a good cough medicine. My research turned up some interesting results. Different countries have their own go-to medications for decongestants. Actual different drugs, not just the same thing under a different name. None of them work. Anything that does work is banned unless the people making it have been doing so for a couple of hundred years, then it seems that they just pretend it's not there. When challenged the industry defended their sale of ineffective products by saying if they didn't work, people wouldn't buy them. Anecdotal evidence is taken as gospel in many public health circles. When an attempt to have a substance banned was rejected on the basis of no evidence of abuse, it appears that means 'try again later', not gather evidence. You only have to wait for someone who shares your ideology once and it gets done and getting it undone is too much work for anyone to consider. It's almost enough to send you off to a music festival to gather your own supplies for home remedies.
- titanomachy 4mo ago
  Adderall (amphetamine) is a very effective decongestant. And it helps you get more work done!
  - Lerc 4mo ago
    Well that's a bad sign. I'm managing the tail end of a cold again at the moment and I'm already taking dexamphetamine.
nodamage 4mo ago
> Most studies have found that dextromethorphan performs the same as a placebo The citation linked does not support this claim. In fact it suggests the opposite: "Dextromethorphan was tested in three of the included studies (Lee 2000; Parvez 1996; Pavesi 2001). One report on a series of three successive studies on a total of 451 adults favoured dextromethorphan 30 mg given in a single dose to placebo in terms of cough counts (measured through cough acoustic signals using a microphone on the nose) and subjective visual analogue scales (Parvez 1996). Differences in mean changes of cough counts between active treatment and placebo varied from 19% to 36% (P value < 0.05) in the three studies (up to a net difference of eight to 10 coughing bouts every 30 minutes). This study did not report on side effects. A study involving 44 participants tested a single 30 mg dose of dextromethorphan versus placebo (Lee 2000). Both treatment groups showed a decline in cough frequency (from 50 to 19 per 10‐minute period in the active treatment arm compared with 42 to 20.5 in the placebo arm, P value = 0.38 at 180 minutes follow‐up). Mean subjective cough scores showed a decline from 2.0 to 1.0 in the active treatment group compared to a decline from 2.0 to 1.5 in the placebo group (mean difference in decline in cough scores 0.5 at 180 minutes, P value = 0.08). Pavesi and colleagues also tested a single 30 mg dose of dextromethorphan versus placebo (Pavesi 2001). Outcomes were measured through a three‐hour continuous cough recording, measuring cough bouts, cough components, cough effort, cough intensity and cough latency. Average treatment difference was 12% to 17% in favour of dextromethorphan for cough bouts (P value = 0.004), cough components (P value = 0.003) and cough effort (P value = 0.001), with an increase in cough latency (P value = 0.002)." Two out of the three studies found DXM was effective in adults. The studies did not find the same efficacy in children but that could be due to differences in dosage (adult dosage is 30mg, child doses vary based on body weight) or in measurement techniques (as far as I can tell the child studies measured results via parental survey as opposed to more objective techniques like cough recordings).
fdgwhite 4mo ago
The FDA did this to us by outlawing effective but problematic products and replacing them with relatively safe but ineffective products. And then letting product makers off the hook on claims and pricing
aunwick 4mo ago
In the pharmacy in the US there are about 1000 over the counter drugs made if varios combinaciones of about 50 ingredients. Many of them contain acetaminophen. I can see how accidental liver damage can occur. On DayQuil specifically, the only time I took it I was about as useful as someone stoned. I would have been better off and less dangerous to society if I had just taken rest.. As far as pain management I personally find acetaminophen does nothing for pain and only helps with fever. Similar ibuprofen only helps me with sever muscle pain associated with over exertion or bruising. Having unfortunately suffered from nerve pain I can say the pain relief opiates provide, even at low levels, is on a whole different level. My experience is that taking them only for pain, when it is unbearable, was not addictive and made pain on the level of I need to go to the hospital bearable. Just my experience.
dreamcompiler 4mo ago
Until the late 1960s, codeine was considered the definitive over-the-counter cough medicine. It worked well. Maybe a little too well, because it was easy to get addicted to it. So the FDA banned it from OTC sales and dextromethorphan was substituted. Which brings us to today.
tsoukase 4mo ago
Placebo is a multi trillion market. Not only in the form of vitamin, dietary supplement or other non-active pill but also of shopping, psycho-boosting or feel-good behaviour. Even religion is a form of placebo! I am fed up with various "products" that come to my door: mix of vitamins, a-lipoic acid and ashwagada. I can imagine among the billions of physically healthy adults, there are many that choose them. While regulation for drugs is strict, for these products it is less that potato chips. The FDA goes like, as soon as they sell snake oil that doesn't hurt anyone, let the market loose.
casey2 4mo ago
In the US? Of course. It's not the FDA's job to make laws. Government needs to stay out of private business.
tancop 4mo ago
legalize pseudo and codeine again. prohibition is literally killing people. its forcing everyone to use less effective otc drugs where you need to take a more dangerous dose for the same effect. and when its harder to get codeine or real percs/oxys/xans/anything else people get fake street pills laced with fent. thats how they od and die. all these drugs should be sold with alcohol like rules (free access for adults/over 21, Rx only for minors) and warnings explaining exactly how to take them safely, both for "legit" and recreational use. the harm of drugs is half accidental ods and half organized crime. this defeats both and if cocaine was legal too, cartels would go out of business in a year.
cykros 4mo ago
"Most studies have found that dextromethorphan performs the same as a placebo and some suggested it was worse than honey." Something tells me this is because they're using it at the dosages listed. Because let me tell you, it certainly does NOT do nothing if you take more... Part of the issue though is that 1 in 10 people have a CYP2D6 enzyme deficiency and if you take the tablespoon or so that would be more effective (that a pharmacist I used to work with advocated for) you REALLY shouldn't be driving (or going to work for that matter). Phenylephrine of course is absolute garbage -- they just felt like they had to leave people a placebo for when they took away pseudoephedrine from the shelves to stop people making meth out of it. Beyond that, I do sort of agree that putting all of these actives into a single product entirely prevents you from working the doses for what actually is effective. If you have a product full of acetaminophen you CAN'T then just take more of it to get the effective dose of dextromethorphan (and I'm not even sure there IS an effective dose of phenylephrine, but if there is it's definitely higher than what's on the label). Not gonna say "there should be a law!" because I don't think anyone needs men with guns coming for them over this, but I do wonder why anyone buys this crap when the individual active ingredients can all be purchased and used in appropriate amounts. But I guess most people just take what the label tells them to...

