I didn’t know this until recently either. I grew up on a family where if there was pain, you just take tylenol to deal with it. We always followed the dosage timing and never had issues. So recently when my wife had some chronic pain I suggested taking tylenol but even after two days the pain would not go away and she went to ER. They did a blood check to see if they could find anything. They didn’t find the cause, just suspected food poisoning, but they found her liver enzymes were near dangerous levels. This was even with timing the dosages absed on instructions. Now I am super careful wtih Tylenol.

It's not under appreciated in the UK and Ireland where you can only buy tiny quantities of it at a time. Cash registers will literally refuse to process a sale if there is more than one pack of acetaminophen in your groceries.

On the plus side you can still buy psuedo OTC.

> 7g of acetaminophen can kill you, and 12g is likely to [3]

I agree that people should be cautious, but I think you are significantly misunderstanding [3].

"Toxicity" != death -- toxicity is merely "some evidence of a toxic effect" -- possibly as simple as a transiently abnormal blood test with no symptoms or sequelae, ever.

Single (accidental) doses of up to 200 mg / kg are routinely recommended to be managed at home [0], i.e. "you don't really need to go to the emergency department for this." For me, a fairly average 79kg male, this would be about 16g.

Please consult with your local poison control if you have concerns or questions!

[0]: https://pubmed.ncbi.nlm.nih.gov/16496488/

Therapeutic index of fentanyl is much higher than heroin or morphine, but I don’t think people really think that it makes it safer.

I'm grateful for you mentioning this. I grew up with ibuprofen as my default painkiller without really thinking of it too much but am about to do PRP which requires no NSAIDs for a week prior and 3 months after - but they do allow/recommend Tylenol as an alternative, especially for the post-procedure pain. I just would've assumed it was a sufficiently good substitute that I could treat them equivalently but now i know to be very careful about tracking how many I'm taking each day

The safety ratios listed in reference [1] are exaggerated, as can be determined by the following qualification: "The majority of published reports of acute lethal toxicity indicate that the decedent used a co-intoxicant (most often alcohol)."

The vast majority of so-called drug overdoses are due to polydrug intoxication. It's much harder to die by consuming a single substance. This is clear from the statistics of the few jurisdictions that report all substances in the blood in coroner's reports. See, for example, the Scottish data from 2020 (https://www.drugsandalcohol.ie/34642/7/ndrdd_report.pdf ): "In 2020, almost all (96%) [drug-related deaths] occurred after the consumption of multiple substances."

In most countries 4g is the upper limit and it is considered perfectly safe within that limit. So 8 500mg pills in 24 hours.

Thank you - this is correct and cannot be repeated enough, especially in the context of infant and child doses.

Replacing Aspirin with Acetaminophen/Paracetamol was absurd. Reyes’s syndrome was nowhere as prevalent as acetaminophen overdoses, which are a horrible way to go.

Liver failure is the worst way to go, it's slow and painful. if someone accidentally takes too much you can give them activated charcoal before you get them to the ER to give them a better chance of not going through liver failure

>4-6 500mg tablets within a 24 hour period

On top of that daily use brings it down to 3-5, preferably 4 or less of those a day. And they last less than 6 hours.

The 8h extended release is 650mg a tablet, and you can have 3-4 a day daily. And if you have any experience taking them you can feel the first half of the extended dose wear off before the extended one kicks in, which leads to basically NEEDING 4 a day, and staggered start times.

I simply do not take acetaminophen because of this risk.

Safety ratio as you present it is a bit misleading, numbers for hard/soft drugs are usually for a single dose.

Acetaminophen should be treated with more caution in general. So many people have reacted with shock and upset when I told them that taking Tylenol (or anything with acetaminophen in it like Dayquil/Nyquil) while drinking can cause immediate liver damage.

The thing about it is, _if taken as directed_ it's extremely safe, moreso than just about any other painkiller. In some countries it's the only one available in supermarkets.

