One of the advantages of living in the modern world, specifically in an urban area where there are practically two pharmacies on every block, is that when you have a cold, there’s a product you can buy to ease the symptoms, and that product is widely available, right?

So the other day, I go to a CVS to buy a nasal decongestant. As expected, there are shelves of decongestants, a sea of options. But I’m finding that most of the visible products are for chest congestion and they feature an active ingredient called guaifenesin. I’m looking for a nasal decongestant and I can’t find it. 

But finally, I find it! The decongestant aisle is even vaster than I thought and I just needed to walk a few meters to another part of this township. Turns out, there are several shelves full of “cocktails” that include a painkiller like acetaminophen, an “expectorant” like guaifenesin, and bingo! A nasal decongestant for good measure.

But I don’t want a cocktail. I don’t have pain that needs to be killed. I just have nasal congestion that needs to be decongested. I just want a nasal decongestant by itself. So I look on all the packaging of all these cocktails to find what chemical is being included as the nasal decongestant in the mix and it’s always a thing called phenylephrine. Can I get phenylephrine by itself? No, it seems, if I want it, I have to buy one of these cocktails.

Wait… I don’t give up searching and finally – victory! – I come across a package of tablets that are pure phenylephrine. That’s what I’m looking for. That’s what I now understand I want.

I bring my phenylephrine home and I’m so proud that I figured out what I really needed and found my way to purchasing only that thing. I’m a successful minimalist. Now I get to consume my one active ingredient and attain some relief from my nasal congestion, right?

Somewhat randomly, I decide to google “phenylephrine” before I actually take my first pill. And guess what? The web is full of articles from the past 10 days saying that the FDA just declared that phenylephrine is useless. It doesn’t help with nasal decongestion at all when taken in pill form. This was announced during a Non-prescription Drug Advisory Committee meeting Sept. 11-12, 2023. 

In other words, if I had developed my cold and bought my precious phenylephrine two weeks ago, like on September 10th or pretty much any time in the past 20 years, I would have eagerly consumed the phenylephrine because I would not have had access to the breaking news that it’s useless. Actually, it’s worse than useless: it has side effects including nervousness, dizziness, and sleeplessness.

Nevertheless, our beloved pharmaceutical companies have been selling us phenylephrine and labeling it as a “nasal decongestant” for years. They’ve been selling a placebo with side effects for years. It’s in all of our pharmacies. All those pharmacies that litter our city streets – each one of those ubiquitous pharmacies in every city and suburb in our large country has multiple shelves of phenylephrine products. And the prices are not $0. And they don’t give you money back because you’re incurring side effects for no benefit. No, they charge you ten dollars, maybe fifteen dollars, maybe twenty-five dollars for a box of pills containing phenylephrine and they happily lead you to believe that when you take those pills, you’re going to be nasally decongested. But guess what? You ain’t gonna be.

Turns out if you want a real nasal decongestant, you have to go to the pharmacist and ask for a product containing pseudoephedrine, which they keep behind the counter. Then you have to show them your ID to assure them you’re not going to use pseudoephedrine as a precursor in the production of methamphetamine. Because of course you’re running a meth lab. And somehow you have to just know this protocol. There are no signs on the shelves and shelves of phenylephrine products saying “Psst. This doesn’t work. Walk over to the pharmacist and ask for pseudoephedrine instead.” You just have to know.

I really had confidence in “the system” of modern society before this adventure. I truly believed that everything was hunky dory and running smoothly and that we had figured stuff out and put good processes and protocols in place to have a functioning world. But now that I know that the nasal decongestant that’s been marketed and sold to us for decades doesn’t actually work, I’m starting to question more than just this one thing. ■

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