241 points by paulpauper 4mo ago

I think it’s outrageous that pseudoephedrine has become difficult and annoying to purchase while they put that ineffective garbage out through all these combo drugs.

nekusar 4mo ago

All drugs should be legal, full stop. And I should be able to get medical drugs on my own, without a permission slip from a doctor I have to convince. Drug prohibition has caused magnitudes more harm than decriminalization and legalization. And part of this article is about claims from what is likely inert or mild effect at best. Remember, we used to have amphetamines, pseudoephedrine, and much more potent drugs to alleviate colds and such. But because of the forever-drug-war , we're stuck with substandard crap, and everything good gatekept by doctors.

antonkochubey 4mo ago
Are you sure you have read the article, not just its title?
- nekusar 4mo ago
  Yes, and the question lends itself to control (or lack of) by relevant medical "authorities". I honestly do not trust somebody with a doctor license who I talked to for 7 minutes out of 259200 minutes (6 months). For example, when I went on a camping trip, I got bit by 15 ticks. After I got back, went to doc for 15 day doxycyclene, gold standard. And its cheap, like $15. NOPE, fucker wanted the ticks in a bag to grind up and waste a $400 Lyme test. And that test is only 60% accurate, tons of false negatives. If I could have, I would have bought doxy, scaled it to my weight, and did the 15 day run. But nope. I ended up getting the second recommended, amoxicilian as "fish antibiotics".
  - bigfishrunning 4mo ago
    One of the reasons doxycyclene is so effective is because it's less overprescribed. Antibiotic resistance is a real thing, and the day we run out of viable ones is going to be ugly. Having a gatekeeper isn't a bad idea.
    - Sohcahtoa82 4mo ago
      To add to this, despite all efforts to educate people, many STILL don't know that antibiotics don't work against viruses and will want one when dealing with a cold or other viral infection. If we let antibiotics be over-the-counter, every damn infectious bacteria will be a super-strain in a year.
      - nekusar 4mo ago
        Antibiotics are routinely given to all of their farm animals as part of their food, for prophylaxis. But allowing humans to buy when they're sick is somehow the super-strain-end-of-times?? Antibiotics stop bacteria. Antivirals stop viruses. Except bacteria can be attacked whenever, the sooner the better. Antivirals need a rapid and early timeframe to work. Getting a fucking doctor to say yes is almost always too long, and you missed your treatment window. That is unless you go the ER, and lucky to not get shoved aside. Then pay $$$$$
        Melatonic 4mo ago
        Those are two separate issues and we obviously should not be just giving feedstock and animals antibiotics constantly. That's no good for anyone. Maybe the better solution is that the government should be paying for the Lyme test as a public health measure. Knowing which areas it is spreading too is extremely important. And on the flip side I know someone whose father got Lyme but didn't know it for years - he was not very symptomatic at first and ended up with major nerve damage. Not one to mess around with
        bigfishrunning 4mo ago
        > Antibiotics are routinely given to all of their farm animals as part of their food, for prophylaxis. That's also a problem [0]; and it's one that can't be solved by creating a second, somewhat related problem. 0: https://pmc.ncbi.nlm.nih.gov/articles/PMC11200672/ https://pmc.ncbi.nlm.nih.gov/articles/PMC11200672/
- stickfigure 4mo ago
  When an article has a misleading clickbait title, I think it's fair game to redirect the conversation to the subject of the title.
robertpateii 4mo ago
Read the article. It doesn’t even ask if dextromethorphan and phenylephrine should be illegal. It asks if intentionally misleading consumers about their efficacy should be.
CommieBobDole 4mo ago
The article is not about "should people be allowed to buy this product because it's potentially dangerous/addictive/etc" but "Should the company be allowed to sell this product because it consists of acetaminophen plus two useless ingredients and is basically a scam".
techbro92 4mo ago
What is the argument for legalizing drugs that are contraindicated for all medical purposes, are toxic, and have a high addictive potential? How does it benefit me or society if my neighbor is permitted to choose to basically roll the dice on afflicting themselves with a debilitating chronic illness (severe addiction)? If I don’t want to do illegal drugs why would I ant to support this?
- tyami94 4mo ago
  [dead]
- yomismoaqui 4mo ago
  - People that want to do drugs already can buy them, with worse quality and the with the side-effect of funding crime at a planetary scale. - Alcohol, tobacco & weed are already legal... why them and no other drugs? Check how many deaths do alcohol & tobacco provoke. - Taxes, lots of taxes, literal mountains of money... a small percentage of which can be redirected to treating addicts.
- the_sleaze_ 4mo ago
  I went to a southeast asian country and got a staph infection. I walked down to the pharmacy, asked the pharmastst for a topical and an oral antibiotic. 3 days later i was healed, continued the course the rest of the week and that was it. $12 dollars american. I got another staph infection previously in the united states. Needed to go to a doc in the box who misdiagnosed it. A few days went by and i needed to go to another doc in the box who gave me topical and trued to give me a steroid shot. Needless to say it progressed and turned into fullblown MRSA which required admitance and a IV antibiotic. Extremely painful. I don't have the ability to add the costs but north of $10k easily. That's why drugs should be legalized.
  - ikesau 4mo ago
    I'm sorry that happened to you. Sincerely. That sounds incredibly frustrating, painful, and scary. I think your maximalist conclusion of "drugs should be legalized" might have some second-order effects that might be net worse for society, though. Addiction, misuse, MRSA, overdoses, etc.
rustcleaner 4mo ago
Agree with you. It is a collateral consequence of the War on Drugs™ that everything good and effective is getting locked behind a $50-$200 doctor's visit for a 'scrip. This scam medicine problem could be helped if a bunch of substances were moved out of Rx and back to OTC. The nanny state will continue to grow to meet people's definitions on how much others should be warded.

