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.
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
DXM may or may not suppress coughing relative to placebo - the study cited here appears to be have been written entirely by authors from drug companies, so perhaps there is some bias. Here's a meta analysis that favors honey over DXM https://pubmed.ncbi.nlm.nih.gov/32817011/, the original study that kicked off this idea that also favors honey https://pubmed.ncbi.nlm.nih.gov/18056558/, and a different meta analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC6513626/ which found little or no difference between honey and DXM. Whether its effective or not, to me there doesn't seem to be compelling evidence that it is more effective than honey.
It's funny that TFA seems to use the comparison to honey as disparagement, rather than interpret the same information as an endorsement of the helpfulness of honey.
An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself, and similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.
> An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself,
Auvelity is interesting, but the exact mechanism of action is not very clear.
Auvelity is a combination of two drugs: Dextromethorphan and Bupropion. Bupropion, aka Wellbutrin, is an antidepressant by itself. In Auvelity it helps alter how Dextromethorphan is processed by the body, but we can't rule out that it contributes to the antidpressant effect. I mean it's literally an antidepressant.
Dextromethorphan has a lot of interactions and gets a lot of comparisons to ketamine because it has NMDA affinity, but if you look at the table of receptors it interacts with the serotonin receptor is one of the strongest interactions. It is a potent serotonin reuptake inhibitor, which is also known to have antidepressant effects. It also has some sigma receptor interactions which might be doing something significant.
The NMDA interactions get all of the attention because if you put "ketamine" in the headline you get a lot more attention, but NMDA may be much lower on the list or even negligible for this combo.
This is straying a bit from the original post, but agreed, NMDA antagonists and related compounds effecting glutaminergic tone are showing promising directions.
N=1, I've had very positive experiences with DIY Auvelity, using 150mg Buproprion XR that I'm RX'ed with 60mg OTC DXM-only tablets.
In my subjective experience, Dextromethorphan (DXM, as the robo-trippers call it) does almost nothing for me, in the 1-5% range
The only cold and cough medicine that really truly works is the over-the-counter stuff, pseudoephedrine, works amazing for me. I usually pick up a box of the stuff when school starts in the fall and I go through half a box of it by the following summer.
> ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.
To be fair, you're doing pretty much the same by claiming these studies exist without proof.
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.
> 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.
But I don't have time to do that. I would rather have a retailer do that curation for me and provide me with effective high value products, and stand behind returns when they miss the mark. Then as a customer I can reward them for that value added work.
That's why Costco is great most of the time. Although they sometimes miss the mark with certain products they stock.
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.
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.
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.
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.
"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.
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.
> 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.
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.
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.
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.
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.
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.
> 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.
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.
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.
> 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.
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.
>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.
This is a story about mental health, psychedelics, psychology and the mind. It is a story about the joy of family, the joy of friends, the joy of being in love, and the joy of doing scientific research. It is a story about life, the world, and how amazing they both are.
After 18 months of intolerable torture, and after many months of consideration I have decided to end my life."
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).
> 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.
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.
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!
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.
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.
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.
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.
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".
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.
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.
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".
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.
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.
I generally agree, but it seems darkly comical to be worried about gatekeeping antibiotics as a tick disease prophylactic when the vast majority of antibiotics are applied non-therapeutically to farm animals.
That's why I went amoxycillan. I can buy medical grade as "fish antibiotics".
Alpha-gal wasn't prevalent then. It was primarily Lyme and rocky mountain spotted fever. Doxy and amox is the gold/silver standard for both.
I don't need a fucking doctor to tell me I was bitten by 15 ticks. I removed them myself with a tick puller. I don't need to he told that I probably got a disease from at least 1 of them. So yeah, its either going to cure the infection before it starts up, or is a prophylactic to prevent it.
And in more sane countries, I can go in a pharmacy, tell the pharmacist and reasonablely and cheaply treat myself. US? Not so much.
By I can smoke delta8, tobacco, and drink until my lungs and liver give out.
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?
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.
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.
Legal status of these chemicals is not going to prevent your neighbor from getting them and becoming addicted.
Legal status (along with stigma associated with it) does prevent them from getting help before completely crashing out. It has the additional side effect of whatever portion of their lives they come out of it with being completely destroyed by the legal process. You know, because chronic illness obviously deserves punishment.
So I guess the real question is: what is the goal? Help chronic illness, or punish people that do things we don't like?
Also, don't we already have laws for literally all the bad things someone can do while addicted? If not, then why is it bad just because they are suffering from a chronic illness?
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.
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/
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
DXM may or may not suppress coughing relative to placebo - the study cited here appears to be have been written entirely by authors from drug companies, so perhaps there is some bias. Here's a meta analysis that favors honey over DXM https://pubmed.ncbi.nlm.nih.gov/32817011/, the original study that kicked off this idea that also favors honey https://pubmed.ncbi.nlm.nih.gov/18056558/, and a different meta analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC6513626/ which found little or no difference between honey and DXM. Whether its effective or not, to me there doesn't seem to be compelling evidence that it is more effective than honey.
It's funny that TFA seems to use the comparison to honey as disparagement, rather than interpret the same information as an endorsement of the helpfulness of honey.
An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself, and similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.
> An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself,
Auvelity is interesting, but the exact mechanism of action is not very clear.