Perhaps it's useful to know that NAC is the treatment for acetaminophen toxicity, should you happen to find yourself in the middle of a zombie apocalypse with a Tylenol ODed friend and a supplements isle handy but no readily available medical support. :D

There has been some suggestions that acetaminophen products should contain NAC to offset some of the toxic effects, but I dunno where they've gone-- there probably isn't any money in it to study it formally.

I try to make an effort to know what the treatment/antidote is for any hazardous substance in my home... things you hope you never need to know but are glad if you do.

There is an antidote available for acetaminophen overdose, but it's only available in the hospital. So if you think you took too much, get to a hospital quickly before your liver suffers permanent damage.

Untreated acetaminophen overdose is an extremely unpleasant way to die.

It's a good darwin effect clearer/cleaner I think.

Can't read or follow simple instructions? Well maybe modern society is not for you anymore.

I was in the hospital on Thanksgiving Day last year. I received 8 diagnoses at that time, including "Diabetic Hypertension" and "Metabolic Acidosis" and E. coli infection, and Hyponatremia.

They treated me with an antibiotic, a potassium-rich saline drip and acetaminophen. Yeah that's all they put in my orders.

The thing that pissed me off so much, firstly they insisted on calling it "Tylenol" when it was not, in fact, brand-name Tylenol but generic acetaminophen (even if they could charge $$$ per pill on it) and also that they basically refused to administer it at a rate that would keep my exquisite headache pain at bay. I was literally screaming and moaning through the entire night and day. (Actually, I was wearing one of those radio-transmitting heart monitors, and mostly the screams happened when I moved suddenly, and the electrodes tore at my chest hair...) But my head was also constantly throbbing, and that's how I knew to go to the hospital in the first place.

The nurses could tell me how long to wait between doses, but they couldn't explain to me how to know that interval, given no clocks and no written-down time of dosing. So basically I had to keep guessing throughout my sleepless nights. And they didn't really inform me of a way to just put it on automatic dosing like a normal hospital would have a schedule for.

I really didn't want acetaminophen at all; I don't like it much, and it really hasn't ever relieved any pain I've ever taken it for. My parents chomped so much of it, made me sick just watching them. I lived through the cyanide adulteration episodes and though unsolved, that guy wasn't wrong.

When I finally got to visit a sane PCP after all this madness, I told him I was taking big doses of Bayer Aspirin, and he said that's fine; just follow instructions and heed warnings, and he also warned me: for Heaven's sake don't ever take any acetaminophen, because it would seriously harm my liver!!!

Ibuprofen isn’t much better, unfortunately.

I work for a large agricultural company, in my part of it we sell fertilizer, chemical, and agronomic services. As part of this, we end up putting out a lot of trials so we can actually say something true instead of “buy our stuff it’s great I promise ;)”

One of my favorite slides is when we compiled dozens of trials on something that’s basically a nitrogen fertilizer, which as much of a guaranteed positive effect as you can get in agriculture. When compared in a graph most of the trials show an overwhelming effect on increasing yield over an untreated check, however there’s always a portion of the trials where the yield decreases compared to the (untreated) check.

Real life is extremely noisy for a multitude of circumstantial reasons that are either not practical or possible to control for, so a single trial is generally worth fuckall. It takes a lot of testing to see a consistent trend across them.

DXM may or may not suppress coughing relative to placebo - the study cited here appears to be have been written entirely by authors from drug companies, so perhaps there is some bias. Here's a meta analysis that favors honey over DXM https://pubmed.ncbi.nlm.nih.gov/32817011/, the original study that kicked off this idea that also favors honey https://pubmed.ncbi.nlm.nih.gov/18056558/, and a different meta analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC6513626/ which found little or no difference between honey and DXM. Whether its effective or not, to me there doesn't seem to be compelling evidence that it is more effective than honey.