robobro 4mo ago

Dextromethorphan is definitely not a placebo. Take enough and you'll go to space and meet God. Smaller doses produce euphoria and dissociation, which, even if they don't make the cough go away, makes it easier to tolerate a cold -- same reason antitussives have historically contained alcohol, cannabis extract (which may incidentally work as bronchodilator but was not the reason I imagine it was in antitussives) Funny amphetamine used to be an over the counter cold medicine, which the article doesn't mention despite talking about the meth precursor? Fine article but these two details stuck out to me while reading it.

jona-f 4mo ago
Came here to say this, the author is hating on dextromethorphan like he never robotripped before. But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that.
- MisterTea 4mo ago
  > But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that. Ketamine is neurotoxic itself and can cause permanent brain damage. I can't find the info but there was someone in the tech industry who accidentally overdosed and suffered a two year bout of severe debilitating depression culminating in suicide.
  - sph 4mo ago
    Sorry to say, we shouldn't really base our opinion on drug safety from people who accidentally overdose or are generally reckless with drugs. There's people who drink for the first time and end up in the hospital. If you want to do it the smart way, just consult erowid.org and use a little common sense. https://erowid.org/chemicals/ketamine/ketamine_faq.shtml https://erowid.org/chemicals/ketamine/ketamine_faq.shtml
    - MisterTea 4mo ago
      The post I replied to stated that a DXM OD is dangerous then mentions ketamine without stating its OD dangers giving it the appearance of a safe alternative.

robertpateii 4mo ago

Yeah, intentionally misleading consumers should always be at least somewhat illegal. Sure caveat emptor, but consumers having accurate information is implied and a cornerstone of a competitive market.

ryandrake 4mo ago
"Caveat Emptor" and "Do your own research" is not a basis for a functional society. Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level. And letting marketing decide what counts as "accurate information" is just letting the fox guard the henhouse.
- ultrarunner 4mo ago
  Counterpoint: 54% of adults read below a sixth-grade level because a society has been created to facilitate (and encourage) just that. Encouraging a population to rely on the thought processes of others is exactly what leads to over reliance on marketing.
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- mindslight 4mo ago
  > Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level This is obvious, but thank you for putting it so succinctly. One has to wonder how much support for "do your own research" is driven by people who want to remain proudly-in-denial about their own inabilities.
  - ryandrake 4mo ago
    It's no surprise that the political party/forces pushing on policies that result in worse education and literacy outcomes are the same ones who want "Buyer Beware" and "Do your own research" to be fundamental product regulatory principles.

mindslight 4mo ago

The more general deeply-entrenched golden goose here is branding, which applies to much more than OTC medicines. Make it so the active ingredients have to be listed prominently - the largest text on the front of the product package - and these concerns diminish greatly. It would also fix the homeopathic snake oil as well, which has started showing up as options in previously-reputable medicine aisles. So at any rate, be on guard if you don't want to end up accidentally buying a bottle of water plus flavoring in your cold-addled state.

ryandrake 4mo ago
Making the active ingredients prominent is a good start but not sufficient. As the article points out, the word "phenylephrine" looks/sounds similar enough to "pseudoephedrine" to broadly fool the population.
- mindslight 4mo ago
  That's why I said "diminish greatly" rather than solve - by doing something basically everybody should be able to agree on regardless if you think a given product should be on the market or not. They should probably have to split up large words with dashes or even spaces "phenyl-ephrine" "psuedo-ephedrine". Maybe even "phenyl-eph-rine" "psuedo-eph-edrine". One authoritative list published by the FDA (they already keep a list of what's allowed to be sold OTC in the first place, right?) of how the active ingredient names have to be distinctly stylized to best inform.
  - ryandrake 4mo ago
    It just seems like a quick patch that doesn't acknowledge or address the root cause: that the FDA is supposed to be regulating both safety and effectiveness, but it is largely abdicating the "effectiveness" role over to companies' marketing departments. If corporate marketing can convince the public that the serpensoleum drug works, then that's enough to put it in a shiny box in the drug store.
    - 4mo ago

shin_lao 4mo ago

Oral phenylephrine is considered to be ineffective, phenylephrine in a nasal spray is considered effective.

ursuscamp 4mo ago
Nasal phenylephrine is a miracle when I am trying to sleep with a stopped up nose. A spray in each nostril and my nose is clearer than even normal within a few minutes.
advisedwang 4mo ago
BRB, spraying DayQuil up my nose
dreamcompiler 4mo ago
Absolutely true. Phenylephrine liquid applied directly to nasal mucosa is a quick and effective decongestant. It doesn't last as long as oxymetazoline (the other big nasal spray ingredient), but it also doesn't cause you to become dependent on it as much as oxymetazoline does.

delichon 4mo ago

Of course placebos should be legal, they're effective medications. https://www.health.harvard.edu/newsletter_article/the-power-of-the-placebo-effect https://www.health.harvard.edu/newsletter_article/the-power-...

eli 4mo ago
The placebo effect is not an excuse to allow drug companies to make false claims about the efficacy of the ingredients

Sohcahtoa82 4mo ago

> If you walk down the cold and flu aisle at CVS and start looking closely at labels, you will count about 100 products and around six active ingredients It's so utterly ridiculous how much space the Cold and Flu section of the medicine aisle takes for no reason at all. And the whole thing about combining so many medications is just silly, especially the marketing for it. "Why take 3 medications for your cold symptoms when you can take just this one?" then gets countered with "Why take a cold medication that has ingredients for symptoms you don't have?" IMO, DayQuil should never have existed simply for the reasons the article mentions: It leads to people being unaware of what they're taking. Yeah, the label is right there, but you gotta consider the lowest common denominator when selling things to the general public.

