
Phenylephrine Is No More Effective Than Placebo for Nasal Congestion (2015) - DyslexicAtheist
https://www.jwatch.org/na39054/2015/09/17/phenylephrine-no-more-effective-placebo-nasal-congestion
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pnutjam
That's the "Sudafed PE" you can buy without going to the pharmacy, right? I
always joked with my wife that he PE stood for Placebo Effect. That stuff is
garbage.

~~~
TACIXAT
I had chronic sinus headaches triggered by food. I've always found it
effective.

~~~
norswap
It is a big misconception that the placebo effect must be ineffective — there
wouldn't be an effect at all if that was the case. I hear it's sometimes even
effective when you're _told_ you're taking a placebo.

~~~
losvedir
I've always found it fascinating that naloxone (the drug administered to
people who OD on heroin, since it counters the effects) actually does make the
placebo effect go away (that is, placebos become ineffective). Makes me think
that the placebo effect is very real and something like a self-induced opiate.

~~~
copperx
I've always wondered why placebo works for minor problems (a cold, nasal
congestion, mild pain) but it does not for real diseases. For example, you
never see chemotherapy treatments compared to placebo (because it is unethical
to conduct such a study), but it could be done with "wait and monitor" cancers
such as slow-growing prostate cancer.

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patwolf
I would consider voting for a politician with a platform of eliminating
phenylephrine and making it easier to obtain pseudoephedrine, i.e. not having
to get it from behind a counter while showing ID and signing a logbook.
Although perhaps I'm naive about the seriousness of the methamphetamine
epidemic and the positive impact the additional restrictions have had to
society.

~~~
richardhod
Beware pseudoephedrine. People have been known to abuse it, and it has dangers
especially for those with heart issues: People with heart disease or
hypertension should watch out for any legitimate drug that contains
pseudoephedrine. See, pseudoephedrine doesn't just constrict the blood vessels
in your nose and sinuses; it can also raise blood pressure and heart rate,
setting the stage for vascular catastrophe. Over the years, pseudoephedrine
has been linked to heart attacks and strokes. "Pseudoephedrine can also worsen
symptoms of benign prostate disease and glaucoma,"
[http://www.nbcnews.com/id/24777955/ns/health-
health_care/t/d...](http://www.nbcnews.com/id/24777955/ns/health-
health_care/t/drugs-doctors-wouldnt-take/)

~~~
e40
I remember years ago I was at the gym with a work buddy and we decided to try
one of the drinks offered there, since we forgot our water bottles. We had the
most amazing workout. We both executed personal bests, and after the workout
we felt great. Much less tired than normal. At that point, I turned to the
empty bottles and found it was chocked full of pseudoephedrine. It was a
little scary to us, so we never did that again.

Yes, it is a powerful drug.

~~~
psychometry
Where can you buy beverages with pseudoephedrine added?

~~~
Zak
More common would be ephedra, though this has been mostly illegal to sell as a
food/drink ingredient in the US since 2004. Ephedra contains ephedrine and
pseudoephedrine.

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AdmiralAsshat
Phenylephrine has been the bane of people's existence for years. I have to
constantly remind friends/family when they're complaining that their cold
medicine didn't help: "If you pulled it off the shelf yourself, it won't do
anything. The kind with the active ingredient that actually _works_ is behind
the counter."

~~~
richardhod
In general, cold medicines do not work. We cannot cure the cold viruses, only
alleviate symptoms. Mostly, warmth, fluids and rest, and not spreading the
cold to others is best advice, plus decongestants, which is what you're mostly
being sold. Even so, people ask for antibiotics for many ailments where they
are useless, and add to resistance instead.

~~~
Silhouette
I had one of those experiences a while back where the conclusion is so obvious
that you wonder how you hadn't worked it out many years earlier.

I actually did rest and drink plenty of fluids when I had a horrible cold.

I stayed in bed for most of the next 24 hours, sleeping when I could, at a
comfortable room temperature and with a little ventilation.

I made sure I drank several pints of water during that time, even though at
first my sore throat was hurting every time I swallowed and I really didn't
want to.

One day later, a condition that had felt like it was going to give me at least
another week of unpleasantness was already greatly improved. Not fully
recovered, but much, much better, far beyond anything any cold remedy
medication had ever done for me (though the real medicine did also help with
decongestion and allowing enough comfort to fall asleep).

It turns out that doctors have been right all along and it was just me not
getting it, fooling myself into thinking that if I went to bed a bit early and
had a few extra sips of water then I was following the doctors' advice.

~~~
kbutler
Post hoc ergo propter hoc.

I took megadoses of vitamin C and my cold I was sure would knock me out for a
week went away!

~~~
Silhouette
_Post hoc ergo propter hoc._

Except that taking proper rest and fluids has consistently helped me to get
over anything like colds ever since, and as far as I'm aware it is the only
common factor that changed other than my age.

~~~
kbutler
I'm not saying you're wrong, and I agree that the data supports "rest and
fluids".

But I have relatives that make similar statements about lots of health
treatments that are absolutely not supported by the data, and probably just
demonstrate variability and placebo effect.

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swebs
It looks like this was known for a while now.

>The Food and Drug Administration withdrew its 1976 approval as a nasal
decongestant in 2007

[https://en.wikipedia.org/wiki/Phenylephrine#Decongestant](https://en.wikipedia.org/wiki/Phenylephrine#Decongestant)

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pbhjpbhj
It shows a real disdain for the public; pseudephedrine used to be in Sudofed
IIRC, which was really effective for me. They kept the exact name and
packaging and removed the active ingredient - that's fraud IMO.

