My problem with this approach: As I'm quoted as saying in Jim's article, I just think it's a non-starter for most people to do this, ie keep an inventory of sorts in their medicine cabinet and recombine them as needed. Jim is thinking like a doctor, not like your average, non-medically-trained person. There's a reason pharma makes combo products — people do like getting multiple ingredients in one pill. It's convenient! Most people have neither the patience nor the medical education to recombine individual generic ingredients on their own. And trying to do so could actually put them at higher risk for drug interactions or other human error. You have to read and reconcile warnings and directions labels from 3 or 4 different product packages, instead of just one.
>"And trying to do so could actually put them at higher risk for drug interactions or other human error. You have to read and reconcile warnings and directions labels from 3 or 4 different product packages, instead of just one."
I don't see how "combined" pills that are vetted by pharmaceutical companies or the FDA stop unwanted interactions from drugs. People don't read the entire huge and tiny-font booklet that comes with most medicine and cross-reference the ingredients from each with all the other medicine they're taking. Sure, they rely on doctors to help them out (if they know/can anticipate), but that's just as much a disaster waiting to happen as what you're arguing against.
So what ends up happening is that the drug interactions occur anyways even though people took approved combinations of ingredients. I'd rather we not promote this whole approved combinations prevent unwanted interactions as people mix different pills anyways.
Having your SOP for dealing with a cold being "select exactly one box from your medicine cabinet [or pharmacy shelf] and take the recommended dose" is likely to produce fewer unwanted interactions than if your SOP is "select 1 to N boxes from your medicine cabinet and take the recommended dosage of each of those medications", especially when the person selecting is far from their peak mental performance due to the cold symptoms they're experiencing.
Many (likely most males under 60) people take zero pills on a given day when not sick.
I certainly agree with you that some people are not going to keep a small inventory of common drugs, others can't be bothered to take more than one pill, and a few cannot successfully manage that sort of combination.
On the other hand, though, I think there are a lot of people who would like to learn more in order to make the best choice about what drugs they take, and the branded combination solutions really end up muddying their conceptions of these medicines. I know a number of people who just buy whatever they've decided is their favorite variety of DayQuil when they're feeling sick during the day (you're quoted relating similar experience in the article), and I know a number more who don't realize there are major differences between traditional Alka Seltzer and the proliferation of their cold products. The brands and the proliferation undermine people's ability to concentrate on the drugs they're taking, and they mentally give up on figuring the situation out and determining the best medical choice (especially if they also consider the cost and branded/generic elements of the equation).
The identification with brands rather than the actual drugs is likely the largest problem, especially now that each long-existing drug manufacturer sells combinations of the various drugs under their own name. I wouldn't mind seeing these companies have to devote the top 1/3 of the front of their boxes to a large, unadorned list of the product's active ingredients.
I think people who would like to be more informed consumers, but who struggle because of the current setup, are underaccounted for. I think there are many people who would love an inexpensive pack of 50 of each of these generic drugs to keep a small inventory at home, and who would be perfectly capable of managing it.
While it may be easy for a doctor who is familiar with these medicines to erroneously assume that they are very familiar to others, I think it is also easy for a doctor to not give patients enough credit in being engaged with their health treatment and being willing to spend a small amount of time and effort becoming familiar with a few extremely common drugs.
How often are people, on average, mildly sick in their adult lives? About once per year? How often do they care for others who are sick? These drugs are incredibly common, they are relatively simple, and people are likely to have a lot of contact with them over a lifetime. I think greater familiarity with them would be very useful in the average life, and I think an education effort would provide a lot of health value, even so little as starting with a simple reference in the store.
I am not a medical doctor or a pharmacist, and my list above is from memory (except for spelling). Perhaps I have engaged in the care of illness slightly more than average, but it didn't take a medical text to learn this stuff. It just took some concern over what I was giving myself/others and whether it was appropriate for me/them, and then a small bit of reading. This is an issue I care about because it seems to me the ill are victims in a corporate marketing game where the outcome is often someone sick ending up with an inappropriate product.
