<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>samtho</author><text>Why can you go to the store and buy rubbing alcohol to drink? It’s primary ingredient is just ethanol. The FDA literally mandates that the ethanol is not able to be safely consumed and is cut with poison that is not easily separated from ethanol.&lt;p&gt;Similarly, cutting opioids with Tylenol is not actually intended to be a deterrent to someone who gets their hands on the pills rather it deters people involved with illicit drug manufacture and distribution from using it as a base to grind up and sell.&lt;p&gt;Tylenol is really not super safe, at least by todays approval standards. Most official sources, which unsurprisingly have a huge bias towards Tylenol’s safety, state that allergic reactions are very uncommon, but recent meta-analysis’ are beginning to uncover that mild to moderate allergic reactions to acetaminophen is more common that  originally thought. It does not get reported because if you’re already feeling like crap when you take it, some mild itchiness, redness, and discomfort would not be out of the ordinary without the Tylenol. As mentioned before, the toxic dose is much too close to the effective dose, I’ve heard from medical professionals that doubling a single recommended dose on extra strength Tylenol is enough to cause long-term damage to your liver. On top of all that, the fact that it is a weak pain reliever at best would solidly put this as a drug that’s not super useful.&lt;p&gt;I have a very low opinion of how we go about drug policy in the US. I am on a very controlled medication due to a sleep disorder (that causes hypersomnia) which I cannot go off for safety reasons. I also cannot get it filled more than 24 in advance without complicated authorization procedures that must be completed in the correct order. It’s a goddamn mess and serves only as a punishment to law-abiding patients for needing this medication. It also does nothing to curb illicit use because synthesis of a more potent product is so trivial.&lt;p&gt;This is an example of poorly targeted legislation, which was put into place because it’s the only thing they could exert control over. It does not further the stated goals of drug enforcement because it’s so easy to manufacture this stuff and the resulting product is so easy to move, bad actors can simply avoid this system. While I’m spending 3 hours every month orchestrating the complicated dance of my prescription between my providers, the pharmacy, and my insurance, someone is making a batch of shake-and-bake meth in about 3 minutes.</text><parent_chain><item><author>edmundsauto</author><text>What makes you say the FDA is actively adding poison to other drugs, are there first hand sources from them? This sounds like it could also be a case where they want to lower opiate consumption, and so adding some Tylenol increases pain relief without increasing opiate intake.&lt;p&gt;I am not sure that’s wise policy, but if you don’t think Tylenol is all that bad (again, I’m not sufficiently informed to say this, but the FDA obviously thinks it’s safe), then it’s not a bad overall policy.&lt;p&gt;It sounds like it could be either situation, I’m just looking for more evidence before making up my mind. (Yes, I am aware the US government poisoned people during prohibition in this exact manner, but I dispute that has any relevance as the decision makers and cultural awareness is very different now. We’ve come a long way since the 30s)</text></item><item><author>paulmd</author><text>&amp;gt; doesn&amp;#x27;t get you high.&lt;p&gt;this is the big one.  Phenyl-epinephrine doesn&amp;#x27;t work at all, it&amp;#x27;s consistently failed to outperform placebo, and the only reason it&amp;#x27;s on the market is because the FDA doesn&amp;#x27;t like pseudo-ephedrine (sudafed) because it can be used as a precursor for meth.   Same reason they&amp;#x27;ve required individual blister packs for sudafed (if only there was some illicit drug which gave you the focus and drive to perform repetitive tasks for hours on end...)&lt;p&gt;Same thing for imodium.  The reason all of a sudden it&amp;#x27;s in blister packs?  People found a way to abuse it and the FDA is going to ruin it for the rest of us.&lt;p&gt;In the case of acetaminophen, the FDA actively uses it as a poison to &amp;quot;discourage&amp;quot; addicts from taking large doses of painkillers or cough syrup.  The point is explicitly that if you take too much, you&amp;#x27;ll burn out your liver, the FDA is actively inserting poison into the medicine to &amp;quot;discourage abuse&amp;quot;.&lt;p&gt;In all of these cases, the common factor is that it makes things much more annoying or even dangerous&amp;#x2F;lethal for average people, while addicts are completely unaffected.  