Aurornis 4mo ago

This article uses the trick where you pick studies that support your argument and ignore all of the studies that disagree with it. There are other studies where Dextromethorphan improves both objective and subjective measures of coughing: https://pubmed.ncbi.nlm.nih.gov/37232330/ https://pubmed.ncbi.nlm.nih.gov/37232330/ They also picked a study that shows honey outperforming Dextromethorphan but ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect. There are so many studies and papers published now that you can find both positive and negative results for just about anything. When someone starts pulling up singular random links to papers you should be suspicious. Be even more suspicious when someone is calling for bans or regulations based on those individually selected papers

vlovich123 4mo ago
> There are so many studies and papers published now that you can find both positive and negative results for just about anything. Doesn’t that suggest that the effect overall is neutral?
- Aurornis 4mo ago
  You can find positive and negative results for everything. If that implies the effect is neutral, then by extension that means nothing works at all.
- eli 4mo ago
  No, you can't just "average" different studies and I'm not sure what "neutral" means in the context of some studies showing a benefit and others not showing a benefit.
- jibal 4mo ago
  Only if you assume that all studies are valid and accurate. And even then you are drawing the wrong conclusion -- if everything is "neutral" then that means that all the positive studies are wrong and all the negative studies are correct. (You seem to have erroneously assumed that a negative study means that something is bad for you.) Also, the very claim that there are positive and negative studies for everything is handwavy nonsense. There might 100 studies, all of which agree except for one outlier ... what does that "suggest" to you?

icodestuff 4mo ago

I only know one person who has ever found phenylephrine effective. It's definitely not for me, but they've done single-blinded self-studies (with help) to see if it's a placebo effect, and it's pretty clearly not. DXM is also not a placebo, although it might be specifically for cough. I don't especially want the FDA to ban them, but requiring separating out the acetaminophen might not be the worst idea.

QuercusMax 4mo ago
Phenylephrine only works as a nasal spray. It doesn't do anything when taken orally, because it is broken down in the digestive tract.

bityard 4mo ago

I just can't get super upset about this. Sure, OTC companies are duping customers with marketing, but what's new about that? As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product. Or ask my doctor/nurse/pharmacist what to do, if I can't be bothered to make the effort myself. When I want to get irrationally angry about something in a department store, I'll walk over to the shampoos, which for some reason always have a whole entire aisle dedicated to a single product, when they all do literally the same exact thing, just with different scents and advertising budgets baked into the sticker price.

ryandrake 4mo ago
The reason to take this seriously is mentioned in the article: It is possible to OD on Tylenol, and when consumers miss the fact that these drugs are all just Tylenol+junk, they might believe they need to take several of them together to get well. It's similar to the shampoo example (a huge selection of borderline useless products that make money purely because of marketing) but with a minor safety consideration, too.
- kube-system 4mo ago
  Especially when the phenylephrine they took doesn't fix the problems the box promised to fix.
runarberg 4mo ago
You are ignoring the existence of consumer protection, which is not unusual as it seems like regulatory bodies around the world (but especially in Europe) have forgotten the existence of consumer protection as well. You ask what is new about this, and the answer is, in 2026 context: nothing, but compared to the year 2000: plenty. Regulators used to issue fines for this behavior, and for worst offenders, regulators used to shut them down. Lying to customers is illegal in most jurisdiction, it used to have consequences, and it should do so again.
robmccoll 4mo ago
Not totally accurate - there are a handful of foaming agents and surfactants that are mixed and matched to make shampoos, so really it's nearly the same except that no one has ever overdosed on applying too much sodium lauryl sulfate to their scalp.

Hasz 4mo ago

> So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen this argument makes very little sense. Plenty of very potent drugs are in the single digit mg range in a tablet that weights hundreds of mg. More importantly, as always, it is a problem of incentives. There is no strong, commercial entity focused on removing ineffective drugs from the market, but plenty of commercial pressure to keep them. The FDA has zero incentive to clean house. The magic hand of the market is supposed to be consumers choosing not to buy these drugs because they are ineffective, but for many reasons (choice, placebo effect, basic scientific literacy) this does not happen. I don't know what the most effective entity is. I cannot personally imagine a commercial structure to support this, but perhaps one could be built.

rhdunn 4mo ago
The other ingredients would be doing other things: making the pill/drug easer to swallow/consume, extending shelf-life, etc. You need enough of the drug for it to be effective, but not too much to overdose or exhibit side-effects.
tptacek 4mo ago
The mass of the acetominophen isn't really important, it's just vivid writing. The point is that 8g is obtainable for orders of magnitude less when it isn't wrapped in misleading marketing.

christina97 4mo ago

This should be divided into three parts: marketing and selling people questionable combo drugs at insane cost (bad), the case of oral phenylephrine (idiotic + bad), and the efficacy of the other drugs in the mix (guaifanesin, etc) (unclear).

deaton 4mo ago

No it should not be, but not because of the dextromethorphan or the phenylephrine being ineffective. By far the biggest issue is the acetaminophen it contains, which it isn't super obvious about, and frequently leads to acetaminophen overdoses. The vast majority of acetaminophen overdoses occur because people combined different medicines containing it (like DayQuil and Tylenol) without realizing they were taking the same thing multiple times. Its a completely preventable cause of liver failure and we should not be making cocktails with it that don't clearly show exactly what they are.

jmalicki 4mo ago
Acetaminophen (Tylenol) is probably the OTC drug that is at the top of the list to be made RX-only due to its dangers.
- rustcleaner 4mo ago
  Please no. We need to be going the other way on that trend: converting things which won't easily outright kill/maim you (and dare I say, even potentially addictive ones) at normal doses from Rx to OTC! Acetaminophen is one of the few cheap, easy, and working products on the shelf!
  - kube-system 4mo ago
    A concern with OTC drugs is specifically that they won't be taken at normal doses. People confuse brand names and drug names, and don't realize they are taking more than the reccomended amount. This is especially problematic with combination drugs.
    - Melatonic 4mo ago
      Doesn't OTC specifically mean the ones that can't just be on the shelf ? Where you do not need a prescription but a pharmacist still has to be asked to hand it to you "over the counter" ?

petesergeant 4mo ago

> Why do we even have combination over-the-counter products at all? In America? No idea. In the UK it's because they sell codeine+tylenol OTC, and they want it to poison you if you try and get a codeine buzz from it. Incredibly this is true.

deleted 4mo ago
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Latty 4mo ago
“Incredibly”? The US does exactly the same thing in another case: denatured alcohol.

gavinray 4mo ago

"DXM does nothing", proceeds to link a study whose contents describe significant decreases in cough severity versus placebo. I am convinced that many people ask LLM's "give me a citation URL" and don't bother to read it.