And, all of this, to avoid selling a little bit of the narcotic codeine. Which was technically permitted to be sold "behind the counter" without prescription, but was made Schedule II as part of cough syrup in the US not long ago. (It used to be Schedule III or IV when combined with homoatropine or promethazine).

> This article uses the trick where you pick studies that support your argument and ignore all of the studies that disagree with it.

It's even worse than that, they appear not to have actually read the analysis they cited because two of the three studies on DXM found it was effective in adults. The same efficacy was not found in children but there are other very plausible explanations for this (difference in dosage and measurement techniques).

An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself, and similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.

I was wondering about that. I've taken a number of different cold medications over the years, one active ingredient at a time, to check their effectiveness while sick. Phenylephrine, as widely reported, had zero effect. But Dextromethorphan seemed to work for my kids - give it to them, stopped coughing. Started coughing again 6 hours later, etc. n=1 and it's a 4 year old, but in one of those cases my results clearly matched the studies, and in the other it didn't, at least as reported by this article.

In my subjective experience, Dextromethorphan (DXM, as the robo-trippers call it) does almost nothing for me, in the 1-5% range

The only cold and cough medicine that really truly works is the over-the-counter stuff, pseudoephedrine, works amazing for me. I usually pick up a box of the stuff when school starts in the fall and I go through half a box of it by the following summer.

Are you sure you posted the right paper? That paper appears to present a clinically insignificant outcome for DXM in children.

I think it's perfectly reasonable to contest the research summary this article is providing. All science-based articles on interesting topics are going to be like that. But you're writing your comment as if they took a flyer on DXM, and the research consensus is in fact that DXM is not effective. It's not as bad as phenylephrine (it has detectable, if immaterial, impact in adults), but it's pretty bad.

The point of the article, of course, isn't that Dayquil should be illegal because it's dangerous; it's that it doesn't work. Having spent an unreasonable amount of time in HN pseudoephedrine threads, I think the broad consensus of this site is that phenylephrine should be taken off the shelves.

> ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.

To be fair, you're doing pretty much the same by claiming these studies exist without proof.

Isn't it a bad sign that there are such varied results? Perhaps that's only a bad sign for the state of science, but I suspect it's also a bad sign for the effectiveness of the drug.

> There are so many studies and papers published now that you can find both positive and negative results for just about anything.

Doesn’t that suggest that the effect overall is neutral?

> It's not even available behind the counter anymore, presumably because they can make more money from morons buying the placebos.

What do you mean "morons"? Say I'm a normal person who doesn't habitually read magazine articles about drug effectiveness. How am I supposed to know that phenylephrine doesn't work? It's in the drug store and they're selling it as a decongestant; I have good reason to believe it will decongest my nose.

> you'd overdose on the acetaminophen first

which is a much, much worse way to go, apparently

I’m not sure. Another explanation is that it is accessible, with a small amount of friction.

But then drug makers realize they can get more sales by selling a placebo that won’t have the friction.

> The article mentions this but just accepts the inaccessiblity of the real thing as a given.

Reality is in fact a given. If you mean that the author is just fine with that reality, that's patently false.

> presumably because they can make more money from morons buying the placebos.

If that's your evaluation of everyone who lacks perfect information then you need to look in the mirror.

> You used to be able to get Sudafed; it worked. It was moved behind the counter for $REASONS. You've got enough to guess that the new stuff is some kind of inferior substitute and that you're only going to be able to get the real thing during pharmacy hours.

Grossly intellectually dishonest and downright unintelligent nonsense. Here's a fact that is inconvenient for this moronic argument: acetaminephen is readily available on the aisle. Things not being locked away does not imply that they have no effect. The more complex reality is actually discussed in TFA.

> Yeah, the acetaminophen was there to PREVENT abuse of the Vics and Percs 'cause you'd overdose on the acetaminophen first. Sure, there was an easy workaround, but that was it's intent.

The misspelling of "its" is the least egregious part of this nonsense.