No opiate addict in the world is going to get clean because of &lt;i&gt;individual pill blister packaging&lt;/i&gt;.  Meth addicts will just pop some pills and churn through the sudafed blister packaging, etc.&lt;p&gt;I am waiting for the other shoe to drop on imodium, now that the FDA is targeting it, it can&amp;#x27;t be too long until it&amp;#x27;s behind the counter or pulled entirely.  And as someone who (TMI warning) suffers from what I&amp;#x27;d term as moderately frequent IBS (never diagnosed but maybe I should) that&amp;#x27;s really going to suck for me.&lt;p&gt;The FDA is simply an instrument of drug-war policy, they&amp;#x27;re not oriented towards patient care and outcomes at all.</text></item><item><author>caymanjim</author><text>&amp;gt; OTC medicines that by current standards would not be made OTC&lt;p&gt;Acetaminophen would almost certainly be in this category, if it could even get FDA approval at all. The effective dose is dangerously close to a toxic dose that causes liver damage, and not comfortably-far from the LD50. The only reasons acetaminophen is OTC is that it&amp;#x27;s been informally grandfathered in, makes an absolute fortune for pharmaceutical companies, and doesn&amp;#x27;t get you high.</text></item><item><author>dataangel</author><text>I&amp;#x27;ve recently had to deal with the medical profession a lot more than in the past and I&amp;#x27;m finding this sort of thing everywhere. OTC medicines that by current standards would not be made OTC, &lt;i&gt;surgeries&lt;/i&gt; that are extremely common but have never had quality  randomized trials, official sounding diagnoses that on inspection are actually defined as &amp;quot;we have no idea&amp;quot;, lack of consensus about how to treat some of the most common conditions in the human population (e.g. back pain), medical device approvals abusing the shortcut of being &amp;quot;substantially similar&amp;quot; to an existing device to evade regulatory scrutiny, the complete lack of enforcement of what goes in supplements... I feel like my entire understanding of the medical system in the US was a lie. We&amp;#x27;re constantly touting that we have the most advanced technology but if you have a complex condition you are likely to fall prey to multiple kinds of grift.</text></item></parent_chain></comment><story><title>The Uselessness of Phenylephrine</title><url>https://www.science.org/content/blog-post/uselessness-phenylephrine</url></story>
<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>salawat</author><text>Look up DXM.&lt;p&gt;You will never find it without either Gualfenisin or acetaminophen.&lt;p&gt;Does DXM need either of those to do what it does?&lt;p&gt;No.&lt;p&gt;Would it simplify dosing to be sold alone so that laymen didn&amp;#x27;t have to worry about potentially overdosing on three drugs at once instead of just one?&lt;p&gt;Yes.&lt;p&gt;However, from the war on drugs perspective, that makes it &amp;quot;easier to abuse&amp;quot; to achieve it&amp;#x27;s hallucinogenic side effect. Bundled with acetaminophen or gualfenisin however, you&amp;#x27;d have to be a chemist intimately familiar with how to seperate the other two components to distill DXM in any amount with abuse potential, and the naive non-chemist trying to get high will either end up puking their guts out (Gualfenisin OD) or burning out their liver (Tylenol OD, which is exacerbated by alcohol consumption as well).&lt;p&gt;The Tylenol one is particularly problematic, because acetaminophen is also commonly prescribed with other common multi-drug formulations that people may not realize are additive.&lt;p&gt;When you take the route of adding a substance that does harm to discourage a pattern of behavior, you are poisoning. Poisoning being the act of artificially and with intent increasing the toxicity of an imbibed substance to disincent some pattern of behavior.&lt;p&gt;This is actually based on a natural pattern of behavior by the way. There is a mushroom that is generally completely harmless... Until you drink alcohol. Metabolizing the mushroom depletes the supply of the same enzymes that detoxify alcohol (and Tylenol).&lt;p&gt;&lt;a href=&quot;https:&amp;#x2F;&amp;#x2F;en.m.wikipedia.org&amp;#x2F;wiki&amp;#x2F;Coprinopsis_atramentaria&quot; rel=&quot;nofollow&quot;&gt;https:&amp;#x2F;&amp;#x2F;en.m.wikipedia.org&amp;#x2F;wiki&amp;#x2F;Coprinopsis_atramentaria&lt;/a&gt;&lt;p&gt;So to be clear... If you call this mushroom poisonous, and it targets the same enzyme that alcohol does, then adding something like tylenol to something that doesn&amp;#x27;t need it to do it&amp;#x27;s job, you are poisoning.&lt;p&gt;It just happens to be handwaved because in the establishment&amp;#x27;s mind, those damn druggies aren&amp;#x27;t worth caring about anyway.