I think the placebo effect still working even if the person is told it is a placebo is a factor of whether or not you consider placebo to be "bad" or "ineffective". To me it just suggests a difference in the actual mechanism of how the placebo is effective. I'm curious to know if there are ways to increase the effectiveness of placebo by having a strong/pleasant smell or taste associated with it or some other sensory effect that is immediately noticeable.
So yeah, people need to be aware that pseudoephedrine has side effects, but it’s arguably equal to if not better than the alternative that’s being pushed as “safe”.
Yes, it is a powerful drug.
I feel like the dichotomy between OTC and prescription medications tends to make me assume that prescription drugs are potentially dangerous while anything available OTC is harmless.
I want to be trusted with medicine that actually works, and that means I need to take some responsibility for understanding the dosing and side effects before I take it.
The annoyance is that there's an ineffective medicine taking their place on the shelves in front of the counter, and no sign saying "don't bother, just ask the pharmacist for the real thing". But you know that now, so this isn't so much a problem for you.
The OP you're responding to is just saying, be careful with pseudoephedrine, independent of the law. And they're right; it's been linked to heart attacks and strokes.
But I have to go begging for working cold medicine.
I swear they all believe in phenylephrine and think the only reason someone would buy psueudafed is to do meth.
I can't imagine one giving me any actual lip, but my escalation strategy there is to look them dead in the eye and ask them whether they're going to give me my perfectly-legal cold remedy or not.
Now that sounds like a project.
If you follow along with the thread, you'll realize this isn't about OTC cold medicine.
By other people I am including my mother, who is the nicest lady you could imagine, but regularly gets shamed and embarrassed by the medical establishment. This stuff affects her.
It doesn't affect me. I will either escalate all the way to a physical fistfight if I have to or just suddenly decide all of a sudden it's not worth my time and just walk away and forget about it. Usually a bit of both because I typically find that the dynamics I thought I was dealing with going in weren't really there and I'm just acting silly.
Either way I get answers, darnit, and I don't stop until I get them. Same hacker mentality applied to the interpersonal realm. I don't really know how to articulate this mindset, that you really don't have to put up with this behavior, that you can have power over the situation, not even to my own mother.
I bought some sudafed a week ago and got offered more of it by the pharmacist (they sold me a package with twice as many pills as the one I brought up a card for). And I am a pretty scruffy looking dude; on my better days my fashion sensibility and grooming approaches "possibly homeless".
Otherwise she will just ask for "Mucinex" because it worked really well that one time. This ignores the fact that like all of the *Quils, Sudafeds, Tylenol Cold-Flu-and-Explosive-Diarrheas, and Robitussins, there are multiple preparations made from various ingredients.
If I need an expectorant, I want guaifenesin. Cough suppressant: dextromethorphan. Decongestant: psuedoephedrine. Pain reliever: acetaminophen or ibuprofen or whatever.
It also doesn't help that it's hard to find the specific mix you need in a single preparation but it's also gotten harder to find just single ingredient store brands of some of these as well.
I don't want to take something I don't need so I'd rather not just buy some name brand kitchen-sink capsule that adds various decongestants or antihistamines if I don't need them.
But then the same focus on brand names and basic descriptions can lead to people buying homeopathic sugar pills because they're in the same department and list similar symptoms. If you never shop by ingredient, you won't know that a 1000x diluted extract of duck liver isn't the same as pseudoephedrine and guaifenesin.
It's not just patients either. Some OTC products are covered by some insurance plans. I've had prescribers change from one OTC product to another that shared none of its ingredients with the first. Not sure what they were treating other than "patient wants a prescription".
And don't get me started on homeopathic products. I had a man come in once with the box of a homeopathic product looking to buy more for his wife. I looked around, showed him a similar product, and asked if this was OK. He said it was as long as it worked as well. That I could guarantee!
I do try to dissuade such purchases, but when the customer comes in knowing what they want, it's often a losing battle. The one time homeopathic products can be useful is when someone just has to have something to treat their two-year-old's cold.