QuercusMax 4mo ago
It's the same people who just googled a couple keywords and used that as a citation without reading the link, pre-AI.
MichaelDickens 4mo ago
I read the main section of the lit review linked by OP, and it didn't seem to come to any real conclusions. > The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. [...] There is no good evidence for or against the effectiveness of OTC medicines in acute cough.
deleted 4mo ago
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rustcleaner 4mo ago

Just bring back ephedrine and pseudoephedrine! Nobody cares if a few enterprising nerds could cook it into methamphetamine! Oh my gawd someone might experience some unapproved, unrentiered joy! Send in the SWAT teams! This is what the War on Drugs™ gets us.

breck 4mo ago

[dead]

OutOfHere 4mo ago

Dextromethorphan is useful. The problem is solely with oral phenylephrine being sold for something that it does not work for. The precise suggestion then is for oral phenylephrine to not be sold for such indications.

ButlerianJihad 4mo ago

The real reason that all these drugs are mixed together seemingly willy-nilly is actually to prevent people from overdosing and going wild with a singular drug, or cooking up more potent mixtures from it. Guaifenesin in particular has been mixed with decongestants, for the primary purpose of preventing use as a precursor. If they sold these chemicals as singular treatments then the abuse would go through the roof. The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this. I injured my legs, then on top of it, had a minor cold recently, and finally grabbed a bottle of Coricidin HBP out of desperation. I have also been stocking up on 0.0% beers. Between doses of the former and bottles of the latter, I managed to get some great-quality sleep and rest. The other thing to notice about the Cold and Flu section of your pharmacy is that most all the treatments are supposed to relieve congestion, clear phlegm, and serve as an expectorant, such as all the cough drops with lemon, or menthol. If you are a lifelong smoker with a productive cough, this is great. That includes habitual pharmacy patrons who've always purchased their cigarettes and cigarilloes right there at CVS, next to the candy aisle and the booze aisle. If you live in a desert and/or suffer from chronic E-N-T dryness and dry coughs, then these treatments will make your life a living hell and must be avoided at all costs. Think about it.

kelnos 4mo ago
> The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this. I think we need to do more around accidental overdoses than suggest that everyone should be a "shrewd consumer".
- ButlerianJihad 4mo ago
  All you need to do is read the warnings and follow the instructions. It is not difficult. It does require literacy and intelligence, but a caregiver or the patient themselves should not have difficulty with the terminating the drug type and the dosage limits. If they do have difficulty, just see a nurse or a PCP. It's not rocket science! All these overdoses are happening because people do not read the warnings and they do not follow the instructions; and if they cannot understand the warnings and if they cannot follow the instructions, nor even consult a professional, then perhaps they deserve an overdose?

jollyllama 4mo ago

They wouldn't be selling the placebos if the real stuff were accessible. That's the real answer. The article mentions this but just accepts the inaccessiblity of the real thing as a given. You used to be able to get Nyquil with real sudafed in it. That was the gold standard. It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos. As an aside: > In January 2011, the FDA set a maximum amount of acetaminophen that could be packaged in combination opioids like Vicodin or Percocet. The odds of hospitalization due to opioid-related acetaminophen toxicity plummeted. Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.

stronglikedan 4mo ago
> you'd overdose on the acetaminophen first which is a much, much worse way to go, apparently
- krispyfi 4mo ago
  User takes a large dose and dies -> "they should have used as directed" User takes a large dose and gets high -> "why does big pharma condone drug abuse???"
lokar 4mo ago
I’m not sure. Another explanation is that it is accessible, with a small amount of friction. But then drug makers realize they can get more sales by selling a placebo that won’t have the friction.
MichaelDickens 4mo ago
> It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos. What do you mean "morons"? Say I'm a normal person who doesn't habitually read magazine articles about drug effectiveness. How am I supposed to know that phenylephrine doesn't work? It's in the drug store and they're selling it as a decongestant; I have good reason to believe it will decongest my nose.

andy99 4mo ago

In Canada if you go to a drug store, the shelves are literally filled with literal homeopathic medicine. You have to carefully confirm that what you’re buying isn’t water, and there is no signage or other differentiation between actual medicine and magic. Completely unrelated, I noticed recently that tire detailing spray that makes your tires look black, and the recommended lubricant for my garage door weather stripping, which both cost $15 or more for a little bottle, are just silicon oil that costs pennies for that amount. I have no moral problem with charging higher prices for convenience plus clarity of what the use is. I do think it’s amoral, obviously, to be involved in snake oil sales and unbelievable that the government allows it. Edit: this is the first result from a Canadian pharmacy searching for cough medicine. Worse it’s for kids: https://well.ca/products/homeocan-kids-0-9-cough-cold-day_88807.html https://well.ca/products/homeocan-kids-0-9-cough-cold-day_88...

graypegg 4mo ago
Ugh yup. My regular pharmacy is a pharmaprix (shoppers drug mart), which is one of the biggest chain pharmacies in canada. The cold and flu isle is right in front of the pick up counter, so when I was sick a few months ago one of the pharmacists flagged me down when they noticed me hovering around the cough drop/coldfx/oscillococcinum part of the isle. The amount of proverbial snake oil on the shelves is bad enough that she was apologizing for how confusing it was. Got me set up with OTC pseudoephedrine instead! (There's some combo PSE/acetaminophen meds they sell in front of the counter, but they're mixed in with the sugar pills.) It's really worth talking to your pharmacist even if you know what you're buying. There's so many more options behind the counter and they're really knowledgable.
Melatonic 4mo ago
Silicone oil can actually vary a lot. Some are safe for certain plastics or rubber materials and not great for others. The tire stuff might be the cheap shit that's not so safe just because tires are so thick and robust. Or maybe it's actually designed for tires.
Maxatar 4mo ago
In Canada all homeopathic medicine must clearly identify itself as such and must also state that it's based on traditional form of medicine and not based on any kind of scientific evidence. The very "medicine" you linked to in fact displays it right on the cover.

thallavajhula 4mo ago

I use DayQuil/NyQuil when I get a cold and in my case, it's always worked well. It suppresses the symptoms and lets me carry on with my day-to-day. I did try once going 1 week without it and it was hell.

saalweachter 4mo ago
When the hubbub about phenylephrine first started, I decided I still felt less miserable taking DayQuil/NyQuil, and switched to the "High Blood Pressure" formulation, which drops the phenylephrine, alcohol and sugar. It takes it down to just the Tylenol, the DXM (, plus the antihistamine in the NyQuil), and the great slightly tearable taste for the ritual of "time to pretend I'm not sick for a little while".

kube-system 4mo ago

I think there's one thing most people agree on: drugs should be safe and effective. DXM is fine but oral phenylephrine should be banned. The only reason it's in any of these drugs is because they don't want to lose sales when the real version that works is locked behind the pharmacy counter after hours. It's a scam to keep sales up.

tzs 4mo ago

> Take your standard 12-ounce bottle of DayQuil, which costs around $15 at CVS. ... > So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen, which separately would run you about 16 cents at Costco. Why are they comparing the price of CVS DayQuil to Costco acetaminophen? Either compare CVS DayQuil to CVS acetaminophen or compare Costco DayQuil to Costco acetaminophen.