&lt;p&gt;Not a partaker of DXM, but &lt;i&gt;very concerned with the ethical implications, and the adverse contribution to trust in public health measures that this practice entails.&lt;/i&gt;</text><parent_chain><item><author>edmundsauto</author><text>What makes you say the FDA is actively adding poison to other drugs, are there first hand sources from them? This sounds like it could also be a case where they want to lower opiate consumption, and so adding some Tylenol increases pain relief without increasing opiate intake.&lt;p&gt;I am not sure that’s wise policy, but if you don’t think Tylenol is all that bad (again, I’m not sufficiently informed to say this, but the FDA obviously thinks it’s safe), then it’s not a bad overall policy.&lt;p&gt;It sounds like it could be either situation, I’m just looking for more evidence before making up my mind. (Yes, I am aware the US government poisoned people during prohibition in this exact manner, but I dispute that has any relevance as the decision makers and cultural awareness is very different now. We’ve come a long way since the 30s)</text></item><item><author>paulmd</author><text>&amp;gt; doesn&amp;#x27;t get you high.&lt;p&gt;this is the big one.  Phenyl-epinephrine doesn&amp;#x27;t work at all, it&amp;#x27;s consistently failed to outperform placebo, and the only reason it&amp;#x27;s on the market is because the FDA doesn&amp;#x27;t like pseudo-ephedrine (sudafed) because it can be used as a precursor for meth.   Same reason they&amp;#x27;ve required individual blister packs for sudafed (if only there was some illicit drug which gave you the focus and drive to perform repetitive tasks for hours on end...)&lt;p&gt;Same thing for imodium.  The reason all of a sudden it&amp;#x27;s in blister packs?  People found a way to abuse it and the FDA is going to ruin it for the rest of us.&lt;p&gt;In the case of acetaminophen, the FDA actively uses it as a poison to &amp;quot;discourage&amp;quot; addicts from taking large doses of painkillers or cough syrup.  The point is explicitly that if you take too much, you&amp;#x27;ll burn out your liver, the FDA is actively inserting poison into the medicine to &amp;quot;discourage abuse&amp;quot;.&lt;p&gt;In all of these cases, the common factor is that it makes things much more annoying or even dangerous&amp;#x2F;lethal for average people, while addicts are completely unaffected.  No opiate addict in the world is going to get clean because of &lt;i&gt;individual pill blister packaging&lt;/i&gt;.  Meth addicts will just pop some pills and churn through the sudafed blister packaging, etc.&lt;p&gt;I am waiting for the other shoe to drop on imodium, now that the FDA is targeting it, it can&amp;#x27;t be too long until it&amp;#x27;s behind the counter or pulled entirely.  And as someone who (TMI warning) suffers from what I&amp;#x27;d term as moderately frequent IBS (never diagnosed but maybe I should) that&amp;#x27;s really going to suck for me.&lt;p&gt;The FDA is simply an instrument of drug-war policy, they&amp;#x27;re not oriented towards patient care and outcomes at all.</text></item><item><author>caymanjim</author><text>&amp;gt; OTC medicines that by current standards would not be made OTC&lt;p&gt;Acetaminophen would almost certainly be in this category, if it could even get FDA approval at all. The effective dose is dangerously close to a toxic dose that causes liver damage, and not comfortably-far from the LD50. The only reasons acetaminophen is OTC is that it&amp;#x27;s been informally grandfathered in, makes an absolute fortune for pharmaceutical companies, and doesn&amp;#x27;t get you high.</text></item><item><author>dataangel</author><text>I&amp;#x27;ve recently had to deal with the medical profession a lot more than in the past and I&amp;#x27;m finding this sort of thing everywhere. OTC medicines that by current standards would not be made OTC, &lt;i&gt;surgeries&lt;/i&gt; that are extremely common but have never had quality  randomized trials, official sounding diagnoses that on inspection are actually defined as &amp;quot;we have no idea&amp;quot;, lack of consensus about how to treat some of the most common conditions in the human population (e.g. back pain), medical device approvals abusing the shortcut of being &amp;quot;substantially similar&amp;quot; to an existing device to evade regulatory scrutiny, the complete lack of enforcement of what goes in supplements... I feel like my entire understanding of the medical system in the US was a lie. We&amp;#x27;re constantly touting that we have the most advanced technology but if you have a complex condition you are likely to fall prey to multiple kinds of grift.</text></item></parent_chain></comment><story><title>The Uselessness of Phenylephrine</title><url>https://www.science.org/content/blog-post/uselessness-phenylephrine</url></story>