I read the main section of the lit review linked by OP, and it didn't seem to come to any real conclusions.

> The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. [...] There is no good evidence for or against the effectiveness of OTC medicines in acute cough.

It's the same people who just googled a couple keywords and used that as a citation without reading the link, pre-AI.

> When I want to get irrationally angry about something in a department store, I'll walk over to the shampoos, which for some reason always have a whole entire aisle dedicated to a single product, when they all do literally the same exact thing, just with different scents and advertising budgets baked into the sticker price.

Somewhere on a shampoo forum people are complaining that all computers do the same damn thing. I guess they probably just don't know what they're talking about.

> As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product

That ignores over a century of law regarding drug safety and efficacy, and false advertising.

That shampoo opinion is a sure tell that you're not a woman with long hair (men with long hair tend to be less picky). My hair behaves noticeably differently with different shampoos/conditioners even within the same brand, and depending on your specific porosity, oiliness, texture, and humidity of the local climate, different hair care products and routines make a big difference if you have hair past chin length and want it to look healthy.

> As the person holding the money, it's my job to look at what is effective and what the active ingredients are in any given product.

But I don't have time to do that. I would rather have a retailer do that curation for me and provide me with effective high value products, and stand behind returns when they miss the mark. Then as a customer I can reward them for that value added work.

That's why Costco is great most of the time. Although they sometimes miss the mark with certain products they stock.

Not totally accurate - there are a handful of foaming agents and surfactants that are mixed and matched to make shampoos, so really it's nearly the same except that no one has ever overdosed on applying too much sodium lauryl sulfate to their scalp.

I think I have two opinions on this, from different angles.

I think the phenylephrine stuff is absolutely messed up. I personally had no idea it was ineffective, and I've bought medicine with that included, believing it would do what it says it does in the active ingredients list. To me, this is criminal, and these companies should be taken to court for outright lying about their products. (And the FDA should be slapped, hard, for not having done something about this by now.)

But when it comes to the CVS brand of acetaminophen costing $5 and the NyQuil brand costing $10, that's just... the result of normal market forces. I'm not a big "free markets" guy (because we don't, and can't, have truly free markets, and if we could and did, it would be a disaster), but it's pretty normal and common for people to pay more for something just because some company did a better job advertising it than their competitor did. That's just life.

It's funny, because when I go to a pharmacy, the store brand is usually shelved right next to the big-name brand, and there's even often a little card next to the store brand (or even printing directly on its packaging) that says "Compare ingredients to $BIG_NAME_BRAND!" And yet, people still buy the big name brand. ::shrug::, that's life.

If someone buys an overpriced shampoo, it only negatively affects them, but the are costs to overall society if people suffer health issues, addiction, etc.

In the past, a lot of people unknowingly ended up addicted to morphine, as it turned out both companies and individual doctors were happy to mislead them about the contents of medication.

The reason to take this seriously is mentioned in the article: It is possible to OD on Tylenol, and when consumers miss the fact that these drugs are all just Tylenol+junk, they might believe they need to take several of them together to get well.

It's similar to the shampoo example (a huge selection of borderline useless products that make money purely because of marketing) but with a minor safety consideration, too.

While I can appreciate the principle of not blindly trusting OTC medicine marketing, it is not realistic to expect every person to be highly competent in fully understanding their medical choices. It is far more reasonable to expect the companies marketing healthcare products to be honest to their customers.

If anything, you need honesty from healthcare companies in the first place if you're even going to begin making an informed decision. You're putting the cart before the horse here: people absolutely should be doing their own research before medicating themselves, but it is the OTC companies that obstruct that.

And, secondary to all of this, your analogy about shampoo is misinformed. Still, it is fitting for this scenario, but not in the way you intended. There are lots of different hair types, including ethnic hairstyles that require specific treatments. There are also a number of lifestyle choices that can change your hair treatment needs. As a result, the shampoo aisle actually is stocked with a wildly varying assortment of haircare choices, but actually figuring out what product works best for your needs can be challenging because it is walled behind layers of marketing nonsense that don't inform the consumer adequately on what makes each product different. This isn't much different than the problems in the medicine aisle.