Melatonic 4mo ago
Yeah that seems odd. It's also a very different delivery mechanism. Might be easier to get a sick and snotty kid to drink some (maybe?) tasty liquid vs cheap pills.
- cozzyd 4mo ago
  that's why you have children's tylenol (or generic) that is $$$ but exactly that.

nostrademons 4mo ago

The article kinda glossed over it, but one fact under-appreciated by the general public is just how dangerous acetaminophen overdoses can be. Scientists often talk about the "therapeutic index" or "safety ratio" of a drug. It's the LD50 (dose at which 50% of recipients die) divided by the effective dose. Common hard drugs like heroin or methamphetamine have a safety ratio of about 6-10 [1]. "Soft" drugs like marijuana or LSD often have safety ratios of about 1000. The safety ratio of acetaminophen is under 4. A typical dosing schedule for an adult is 4-6 500mg tablets within a 24 hour period [2], for a total of no more than 3g. 7g of acetaminophen can kill you, and 12g is likely to [3]. Acetaminophen is the leading cause of liver failure in the U.S, causing 50% of cases and 20% of transplants. When they tell you "don't exceed 6 doses daily", they really mean it, and it's across all acetaminophen-containing products. The margin for error is narrower than heroin. [1] http://politicsofsin.50megs.com/risk/Toxicity.Comparison_Addiction.99,p686_2004.html http://politicsofsin.50megs.com/risk/Toxicity.Comparison_Add... [2] https://pmc.ncbi.nlm.nih.gov/articles/PMC3585765/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3585765/ [3] https://www.ncbi.nlm.nih.gov/books/NBK441917/ https://www.ncbi.nlm.nih.gov/books/NBK441917/

unparagoned 4mo ago
Therapeutic index of fentanyl is much higher than heroin or morphine, but I don’t think people really think that it makes it safer.
- Shog9 4mo ago
  The folks I know who've been prescribed fentanyl weren't particularly upset about it. It is very potent, and thus measuring the dose properly is very important, but it's not particularly fussy beyond that. The people you know may be obtaining it from less reliable apothecaries; that can be a real issue.
- ErroneousBosh 4mo ago
  Reminds me of a comment I saw on a drug chemist's blog decades ago where they were talking about ACE inhibitors for Parkinsons' Disease - by dicking around with nerve conductivity and acetylcholine reuptake you could "boost" the failing nerves a bit, presumably until they fail altogether. Anyway much of the discussion was on how hard it is to make suitable drugs, and someone said "We actually have some fairly inexpensive, reliable, and well-characterised ACE inhibitors with a nice long half-life and known efficacy, but the therapeutic window of nerve gas is pretty narrow..."

wowczarek 4mo ago

I get that the discussion here focuses on doubtful decongestants, but just the mention of acetaminophen makes me think of pharmaceuticals and people's relationship with them in the US. It's a strange world to me, especially how deeply ingrained the brand names are in people's minds - years of evidently successful marketing. What, to me, should be illegal, is building expensive branding around a group of very basic analgesics - well and other groups like antihistamines. In the UK I can buy an own-brand 16-pack (8 g) of paracetamol in a supermarket for £0.35 / $0.45. At the same time, I can buy a packet of Panadol (GSK), same substance, same content, same amount, for £2.35, nearly 7 times the price of generics. How is THAT legal, and how are people so unaware as to actually buy it? "Unaware" may be the key here.

kelnos 4mo ago
Same situation in the US. I can buy NyQuil/DayQuil, or I can buy the pharmacy-branded version for a lower price. Here it's usually not such a dramatic difference; probably the pharmacy brand is a a 30-40% discount off the big-name brand. > How is THAT legal Why shouldn't it be? Companies are free to set prices to whatever the market will bear. In this case it's based on customer ignorance, which makes it feel icky, but I don't think that's a reason to legislate this sort of thing. > and how are people so unaware as to actually buy it? Yeah, I don't know. I do remember that, many many years ago, I didn't know about this, and would always go for the big-name-brand version. At some point I learned to look at the active ingredients and just buy the cheapest one that had the same ingredients in the same dose, but I don't recall when or why I learned that, or why I didn't know that before. I think there's also an implicit quality judgement sometimes, even if it's unfair. When it comes to groceries, say, canned tomatoes, and I see some fancy-looking Italian brand that I've heard of, my brain will automatically rate it much higher than the grocery store's own branded version of it. Maybe that's an effect of marketing/advertising, maybe it's something else, I don't know. And sometimes it's actually true: tomatoes are not all created equal. I think something similar happens with drugs, even if it's an entirely different kind of product. People also often assume that something that costs more is automatically higher quality. For some types of things, that can be true (because yes, there is such a thing as a better tomato, and sometimes it costs more to cultivate said better tomato), but for drugs in a regulated environment, that doesn't really make sense. But people pattern match on what they know and what they feel.

