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Here in the Northern hemisphere we are technically entering cold and flu season. I say “technically” because while that is true, I have personally not had a cold since late 2019 thanks to the fact that with a few exceptions here and there I now wear a mask in public places, don’t tend to eat or drink indoors, have better hand washing and face-touching habits, and stay up-to-date on my vaccinations. But yes, on a population level the fall and winter tend to be when we see an uptick in sniffles and things, so with that in mind, let’s talk about cold medicine. Specifically, let’s talk about the recent FDA decision that is going to cause most if not all over the counter cold meds to go away, why other useless treatments will remain available, and why Big Pharma is to blame for all of this.
So, a few weeks ago an FDA advisory panel announced that there is no difference between the oral consumption of the drug phenylephrine and placebo, despite the fact that phenylephrine is in EVERYTHING currently on the shelves to supposedly treat the symptoms of a cold. Experts assume this means that the FDA will soon revoke authorization for the use of the drug, and in response CVS has already decided to pull those products from the shelves.
The FDA panel’s decision surprised exactly no one in the medical field, because doctors and researchers have known for DECADES that oral phenylephrine is useless. Literally decades: here’s a paper from May of 2006 going over some of the evidence.
I make sure to say “oral” phenylephrine because the problem with the drug is that when you take it as a pill, your gut basically renders it useless long before it gets anywhere where it can do any good. There are nasal spray versions that might actually work.
So it’s great that this useless drug is finally going in the bin, but I found it interesting that CVS voluntarily jumped into action to remove the products when they continue to stock other completely useless products on their shelves, as pointed out last week by Beth Mole at Ars Technica. For decades now, doctors and scientists have pointed out that pharmacies sell real, scientifically proven medicine alongside homeopathy, which is literally just sugar pills. Absolute quackery with zero active ingredients in it by design, because the basis of homeopathy is that substances get more powerful the more you dilute them, up to and beyond to the point that not a single atom of the original ingredient remains, because the water “remembers” it. Literally, that’s what homeopathy is, and here it is right next to real medicine at the pharmacy.
The Ars Technica article explains that the Center for Inquiry is currently suing CVS and Walgreens to get them to, at the very least, separate the snake oil from the real medicine. Because hey, here in California our pharmacies are allowed to sell whiskey but it’s not in the dental health section next to the medicated mouthwash.
I agree that people are absolutely right to be annoyed that CVS is voluntarily throwing away shelves of cold medicines based on this one FDA advisory panel recommendation but continues to refuse to do the same for homeopathy, which the FDA doesn’t even evaluate in the first place.
But as annoying as the “alternative medicine” industry is, there’s a much more infuriating story here, and it involves the industry that secretly controls the alternative medicine industry: Big Pharma.
That paper I mentioned earlier from 2006 contains some interesting tidbits to get us started: oral phenylephrine was approved by the FDA in 1976 along with phenylpropanolamine and pseudoephedrine. At that point there was already substantial evidence that unlike the other two drugs, phenylephrine was no better than placebo at relieving cold symptoms. But the FDA approved it based on “unpublished, manufacturer-sponsored studies conducted by commercial testing laboratories” that resulted in “4 studies demonstrating efficacy compared with 7 demonstrating no difference between this dose and placebo. Thus,” these researchers wrote in 2006, “in our view, the panel reached a specious conclusion that was not based on a systematic review of the available data.”
So the pharmaceutical got a big win there, because they ran into trouble with the two drugs that actually worked: phenylpropanolamine was taken off the shelves due to a link with strokes, and pseudoephedrine became increasingly harder for consumers to get due its convenient ability to be turned into methamphetamine. As legislators called for products like Sudafed to be put behind the pharmacists’ counter, Pharma companies were able to put out products like “Sudafed-PE”, which had the disadvantage of not doing shit but the advantage of being really easy for the customer to grab and take to the checkout when they’re currently suffering from sinuses that feel like they’re the size of apples.
But let’s take a step back and talk a little about that other still-legal and actually effective drug, pseudoephedrine. As far back as the early 1980s, there was evidence that it had the potential to be turned into one of the most addictive substances the world had ever seen: methamphetamine. Gene Haislip was a higher up at the DEA who had succeeded in turning Quaaludes from a potential epidemic to a drug that would probably be forgotten today were it not for Bill Cosby. He did it by controlling the drug at its source: unlike heroin or cannabis, this was a drug that required large factories to produce it in bulk, so by establishing serious regulations he made the drug too difficult for dealers to get.
Haislip wanted to do the same with meth, which required ephedrine or pseudoephedrine to make – two chemicals that, once again, needed to be produced by large factories. He and his staff drew up a law to regulate those chemicals, and to his surprise it FLEW through Congress, through the Justice Department, through the White House, and it was looking like it would be ratified in record time. That is, until the pharmaceutical industry caught wind of it. Regulating those chemicals would cost them more money to prove their legitimacy, so they were against it. So the bill ended up passing and going into effect in 1989 with a specific carve-out for amphetamines that were to be used in over-the-counter pharmaceutical drugs.