Another part of what bothers me about the combination setup is that many people are getting acetaminophen when they don't need it, or even when it could be bad for them. For instance, when I enter "stuffy nose" and "trouble sleeping" into the site, I get products with diphenhydramine, phenylephrine, and... acetaminophen, even though it's not needed for the symptoms. When it is needed for the symptoms, I bet a lot of people take extra tylenol when they have a headache, anyway. Many would be better off with ibuprofin, but in many combinations it's not an option.
I think your project is a very helpful improvement over the status quo, and I'm glad you made it and that it's available! I'll certainly recommend it to my "DayQuil" friends, and someone looking for relief in the store is much more likely to find it with your site than by a first-time confrontation with the cacophony on the cold shelf. My suggestion would be not to discount that people might like--and be capable of--getting down to the basics of each medicine. It's really not hard, and I hold out hope that, contrary to Internet rumors, some people still have some patience and the ability to remember a few things!
that's actually how we built the tool. the symptoms you select are each tied to active ingredients that they treat, and then we show you products (including generic/store brands) that contain those ingredients in the comparison table below. do you think this isn't coming across as we'd hoped?
If I go to http://www.iodine.com/cold-and-flu and click "Cough", I'm presented with a comparison of Delsym, Mucinex, etc. So the first thing I see is the brands. Then I can look down and see what those brands contain and the generics. But the brand is given prominence.
Putting it another way: I understood that you are indexing off of the active ingredients, I was wondering why you chose to emphasize the brand name products (or how intentional that was...).
fair enough! yeah as we've been playing with the design, the generics have moved around a bit. we're still playing, and we absolutely mean to stress generics. that said, from the user's perspective, the thing that's easiest to find on the store shelf is the brand-name product, and then look next to that on the shelf to find the generic equivalent.
We're still thinking through how to approach this, but it's definitely on our radar. Honestly, in my old role in clinical medicine, I'd counsel parents only to treat symptoms if their child seemed uncomfortable or fussy. If they're playing and eating and acting normally, leave em alone. If they seem uncomfortable, children's motrin or ibuprofen is enough to relieve much of their discomfort.
Of course here's my disclaimer that this is not medical advice, and you should talk to a pediatrician. :)
I'm an MD, and I used to avoid treating cold symptoms for these exact reasons, until I came down with a nasty sinus infection that was a complication of my cold virus. Basically, because I left my sinuses all stuffed up, I created a nidus for infection -- ie the perfect environment for bacteria to breed -- so I had a cold for a week, and then I had a bacterial sinusitis for another 2 weeks and finally broke down to take antibiotics. I could have avoided the sinus infection (and the antibiotics to tamp it down) if I'd just taken a decongestant when I had the cold. And the side benefit is my cold would have felt less miserable, too. And it wasn't about not taking time off from work because a lot of this was during a vacation anyway.
Point is, treating cold symptoms can actually prevent complications, so it's not all bad.
In general all these cold and flu medications do is suppress your immune response, which is obviously not the smartest thing to do. You might get rid of some symptoms, but you're also hindering your body from actually getting rid of the infection.
The article above does say that in adults decongestants might be helpful. I think you need to know when it's a good idea to "help" your body treat the infection, and when you're just treating the symptoms and just hindering it. Most people just want rid of the symptoms.
In general all these cold and flu medications do is suppress your immune response
That's not true at all. Over the counter cold formulations contain one of four products: decongestant, cough suppressant, pain reliever and antihistamine.
None of those suppress your immune system.
EDIT: I think know what you meant now. You mean your immune system reacts to a cold by making you cough and the drugs suppress your cough (thus your immune response)? In that case, I see your point.
Yes, they are. Also, I believe most pain medications (apart from opioids) work by knocking out some part of the immune response.
Now, even assuming that the medication doesn't actually interfere with your immune system and just gets rid of the symptoms and makes you feel great, you should be aware that your immune system deliberately makes you feel crappy ("sickness behaviour") so that you'll rest and give your immune system a chance to kill the infection. This is more an issue with the flu rather than the cold.
