I’m running a petition here requesting that the health minister pause the sale and advertising of “PE” medications which are marketed as cold and flu medication all over Australia, indeed the world. I’m petitioning for this because PE has been proven not to work. You should sign the petition.
I’ve had more than a few people ask me why I’d do this when pharmacies are generally quite full of things that are offered out as working but science has proven they don’t; many nutritional supplements, most of alternative medicine and all of homeopathy don’t have any positive effect on the body or any medical condition yet they are sold with the assertion they do. I think this is very different.
When a person goes into a place to buy something to make themselves feel better, there are two distinct “headspaces” around what they’ll face. People are automatically skeptical about alternative medicine, homeopathy etc. because they know they haven’t been proven to work - the people looking for these products believe in some efficacy beyond science and that’s for them, but two different types of people have two different types of attitudes.
The language and regulation is different too; alternative medicine claims (because it’s required to) that it “may be helpful in relieving the symptoms of x” and these claims are held out by the manufacturer. Actual medicine is provided by a pharmacist with instructions about how to use it, warnings about risks of misuse, and a check that no conflicting medicine is being taken.
In short, things that work and things that don’t are in two different camps with two different approaches, overseen by two different people and patronised by two different sorts of consumer.
And PE is in the wrong camp.
A bunch of studies tried to prove that PE was effective against a cold because it was hoped it could replace pseudoephedrine which it is chemically similar to, but unlike pseudo it can’t be used as an ingredient in the production of illegal drugs. This is stupid of course; illicit drug manufacturers don’t go from pharmacy to pharmacy buying pseudeoephedrine three packets at a time, they steal a 5KG sack of it from a laboratory where it’s manufactured, but let’s not let facts get in the way of a good bit of regulating. Each of the studies failed. It seems that while PE is chemically similar to pseudo, 10mg of it in a tablet doesn’t survive your digestive system long enough to dry up your runny nose. The study Hatton, R.C. et al. (2007). “Efficacy and Safety of Oral Phenylephrine: A Systematic Review and Meta-Analysis” (abstract). Annals of Pharmacotherapy 41 (3): 381–390. DOI:10.1345/aph.1H679. PMID 17264159 was the clincher; it was a study of studies (a “metastudy”) and concluded that PE tablets just don’t work.
So why is it being sold? From the Therapeutic Goods Administration’s own page on the issue;
This approach is justified by the pharmacological similarity between pseudoephedrine and phenylephrine, the long history of marketing of cough and cold products containing phenylephrine and the NDPSC’s request to the TGA to facilitate the registration of phenylephrine hydrochloride combination products
They are chemically similar (even though the end result is that one doesn’t work), cough and cold medication containing it has been sold for a long time, and the drug body that wanted an alternative to pseudoephedrine asked nicely.
I don’t think it’s OK to sell something as a medicine, under the same framework with the same regulations and the same attitude as medicine, even explicitly saying it’s a replacement for an existing medicine and works the same way, when it simply does not work.