Auvelity is a combination of two drugs: Dextromethorphan and Bupropion. Bupropion, aka Wellbutrin, is an antidepressant by itself. In Auvelity it helps alter how Dextromethorphan is processed by the body, but we can't rule out that it contributes to the antidpressant effect. I mean it's literally an antidepressant.
Dextromethorphan has a lot of interactions and gets a lot of comparisons to ketamine because it has NMDA affinity, but if you look at the table of receptors it interacts with the serotonin receptor is one of the strongest interactions. It is a potent serotonin reuptake inhibitor, which is also known to have antidepressant effects. It also has some sigma receptor interactions which might be doing something significant.
The NMDA interactions get all of the attention because if you put "ketamine" in the headline you get a lot more attention, but NMDA may be much lower on the list or even negligible for this combo.
This is straying a bit from the original post, but agreed, NMDA antagonists and related compounds effecting glutaminergic tone are showing promising directions.
N=1, I've had very positive experiences with DIY Auvelity, using 150mg Buproprion XR that I'm RX'ed with 60mg OTC DXM-only tablets.
In my subjective experience, Dextromethorphan (DXM, as the robo-trippers call it) does almost nothing for me, in the 1-5% range
The only cold and cough medicine that really truly works is the over-the-counter stuff, pseudoephedrine, works amazing for me. I usually pick up a box of the stuff when school starts in the fall and I go through half a box of it by the following summer.
> 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?
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.
> ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.
To be fair, you're doing pretty much the same by claiming these studies exist without proof.
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.
> 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.
But I don't have time to do that. I would rather have a retailer do that curation for me and provide me with effective high value products, and stand behind returns when they miss the mark. Then as a customer I can reward them for that value added work.
That's why Costco is great most of the time. Although they sometimes miss the mark with certain products they stock.
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.
and, you know, smells and such
i don't need to smell like grandma
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.
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.
"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.
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.
"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.
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.
> 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.
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.
Oral phenylephrine is considered to be ineffective, phenylephrine in a nasal spray is considered effective.
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.
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.
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.
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.
> 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.
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.
> Dextromethorphan is definitely not a placebo.
It definitely works for me. It'd be wild if for all 44 years of my life, it's only worked because of the placebo effect.
The article mentions phenylephrine, and that shit definitely doesn't work. Not even a placebo.
The left enantiomer of methamphetamine (exact same chemical formula and structure, just mirror symmetry) is also an OTC decongestant.
Vicks
Only historically. No Vick's brand product has contained it since 2016. The only "brand" name I'm aware of currently is Benzedrex.
Benzedrex is not l-Methamphetamine, it is Propylhexedrine
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.
> 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.
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
>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.
i believe you are referring to Felix Hill.
https://docs.google.com/document/d/1-jBoSEVlryiX1IaSzV4vKuih...
"On mental health, psychedelics and life
This is a story about mental health, psychedelics, psychology and the mind. It is a story about the joy of family, the joy of friends, the joy of being in love, and the joy of doing scientific research. It is a story about life, the world, and how amazing they both are.
After 18 months of intolerable torture, and after many months of consideration I have decided to end my life."
one off experience of someone in a stressful job. are we gate keeping?
It is entirely reasonable to say that it should be RX-only to be monitored by a physician for these reasons.
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).
> 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.
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.
Acetaminophen (Tylenol) is probably the OTC drug that is at the top of the list to be made RX-only due to its dangers.
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!
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.
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.
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.
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.
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".
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.
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.
Are you sure you have read the article, not just its title?
When an article has a misleading clickbait title, I think it's fair game to redirect the conversation to the subject of the title.
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".
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.
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.
I generally agree, but it seems darkly comical to be worried about gatekeeping antibiotics as a tick disease prophylactic when the vast majority of antibiotics are applied non-therapeutically to farm animals.
That's why I went amoxycillan. I can buy medical grade as "fish antibiotics".
Alpha-gal wasn't prevalent then. It was primarily Lyme and rocky mountain spotted fever. Doxy and amox is the gold/silver standard for both.
I don't need a fucking doctor to tell me I was bitten by 15 ticks. I removed them myself with a tick puller. I don't need to he told that I probably got a disease from at least 1 of them. So yeah, its either going to cure the infection before it starts up, or is a prophylactic to prevent it.
And in more sane countries, I can go in a pharmacy, tell the pharmacist and reasonablely and cheaply treat myself. US? Not so much.
By I can smoke delta8, tobacco, and drink until my lungs and liver give out.
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?
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.
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.
But it's part of this world. Who is to say who can participate in aspects of the world?
Okay question was about drugs that are contraindicated for all medical purposes like heroin.
Also do you see any ironic connection between your two examples: easily accessible antibiotics and a medically resistant infection?
- 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.
Legal status of these chemicals is not going to prevent your neighbor from getting them and becoming addicted.
Legal status (along with stigma associated with it) does prevent them from getting help before completely crashing out. It has the additional side effect of whatever portion of their lives they come out of it with being completely destroyed by the legal process. You know, because chronic illness obviously deserves punishment.
So I guess the real question is: what is the goal? Help chronic illness, or punish people that do things we don't like?
Also, don't we already have laws for literally all the bad things someone can do while addicted? If not, then why is it bad just because they are suffering from a chronic illness?
Of course placebos should be legal, they're effective medications.
https://www.health.harvard.edu/newsletter_article/the-power-...
The placebo effect is not an excuse to allow drug companies to make false claims about the efficacy of the ingredients