maest 4mo ago

Btw, the cosmetics industry functions similarly, but worse. Although I suppose the health dangers are lower (the monetary ones are not). For anti aging stuff, the workhorse ingredient is retinol (with a few formulation variations). However, it is very difficult to buy _just_ retinol - most beauty brands bundle up retinol with a bunch of other ingredients. This has a couple of issues: 1. You won't know your retinol dosage. These creams almost never tell you the retinol proportion and concentration. 2. You're overpaying by _a lot_. The luxury name brand cream will cost maybe 10x more than the similarly sized $9 bottle of retinol from the ordinary, but it will only contain some fraction of retinol. Tbf this has been slowly changing and I see even La Roche Posay sells retinol bottles for $50. Insane markup, but smaller than what was the case 5 years ago. This is all compounded with the fact that it's very difficult to tell if your anti aging cream is actually working from your own experience: - its effect is slow acting - it's difficult to compare the result with the counterfactual, unless e.g. you only use it on half your face

chem83 4mo ago

Interesting that in the US metamizole[0] (dipyrone, or Novalgin and Analgin comercially) is banned in the US due to agranulocytosis[1] risk. It's fairly common in Europe, Asia and South America. [0] https://en.wikipedia.org/wiki/Metamizole https://en.wikipedia.org/wiki/Metamizole [1] https://en.wikipedia.org/wiki/Agranulocytosis https://en.wikipedia.org/wiki/Agranulocytosis

scythe 4mo ago

The author has a point about dextromethorphan and phenylephrine. However, he does guaifenisin dirty: >You’ll also find lots of cough medication with guaifenesin, which has similarly thin scientific backing. He links ( https://pubmed.ncbi.nlm.nih.gov/24003241/ https://pubmed.ncbi.nlm.nih.gov/24003241/ ) which shows that guaifenisin had no measurable effect on sputum volume or consistency (p = 0.12 for volume). But there are other studies with broader outcome measures which show positive effects: https://link.springer.com/article/10.1186/1465-9921-13-118 https://link.springer.com/article/10.1186/1465-9921-13-118 >The pilot study was a randomized, double-blind study where patients were dosed with either 1200 mg extended-release guaifenesin (n = 188) or placebo (n = 190), every 12 hours for 7 days [...] >Subjective measures of efficacy at Day 4 showed the most prominent difference between treatment groups, in favor of guaifenesin. >The DCPD assessment of symptoms also indicated advantages for ER guaifenesin over placebo for the between-day changes from baseline in response to the questions “Over the last 24 hours how often did your phlegm prevent you from going to public places?” (Day 2; p = 0.0016) and “Over the last 24 hours, how difficult was it for you to bring up phlegm?” (Day 5; p = 0.0070). G tends to do well in subjective (symptomatic) assessments, even when subjects are blinded, but poorly in objective assessments. However, this isn't enough to condemn it.

tshaddox 4mo ago

> Historically, Sudafed has contained pseudoephedrine, the wonder drug equally good at clearing congestion and making crystal meth. It's much better at clearing congestion than at making crystal meth. And, as the joke goes, it's easier to make an effective decongestant from meth than it is to buy it from a store.

CodeWriter23 4mo ago

It should be legal. Caveat Emptor applies always. to everything. I'd rather have choices available in a marketplace rather than a nanny state stifling innovation through its own incompetence.

GuinansEyebrows 4mo ago
in the specific case of this article, "innovation" and "choice" are exactly the problem here. we know what works well - they're well-studied generic compounds. there's no social reason whatsoever that "dayquil" or "tylenol" or "sudafed" should exist when generics are readily available and clearly labeled.
jambalaya8 4mo ago
With computerized registers and loyalty programs, it is way too easy to profile. I am not too worried about looking like I chug too much aspirin; it's the further out assumptions or speculations that models (like I myself once designed or otherwise) might make that I worry about, that would not require proof, and would not be documented somewhere. I mean there is also stuff "like" congestion pricing to worry about, and maybe that would work better to make people think about liberties and tech. Dunno.

watchdarkly 4mo ago

Dextromethorphan is abused to get high. Not sure how it could be a placebo.

currymj 4mo ago

OTC decongestants that actually work, some useful info for those of us with bad sinuses. - pseudoephedrine taken orally. - phenylephrine, but only as nasal spray, not if you take it orally. - Oxymetazoline (Afrin) nasal spray and others in this broad family - propylhexedrine, sold OTC as Benzedrex as a vapor inhaler. Unfortunately people crack open the inhaler and swallow the whole thing as a drug of abuse, so often they are out of stock seemingly because of shoplifting, or not sold at all because the pharmacies don't want to deal with the hassle. Anything that goes directly in your nose has the potential to cause rebound congestion after a couple days which can be pretty bad.

dec0dedab0de 4mo ago

Calling Dextromethorphan a placebo is quite a stretch. Sure, I think the point is that it makes you intoxicated so that you don't really care that you're sick, but it is definitely active.

PetaTech-News 4mo ago

[flagged]

chao- 4mo ago

I go with Alka Seltzer specifically because they have an Aspirin variant instead of Acetaminophen.

jambalaya8 4mo ago

I am still bothered that Australia limited the sale of small quantities of codeine in 2018. I had not realized it limited acetaminophen last year to limits similar to the UK. At least in the States I can still economise. On the record, I am 100% for making common painkillers, cold and flu remedies completely over the counter. It blows my mind people are making things that used to be prescription (for good reason) OTC, but limiting purchases for things like acetaminophen. I still find it burdensome to deal with the pseudoephedrine controls, and I don't even use it often.

pkilgore 4mo ago

DayQuil: Because you're sick, and the rest of the office should be too.

erelong 4mo ago

"Yes, legalize all drugs for adults" Simple

annzabelle 4mo ago

I'm not sure what it is in the Dayquil - the DXM or the "decongestant," but there is a stimulant effect that is half of what I buy it for. It is the most effective medication I have found for getting me off the couch and able to power through a workday with a moderate cold, and definitely does something that Acetaminophen alone doesn't do.