So what happened was that at first, the law worked: dealers on the West coast (at the time the only place meth was running rampant) reported being unable to get the ephedrine, so the purity of meth dropped, meaning that addictions dropped, as did hospitalizations and deaths.
But then Mexican drug cartels started getting ephedrine and pseudoephedrine directly from the factories in India, the Czech Republic, and elsewhere, and funneling it into the US. So Haislip went to the factories and got them to agree to stop selling to the dealers. Once that happened, deaths dropped again. Another success. But remember that carve-out? Here’s where it came back to bite America on the ass: the dealers set up a bunch of their own little pharmaceutical companies to legally buy the ephedrine and pseudoephedrine in bulk to make “over the counter tablets,” which they then “bought” and crushed back up and turned into meth.
So in the ‘90s Haislip tried to close that loophole and get a regulation put in place on wholesale pill sellers, but once again the Pharma lobby stepped in. Again, they would still be allowed to buy and sell these ingredients but there would be a few extra hurdles in place and that would cost them money. So they agreed to accept a regulation but convinced legislators to allow a one-year grace period for the industry to adjust to the new rules, and also probably start producing more products with phenylephrine, which again, they know is useless but it’s going to make them way more money if they can have it ready to go by the time these new regulations get going. That allowed the dealers an entire year to ALSO adjust to the new rules, meaning that by the time the regulations became active, the dealers already had new ways to get ephedrine and pseudoephedrine.
By the way, PBS produced a great documentary detailing all this in 2011. They talked to a pharmaceutical lobbyist who had this to say about what he and his pals did: “Now what would you do if there was a bill out there that would negatively affect your industry? It wouldn’t make any differance if you were from the dill pickle industry or from the over the counter medicine industry. You would naturally do what you have to do.”
Well gosh Allan, I can’t say for sure because I don’t work in the pickle industry but I guess the first thing I would do is ask how drug dealers are using homemade bombs to turn my pickles into addictive drugs that destroy entire communities and then I’d figure out how to stop that from happening. But I can see how instead you would pay congressmen millions of dollars to allow it to keep happening because you make money whether people buy your pickles for putting on sandwiches or turning into drugs so it’s all the same to you.
Okay and I can’t help it, here’s one more quote from a Pfizer executive named Steve Robins arguing why they tried to stop a law that would require buyers of Sudafed to go to the counter to buy it instead of just having it on the shelf, and if you’re just reading this in the transcript I highly recommend you click through to minute 40 in the documentary just so you can appreciate how this guy just looks and sounds like the biggest piece of shit on the planet: “There’s been a lot made about how much profit was made by people who were buying this for illicit reasons. On the other side of that coin, we end up paying for the shrinkage that is the theft okay that these smurfers do by going into stores and stealing product and I will tell you I’m not sure anyone’s done the analysis and in the end I’m not sure we made any additional money vs that product we had to actually replace because people had stolen it illegally.”
Uh, a few points here, Steve: first of all, as far as I’m aware if someone steals a box of Sudafed from a CVS, that’s CVS’s problem, not Pfizer’s. CVS already paid Pfizer for that box.
Secondly, you know what would stop most people from stealing Sudafed off the shelves? PUTTING IT BEHIND THE COUNTER, STEVE. LIKE THEY DO WITH THE CIGARETTES AND THE FUCKING RAZOR BLADES.
Anyway, I’m skipping over a lot of detail to just get to this main point: at every step in this process since the 1970s, the pharmaceutical industry has put profits over human lives. Had they not have had a decent lobby back then, the FDA would never have approved the useless drug oral phenylephrine, and the DEA would have had regulations in place to stop meth from becoming an epidemic in the United States. Instead we’ve experienced nearly 50 years now of this insipid back and forth and oh my god I just realized this is basically what happened with COVID. Had governments had a uniform and sensible policy in place and the infrastructure to handle sick people quickly and efficiently, the virus would have been wiped out before it became an epidemic. And because we allowed that, the virus evolved to continue to escape immunity and now we’re just going to deal with it forever, probably.
In fact, reports from the past decade or so suggest that the meth coming out of the Mexican cartels is now so pure and so cheap that now even if we put Sudafed out in a basket by the exit of every CVS, home cooks can’t hope to compete with the stuff. A careful viewer of Breaking Bad might know that there’s an alternate way to make meth that doesn’t actually use ephedrine or pseudoephedrine, and that appears to be what they’re doing: phenyl-2-propanone, or P2P, is how the Hell’s Angels used to do it in the 80s. The cartels figured out a way to make meth with that, but using a better process.
So now we come to the final irony: for years now you have likely been taking a cold medication that doesn’t work, because the one that does work was used to make a street drug via a method that hasn’t been in use for at least the past decade. And all of it is thanks to corrupt, amoral cockroaches like Steve Robins.
