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I briefly worked as a retail pharmacy technician 12 years ago. There were a few pharmacists that I worked with during this time and all of them were aware that phenylephrine essentially did nothing.

I hadn't really thought about it until now, but these pharmacists did not directly work with each other, so it must have been obvious that phenylephrine was ineffective.

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Every human with a nose knew it didn’t work, because when you took it, it didn’t work. The fact it was marketed was purely a regulatory exploit by pharmaceutical companies. The truth is, they could have continued to let pseudoephedrine be behind the counter and it would have been fine. But someone realized phenylephrine was approved OTC and sounded sort of like pseudoephedrine, so they could claim the shelf space and edge pseudoephedrine products.

Their defense to the FDA in being allowed to continue to market despite being proven even before they began their cynical ploy was consumers want convenience, which sadly is clearly true, that despite knowing if you walked five feet further and got the pseudoephedrine they would get relief they grabbed the drug conveniently placed. Fortunately lobbying money only went so far this time.

A lot of pharmacies have limited hours and long lines for people to say "give me the thing" compared to just grabbing it off the shelf at any time of day with no line.

Some people I know are essentially nocturnal, and have to significantly disrupt their lives whenever they have to do an irregular medication pickup rather than having it shipped ahead of time.

So it can be beyond just "slightly more work" for many people to get it.

Personally, I try to remember to get some whenever I refill meds at the pharmacy, not because I go through it that often, but because if I'm feeling poorly enough that I'm taking it, I probably am not in a state where I want to wait an hour in line just to ask for it.

This is sadly so true for many many categories of consumer products; by the time sufficiently enough people discover the product is bullshit to turn general public opinion the original sales already made the "innovator" enough money to make the whole endeavor worthwhile.

Someone make an app where you scan the barcode and it gives you the scoop (Is it BS/dangerous etc).

All professionals knew it did nothing. But the problem is by law FDA only needs to certify that OTC medications are safe not that they are effective. So drug companies go to town making billions off those old safe but useless medications

The real change is to add the mandate of efficacy to FDA for OTC medications.

Indeed. My Walgreens has a whole section of clearly and not-clearly labeled homeopathics for these symptoms.

People want to buy them and they won’t get hurt, let em, I guess.

> People want to buy them and they won’t get hurt, let em, I guess.

I would qualify that as, if people know what they're buying and want to buy them.

And if they know what homeopathy is, they wouldn’t be buying it.

Oh man, good luck with that one. I’ve never had someone super into horoscopes that would stop being super into them, no matter how much you proved they were bullshit.

They will try to shiv you though if you keep trying.

Alright, you got me there.

I've found the best approach is showing a genuine humility and interest in the "lore" and "vibe" of it, the sort of witchy mystical aesthetic while keeping a firm understanding that you're clear it has no predictive power. People don't usually initially get into these for it's effectiveness but for other reasons

I’m guessing you have fewer angry ex wives than I do, hah.

you don't want to go down the road of the "FDA mandating efficacy". However, requiring "truth in medicating" i.e. demonstrable efficacy rates would be nice.

> you don't want to go down the road of the "FDA mandating efficacy".

This has long been a thing already.

https://www.fda.gov/drugs/drug-safety-and-availability/fda-c...

> Many OTC medicines, including phenylephrine, are sold because they have an ingredient that FDA generally recognizes as safe and effective (GRASE) when used as recommended on the product labeling, which is documented in an “OTC monograph.” If FDA determined that oral phenylephrine is not effective, the agency would first issue a proposed order removing phenylephrine from this monograph.

https://en.wikipedia.org/wiki/Generally_recognized_as_safe_a...

The funny thing is phenyl ephedrine is actually very effective - when given IV, or directly applied to mucus membranes. Which this OTC drugs will never be used for.

So it is an effective drug, overall. Just not when used this way.

So good luck nailing whichever bureaucrat approved this.

My dad is a physician and as far back as I can remember, he said it was worthless.

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