I think what threw me off is the use of the word "immune suppression". That word has a specific meaning when referring to drugs and tends to refer to drugs that to interrupt immune response far upstream. These drugs have severe side effects as your body can't fight invading viruses and bacteria.
I think the difference with cold remedies is that they tend to interfere with immune responses that are far downstream that tend to be more symptomatic, rather than major mechanisms by which the body's immune system works.
I'm just one data point, but my children usually suffer pretty badly when they have colds. I teach them that you can't fight the cold, but you can make it more comfortable to sleep (which goes a long way towards fighting the cold).
I give Acetaminophen/Paracetamol/Tylenol for pain, and a mucogenic (Guifanesin or the much better Mucosolvan/Ambroxol if I can get it from Europe) to thin out the mucus secretions.
It goes against instinct but making more mucus keeps it from building up and turning into that gunk that starts sinus/ear infections and never gets out of your lungs once the cold has passed.
I really wish Ambroxol would be approved in the USA, but apparently it's too old of a molecule to successfully recoup the FDA approval expenses.
Yes and certain foods can also be used to reduce symptoms, but of course they're not as powerful. Did that option fail for you?
The case I see more often is people get obvious cold symptoms and are back at work the next day. Thanks to symptom reducers they don't have to rest or eat properly for the condition, so their light symptoms persist for weeks. That also leads to complications.
Also I should have mentioned that most adults are not healthy and don't eat healthy to begin with, which creates a ripe market for band aid medications.
My original point was taking medications to suppress symptoms. For example they'll open your sinuses in 5 minutes and keep them open for hours.
Typically food will reduce symptoms by stimulating the immune system to work faster. Attempts at immediate relief will be short lived. That's how people traditionally treated disease. It's still a valid approach for light ailments where modern medicine can be a harmful crutch.
Hey, I'm an MD at Iodine. Basically, zinc works. A Cochrane meta-analysis from 2013 showed that zinc lozenges reduce the severity and duration of common cold symptoms. It’s the closest thing we have yet to a cure for the common cold. Get the lozenges in particular (other forms don’t seem to work as well), and take ‘em on a full stomach or you can get really nauseated.
I'm actually curious about this too - I've had pretty great success with zinc lozenges, but was off-put by this. Although the study is for some very specific intranasal products from a specific brand, I think.
I only have anecdotal data to add, but I've been using zinc lozenges for years for when I start to get sick (or my kids are exhibiting symptoms), and it really does dramatically shorten the cold and reduce the severity of the symptoms.
Are you aware of any information on the mechanism by which zinc works? I'm content knowing that it does, but it would be cool to understand what's going on with it.
Zinc is essential for all sorts of human biological processes, including DNA transcription, DNA repair, and antioxidant defence. [1] Since most immune cells are don't live very long[2] one theory goes optimum zinc intake improves all cell reproduction but especially fast turnover cells.
I've been using zinc for about 3 years now when I get a cold. It's the best medication I've found. It has a slightly off-putting taste and mouthfeel, but it's worth it IMO.
Hi Tom this is a great q. I'm the MD on the team here at Iodine.
As you know, many people already stop taking their antibiotics without finishing the full course. According to our internal research, people get most freaked out about side effects when they didn't expect them or didn't know they might happen, and when they didn't know it was a common or normal response to a medication. It's our hypothesis that surfacing this data (much of which does already exist online) will actually help with what clinicians refer to as "anticipatory guidance" -- helping people know what to expect -- and that this could reassure people when they do have a side effect, and help them realize that it's temporary. Good anticipatory guidance doesn't always happen in the exam room due to time constraints, etc. In a couple studies we cited in an Iodine blog post recently, docs spend an average of 12 seconds talking with patients about side effects of a new med, and 50% of these new med convos don't mention expected side effects at all. http://www.iodine.com/blog/11-questions-to-ask-about-medicat....
Additionally, our content will develop with more info about how to take a med, including this really important caveat about antibiotics. Another one I can think of is acetaminophen and its really important risk/warning about liver failure.
We still have a lot of work to do at Iodine, but we think we've got a good start. And overall, we think that more transparency is better, even when it comes to antibiotics, to help people have more informed conversations with their doctors about this stuff.