Lerc 4mo ago

I had a cold a year or two ago, I had used the last of a bottle of actually working cough medicine, attempting to buy a replacement failing to do so, I found it had been banned. Turns out the active ingredient was morphine, which is apparently quite an effective decongestant in very low doses(and variants have been used as such for thousands of years) That started me on a quest for a good cough medicine. My research turned up some interesting results. Different countries have their own go-to medications for decongestants. Actual different drugs, not just the same thing under a different name. None of them work. Anything that does work is banned unless the people making it have been doing so for a couple of hundred years, then it seems that they just pretend it's not there. When challenged the industry defended their sale of ineffective products by saying if they didn't work, people wouldn't buy them. Anecdotal evidence is taken as gospel in many public health circles. When an attempt to have a substance banned was rejected on the basis of no evidence of abuse, it appears that means 'try again later', not gather evidence. You only have to wait for someone who shares your ideology once and it gets done and getting it undone is too much work for anyone to consider. It's almost enough to send you off to a music festival to gather your own supplies for home remedies.

titanomachy 4mo ago
Adderall (amphetamine) is a very effective decongestant. And it helps you get more work done!
- Lerc 4mo ago
  Well that's a bad sign. I'm managing the tail end of a cold again at the moment and I'm already taking dexamphetamine.

nodamage 4mo ago

> Most studies have found that dextromethorphan performs the same as a placebo The citation linked does not support this claim. In fact it suggests the opposite: "Dextromethorphan was tested in three of the included studies (Lee 2000; Parvez 1996; Pavesi 2001). One report on a series of three successive studies on a total of 451 adults favoured dextromethorphan 30 mg given in a single dose to placebo in terms of cough counts (measured through cough acoustic signals using a microphone on the nose) and subjective visual analogue scales (Parvez 1996). Differences in mean changes of cough counts between active treatment and placebo varied from 19% to 36% (P value < 0.05) in the three studies (up to a net difference of eight to 10 coughing bouts every 30 minutes). This study did not report on side effects. A study involving 44 participants tested a single 30 mg dose of dextromethorphan versus placebo (Lee 2000). Both treatment groups showed a decline in cough frequency (from 50 to 19 per 10‐minute period in the active treatment arm compared with 42 to 20.5 in the placebo arm, P value = 0.38 at 180 minutes follow‐up). Mean subjective cough scores showed a decline from 2.0 to 1.0 in the active treatment group compared to a decline from 2.0 to 1.5 in the placebo group (mean difference in decline in cough scores 0.5 at 180 minutes, P value = 0.08). Pavesi and colleagues also tested a single 30 mg dose of dextromethorphan versus placebo (Pavesi 2001). Outcomes were measured through a three‐hour continuous cough recording, measuring cough bouts, cough components, cough effort, cough intensity and cough latency. Average treatment difference was 12% to 17% in favour of dextromethorphan for cough bouts (P value = 0.004), cough components (P value = 0.003) and cough effort (P value = 0.001), with an increase in cough latency (P value = 0.002)." Two out of the three studies found DXM was effective in adults. The studies did not find the same efficacy in children but that could be due to differences in dosage (adult dosage is 30mg, child doses vary based on body weight) or in measurement techniques (as far as I can tell the child studies measured results via parental survey as opposed to more objective techniques like cough recordings).

fdgwhite 4mo ago

The FDA did this to us by outlawing effective but problematic products and replacing them with relatively safe but ineffective products. And then letting product makers off the hook on claims and pricing

aunwick 4mo ago

In the pharmacy in the US there are about 1000 over the counter drugs made if varios combinaciones of about 50 ingredients. Many of them contain acetaminophen. I can see how accidental liver damage can occur. On DayQuil specifically, the only time I took it I was about as useful as someone stoned. I would have been better off and less dangerous to society if I had just taken rest.. As far as pain management I personally find acetaminophen does nothing for pain and only helps with fever. Similar ibuprofen only helps me with sever muscle pain associated with over exertion or bruising. Having unfortunately suffered from nerve pain I can say the pain relief opiates provide, even at low levels, is on a whole different level. My experience is that taking them only for pain, when it is unbearable, was not addictive and made pain on the level of I need to go to the hospital bearable. Just my experience.

dreamcompiler 4mo ago

Until the late 1960s, codeine was considered the definitive over-the-counter cough medicine. It worked well. Maybe a little too well, because it was easy to get addicted to it. So the FDA banned it from OTC sales and dextromethorphan was substituted. Which brings us to today.

tsoukase 4mo ago

Placebo is a multi trillion market. Not only in the form of vitamin, dietary supplement or other non-active pill but also of shopping, psycho-boosting or feel-good behaviour. Even religion is a form of placebo! I am fed up with various "products" that come to my door: mix of vitamins, a-lipoic acid and ashwagada. I can imagine among the billions of physically healthy adults, there are many that choose them. While regulation for drugs is strict, for these products it is less that potato chips. The FDA goes like, as soon as they sell snake oil that doesn't hurt anyone, let the market loose.

casey2 4mo ago

In the US? Of course. It's not the FDA's job to make laws. Government needs to stay out of private business.

tancop 4mo ago

legalize pseudo and codeine again. prohibition is literally killing people. its forcing everyone to use less effective otc drugs where you need to take a more dangerous dose for the same effect. and when its harder to get codeine or real percs/oxys/xans/anything else people get fake street pills laced with fent. thats how they od and die. all these drugs should be sold with alcohol like rules (free access for adults/over 21, Rx only for minors) and warnings explaining exactly how to take them safely, both for "legit" and recreational use. the harm of drugs is half accidental ods and half organized crime. this defeats both and if cocaine was legal too, cartels would go out of business in a year.

cykros 4mo ago

"Most studies have found that dextromethorphan performs the same as a placebo and some suggested it was worse than honey." Something tells me this is because they're using it at the dosages listed. Because let me tell you, it certainly does NOT do nothing if you take more... Part of the issue though is that 1 in 10 people have a CYP2D6 enzyme deficiency and if you take the tablespoon or so that would be more effective (that a pharmacist I used to work with advocated for) you REALLY shouldn't be driving (or going to work for that matter). Phenylephrine of course is absolute garbage -- they just felt like they had to leave people a placebo for when they took away pseudoephedrine from the shelves to stop people making meth out of it. Beyond that, I do sort of agree that putting all of these actives into a single product entirely prevents you from working the doses for what actually is effective. If you have a product full of acetaminophen you CAN'T then just take more of it to get the effective dose of dextromethorphan (and I'm not even sure there IS an effective dose of phenylephrine, but if there is it's definitely higher than what's on the label). Not gonna say "there should be a law!" because I don't think anyone needs men with guns coming for them over this, but I do wonder why anyone buys this crap when the individual active ingredients can all be purchased and used in appropriate amounts. But I guess most people just take what the label tells them to...