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.
I took megadoses of vitamin C and my cold I was sure would knock me out for a week went away!
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.
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.
It's dangerous to assume that just because the "cold medicine" doesn't attack the virus that it doesn't work.
This isn't strictly true either. An otherwise healthy person's body will take care of most sinus infections itself given a little time and care. When it turns into something longer-term, that's when antibiotics may come into play.
 And these can be bacterial or viral
Did once - burst an eardrum and had to take a while off work.
>The Food and Drug Administration withdrew its 1976 approval as a nasal decongestant in 2007
[The inefficacy has been reported for a long time, eg 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.
Seriously though just a couple days of this last week headed off a sinus infection so i didn't need antibiotics. Win!
Edited to add: I'm not particularly up in arms about needing ID, and I feel like buying Sudafed got easier somehow recently, but this seemed like a place where I could help explain what sorts of things can be uncomfortable/difficult for some people.
Recent backlash against tech companies tracking users suggests that in general, people do not like being tracked. People may even prefer less effective OTC medications to prescriptions on the basis of anonymity. This may or may not be based on a rational concern about a more concrete negative outcome.
This may be an "exception that proves the rule", since William Fousse, the guy who got prosecuted, was addicted to pseudoephedrine and was buying large amounts of it, so large that the investigating officers found it implausible that he'd be personally consuming it (it turns out, he was; he was doing a see-saw thing where he'd get drunk and then use the pseudoephedrine to come up from it to get work done). He was buying from multiple pharmacies, apparently to avoid the limit.
This is not a case that makes me alarmed for my own safety when going to buy a 40-pack of sudafed, though I'm receptive to the argument that prosecution for an actual sudafed addiction was not the intent of the law and should not have been prosecuted in the first place.
Instead, let's take a look at scenarios where you might buy over 9000 mg in a month. The maximum recommended dose is 50mg every 8 hours, so 3 times a day. 9000/50/3 = 60 person-days. If it's allergy season and they're all taking the maximum dose, a family of four could hit the limit in 15 days.
Inefficient distribution (making sure there's always some in both of the cars, each kid's backpack, at each adult's work) makes it even easier to hit the limit. The largest size normally available is 96x25 mg. Four of those is 9600 mg. Just trying to get a box for each family member makes you a criminal.
Perhaps the limit should be higher? Certainly, I agree in advance that people not making meth and not reselling shouldn't be getting prosecuted. But the story of William Fousse doesn't really have much to tell me about the public policy value of pseudoephedrine restrictions or about the likelihood that an especially allergic family might get caught up in it.
If you find other cases where something like that happened, I'm happy to dig into the filings as best I can.
There are also a couple surveys of the state laws easily Googleable, and most of them have "knowingly" (for evading the limit) or "intent" (to manufacture meth) standards for the offenses themselves.
Regardless, people often do use OTC drugs in ways that might not be advisable, but definitely aren't recreational (leaving aside the issue of whether criminalizing recreational drug use is a good idea).
If a family could reasonably anticipate being arrested or searched for consuming sudafed regularly for several weeks (bad allergies, sinus cold, whatever), I stipulate that's significant and problematic. What I'm contending is that in 2019, that's so unlikely to happen as to be implausible.
I don't know how likely prosecution is in 2019. There have been a few under much more restrictive state laws making pseudoephedrine prescription-only and criminalizing traveling out of state to obtain it, but that's not the original issue we were discussing.
It's probably pretty unlikely under Federal law, but it took several posts back and forth on HN along with a PACER lookup for us to reach that conclusion explains fairly well why many people are uncomfortable with having their purchases tracked in this manner.
It's nice that there's now research backing up these anecdotal pieces.
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.
Nowadays I just take a lot of antihistamines to stop the snot, but they don't do much for congestion.
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.
I didn’t know this until this morning, but it matches my experience perfectly.
However nasal sprays like Afrin are just as effective and don’t have nearly the stimulant effect, especially when used with NyQuil
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.