~~~
_carl_jung
Are you in the US? We have Sudafed with pseudoephedrine in the UK.

~~~
pbhjpbhj
I'm in UK. Perhaps they have a different one behind the counter? The "sudafed
max strength" (presumably they added caffeine to make you think it was
working?) I have only has phenylephrine.

[The inefficacy has been reported for a long time, eg
[https://www.ncbi.nlm.nih.gov/m/pubmed/19230461/](https://www.ncbi.nlm.nih.gov/m/pubmed/19230461/)
.]

Edit: just checked, it seems out of the 30 or so "Sudafed" there is one with
pseudoephedrine, the key phrase in the otherwise identical packaging is
"clears catarrh". Woohoo!

So "max strength" means "no better than placebo", lol.

~~~
_carl_jung
Hah, I don't remember the packaging. I think I went in and asked for the one
with pseudoephedrine and the pharmacist understood.

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Nursie
Colour me unsurprised. It's never worked for me, I've spoken to doctors who
have agreed it's been useless for them and their patients. I won't buy any
product containing it.

It's nice that there's now research backing up these anecdotal pieces.

~~~
mavsman
Had the same experience.

Side note, taking pseudoephedrine HCl has been an absolute lifesaver for me
when I have terrible sinus pressure on planes. If you Google for "relieve
sinus pressure on plane" or something similar, most of it is stuff that won't
help when you're already in pain. I always take an ibuprofin and the real deal
sudafed to open up my sinuses and relieve the pain, it works pretty well.

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dec0dedab0de
This probably sounds like nonsense, but with nasal congestion sometimes I can
clear my sinuses by concentrating on where it feels constricted and trying to
relax that area. I don't know anything about this drug, but I am pro placebo
effect.

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classichasclass
I actually miss phenylpropanolamine. Phenylephrine never does anything for me,
and pseudoephedrine gives me rocks in my head.

Nowadays I just take a lot of antihistamines to stop the snot, but they don't
do much for congestion.

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tptacek
I can't remember where I read this, but my understanding was that
phenylephrine was effective in nasal sprays, but is broken down in the stomach
and isn't effective orally.

It's worth remembering that lots of medications may not be much better than
placebo; for instance, guaifenesin is apparently not effective, despite
forming the basis for popular expectorants.

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MBCook
Heh. I see someone else follows @SwiftOnSecurity.

I didn’t know this until this morning, but it matches my experience perfectly.

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bootsz
I think I tried this once (accidentally) back when pseudoephedrine was put
behind the counter and immediately figured out it was total garbage compared
to the real thing. I can't believe they're allowed to charge money for that
stuff.

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rconti
Hahaha, this is so satisfying, I never buy that crap and insist on waiting in
line in the damn pharmacy for proper pseudoephedrine. I always figured it was
possible it was all in my head (I'm not sick THAT often to say for sure), but
phenelephrine never seemed like it did a thing.

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ndespres
Funny to read this today as I wake up with a "hangover" from taking Sudafed PE
last night. I do have a box of "the good stuff" but it isn't rated for night-
time use. I think I'll dump the remainder of the bottle out.

~~~
orev
Diphenhydramine (Benadryl) usually counteracts the stimulant effect of
pseudoephedrine, and is one of the main ingredients in NyQuil (along with a
cough suppressant). That combination is what made NyQuil so formidable before
the pseudo-pocalypse, but you can recreate the effect just by taking both.

However nasal sprays like Afrin are just as effective and don’t have nearly
the stimulant effect, especially when used with NyQuil

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21
What about eucalyptus oil candy? It instantly unblocks my nose whenever I take
it, I don't think I'm imagining that.

~~~
webmobdev
And if you have sore throat and / or cough, boil a cup of milk with a quarter
teaspoon of turmeric powder, pour it into a cup, add half a teaspoon of pepper
powder, stir and let it cool down. You can also add honey or sugar to improve
the taste. Drink it warm / hot before you sleep and when you wake up, and be
amazed at the quick relief you will feel.

~~~
oliveshell
Great idea! Turmeric is a good anti-inflammatory drug.

If you burn yourself, you can put yellow mustard the burn and let it sit for a
minute or so. Pain will nearly disappear and healing will be notably
accelerated. Supposedly it’s due to the turmeric used as color (brown mustard
won’t work).

Wouldn’t’ve believed it if I hadn’t tried it myself. Works like a hot damn.

~~~
webmobdev
True about Turmeric but for sore throat / coughs it's the Black pepper that
really gives the quick relief.

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notatcomputer68
Why would you pop pills when there are perfectly good sprays?

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raverbashing
There are reasons for using one in detriment of the other. Like rebound
congestion.

~~~
pnutjam
The pill also help if you are prone to ear infections. They thin everything
out up there.