It took a lot of secondhand research to find the ideal hair care product for my thick, curly hair that would mitigate the damage of thrice-weekly swimming in a chlorinated pool. I can assure you, not everything in the shampoo aisle is exactly the same. It was especially hard figuring this out as a man, when so many products are arbitrarily marketed to specific genders.

>Sure, OTC companies are duping customers with marketing, but what's new about that

Downvoting you isn't enough. How about we stop trying to take advantage of people and extra every dollar from them in every possible way?

You are ignoring the existence of consumer protection, which is not unusual as it seems like regulatory bodies around the world (but especially in Europe) have forgotten the existence of consumer protection as well.

You ask what is new about this, and the answer is, in 2026 context: nothing, but compared to the year 2000: plenty. Regulators used to issue fines for this behavior, and for worst offenders, regulators used to shut them down. Lying to customers is illegal in most jurisdiction, it used to have consequences, and it should do so again.

> As the person holding the money, it's my job to look at what is effective and what the act ingredients are in any given product.

I wish the industry, our health organizations, and most people in general acted as though this were true.

The environment we live in in general is increasingly hostile to people who ask those questions, do their own research, and take responsibility for their health in this way. I have first hand experience having reversed chronic health conditions myself by doing my own research. What have and do others say about it? Everything: every person on the sidelines watching who have formed opinions about how things are supposed to be, and how doctors and nurses and pharmacists are supposed to know better, attack and ridicule me and others like me and when we "look at what is effective and what the active ingredients are" we are gaslit and told we can't possible understand and know that and to leave it to the experts. Of course the definition of expert is only ever tribal and is a moving trojan horse for whatever best allows the agenda of an industry to establish its control over you.

"Caveat Emptor" and "Do your own research" is not a basis for a functional society. Providing reading material is not a sufficient substitute for regulation in a country like the USA where 54% of adults read below a sixth-grade level. And letting marketing decide what counts as "accurate information" is just letting the fox guard the henhouse.

In the US at least, medicine is so highly regulated/gate-kept that I don't think caveat emptor really applies. What's happening here is more like deception of the public by the state, or by groups granted special status by the state. It's morally somewhere between fraud and treason.

The mass of the acetominophen isn't really important, it's just vivid writing. The point is that 8g is obtainable for orders of magnitude less when it isn't wrapped in misleading marketing.

The other ingredients would be doing other things: making the pill/drug easer to swallow/consume, extending shelf-life, etc. You need enough of the drug for it to be effective, but not too much to overdose or exhibit side-effects.

Ugh yup. My regular pharmacy is a pharmaprix (shoppers drug mart), which is one of the biggest chain pharmacies in canada. The cold and flu isle is right in front of the pick up counter, so when I was sick a few months ago one of the pharmacists flagged me down when they noticed me hovering around the cough drop/coldfx/oscillococcinum part of the isle. The amount of proverbial snake oil on the shelves is bad enough that she was apologizing for how confusing it was. Got me set up with OTC pseudoephedrine instead! (There's some combo PSE/acetaminophen meds they sell in front of the counter, but they're mixed in with the sugar pills.)

It's really worth talking to your pharmacist even if you know what you're buying. There's so many more options behind the counter and they're really knowledgable.

Silicone oil can actually vary a lot. Some are safe for certain plastics or rubber materials and not great for others.

The tire stuff might be the cheap shit that's not so safe just because tires are so thick and robust. Or maybe it's actually designed for tires.

In Canada all homeopathic medicine must clearly identify itself as such and must also state that it's based on traditional form of medicine and not based on any kind of scientific evidence.

The very "medicine" you linked to in fact displays it right on the cover.

Same situation in the US. I can buy NyQuil/DayQuil, or I can buy the pharmacy-branded version for a lower price. Here it's usually not such a dramatic difference; probably the pharmacy brand is a a 30-40% discount off the big-name brand.

> How is THAT legal

Why shouldn't it be? Companies are free to set prices to whatever the market will bear. In this case it's based on customer ignorance, which makes it feel icky, but I don't think that's a reason to legislate this sort of thing.

> and how are people so unaware as to actually buy it?

Yeah, I don't know. I do remember that, many many years ago, I didn't know about this, and would always go for the big-name-brand version. At some point I learned to look at the active ingredients and just buy the cheapest one that had the same ingredients in the same dose, but I don't recall when or why I learned that, or why I didn't know that before.

I think there's also an implicit quality judgement sometimes, even if it's unfair. When it comes to groceries, say, canned tomatoes, and I see some fancy-looking Italian brand that I've heard of, my brain will automatically rate it much higher than the grocery store's own branded version of it. Maybe that's an effect of marketing/advertising, maybe it's something else, I don't know. And sometimes it's actually true: tomatoes are not all created equal. I think something similar happens with drugs, even if it's an entirely different kind of product.

People also often assume that something that costs more is automatically higher quality. For some types of things, that can be true (because yes, there is such a thing as a better tomato, and sometimes it costs more to cultivate said better tomato), but for drugs in a regulated environment, that doesn't really make sense. But people pattern match on what they know and what they feel.

We see this all over. Generic brands can be on-par with (or even 100% identical) to name-brands, and the name brands still make money. For example at my local grocery store, you can buy distilled white vinegar from Heinz or the generic brand. The generic brand costs half-price (or less if you get the bigger container), but the product should be chemically identical.

There can be some arguments made (maybe you think the generic cuts corners and it is only 4.5% vinegar instead of 5%), and the same arguments can be made for the drugs. But IMHO they come nowhere near to justifying the price gap.

The thing that is particularly frustrating in the case of the drugs is how the brand-name is (for many people) the vernacular name. I grew up in a family that called many drugs by their actual name (eg ibuprofen & acetaminophen), but when I go to the doctor, many of them insist on calling them Advil & Tylenol. Sometimes it seems to take them a second to recognize the generic name.

FWIW my guess is most people are aware, and do know that supermarket/drugstore acetaminophen / paracetamol is the same, in some relevant sense, as Tylenol / Panadol. It's not like the retailers lack marketing resources. But for these off-the-shelf drugs the total $/£ amounts are small for a lot of people.

Then, there _are_ arguments about whether generics face adequate testing to ensure the same quality as the originally-approved name brand drug. A lot of this is FUD - I'll happily buy generic acetaminophen in the US - but it's not a totally irrational concern. I doubt any regulator ensures generic equivalence to the same degree of conformity that a big pharma companies' own quality control does.

For example, I personally find real differences in the jankiness of different asthma inhalers, even amongst generics. Maybe that's because I don't shake/use/clean them exactly per the directions, but then that's real-world use for you. My personal experience says brand-name Ventolin has solved a "robustness against user error" problem in a way some alternatives often have not, suggesting the FDA does not enforce equivalence on this dimension. It's not enough of a difference for me to go name-brand, since out-of-pocket price differences can be egregious, but I do distinguish between otherwise-unknown generics.

Finally, you may trust the UK regulator and so do I, but traveling somewhere without good regulatory oversight, I'd probably reach for Panadol - assuming it seemed authentic - over a generic brand I'd never heard of. Brands have value and brand owners have a lot to lose, which is a kind of insurance (see 1982 Tylenol recall).

Nasal phenylephrine is a miracle when I am trying to sleep with a stopped up nose. A spray in each nostril and my nose is clearer than even normal within a few minutes.

BRB, spraying DayQuil up my nose

Absolutely true. Phenylephrine liquid applied directly to nasal mucosa is a quick and effective decongestant. It doesn't last as long as oxymetazoline (the other big nasal spray ingredient), but it also doesn't cause you to become dependent on it as much as oxymetazoline does.

Adderall (amphetamine) is a very effective decongestant. And it helps you get more work done!

Phenylephrine only works as a nasal spray. It doesn't do anything when taken orally, because it is broken down in the digestive tract.

When the hubbub about phenylephrine first started, I decided I still felt less miserable taking DayQuil/NyQuil, and switched to the "High Blood Pressure" formulation, which drops the phenylephrine, alcohol and sugar.

It takes it down to just the Tylenol, the DXM (, plus the antihistamine in the NyQuil), and the great slightly tearable taste for the ritual of "time to pretend I'm not sick for a little while".

The placebo effect is not an excuse to allow drug companies to make false claims about the efficacy of the ingredients

Yeah that seems odd. It's also a very different delivery mechanism. Might be easier to get a sick and snotty kid to drink some (maybe?) tasty liquid vs cheap pills.

> Dextromethorphan is definitely not a placebo.

It definitely works for me. It'd be wild if for all 44 years of my life, it's only worked because of the placebo effect.

The article mentions phenylephrine, and that shit definitely doesn't work. Not even a placebo.

Yup. The only upside to being sick is that I get to take NyQuil before going to sleep and have trippy as fuck dreams.

The left enantiomer of methamphetamine (exact same chemical formula and structure, just mirror symmetry) is also an OTC decongestant.

Very relevant username

Came here to say this, the author is hating on dextromethorphan like he never robotripped before. But then, overdosing dxm isn't all that healthy and I'd recommend ketamine if you want to experiment like that.

Making the active ingredients prominent is a good start but not sufficient. As the article points out, the word "phenylephrine" looks/sounds similar enough to "pseudoephedrine" to broadly fool the population.

With computerized registers and loyalty programs, it is way too easy to profile. I am not too worried about looking like I chug too much aspirin; it's the further out assumptions or speculations that models (like I myself once designed or otherwise) might make that I worry about, that would not require proof, and would not be documented somewhere. I mean there is also stuff "like" congestion pricing to worry about, and maybe that would work better to make people think about liberties and tech. Dunno.

in the specific case of this article, "innovation" and "choice" are exactly the problem here. we know what works well - they're well-studied generic compounds. there's no social reason whatsoever that "dayquil" or "tylenol" or "sudafed" should exist when generics are readily available and clearly labeled.

> The "accidental OD" scenario where an innocent patient quadruple-doses is realistic, and anticipated, and the shrewd consumer will avoid this.

I think we need to do more around accidental overdoses than suggest that everyone should be a "shrewd consumer".

“Incredibly”? The US does exactly the same thing in another case: denatured alcohol.

Acetaminophen (Tylenol) is probably the OTC drug that is at the top of the list to be made RX-only due to its dangers.

The article is not about "should people be allowed to buy this product because it's potentially dangerous/addictive/etc" but "Should the company be allowed to sell this product because it consists of acetaminophen plus two useless ingredients and is basically a scam".

Agree with you. It is a collateral consequence of the War on Drugs™ that everything good and effective is getting locked behind a $50-$200 doctor's visit for a 'scrip. This scam medicine problem could be helped if a bunch of substances were moved out of Rx and back to OTC. The nanny state will continue to grow to meet people's definitions on how much others should be warded.

Read the article. It doesn’t even ask if dextromethorphan and phenylephrine should be illegal. It asks if intentionally misleading consumers about their efficacy should be.

Are you sure you have read the article, not just its title?

What is the argument for legalizing drugs that are contraindicated for all medical purposes, are toxic, and have a high addictive potential? How does it benefit me or society if my neighbor is permitted to choose to basically roll the dice on afflicting themselves with a debilitating chronic illness (severe addiction)? If I don’t want to do illegal drugs why would I ant to support this?