Profit and Loss

By Jim McVeagh 08/03/2010


Not satisfied with rendering cold and flu medicines ineffective by removing pseudoephedrine from general sale, Medsafe continues it’s onslaught on cold and flu meds by trying to remove all the syrups and infusions from supermarket shelves. Apparently they are concerned about the use of them in under sixes (despite the fact that fatalities are very rare and only from the most insane of overdoses). The interesting thing is that the Herald reports that Medsafe contracted out the report on cold and flu medicine safety to a pharmacist. Weirdly, the article leads with the suggestion that such medicines may go up in price because they are more expensive at the pharmacy. I say that is weird because it is speculative, whereas the real story is the cosy relationship medsafe appears to have with pharmacists.

In a move designed to make their products more acceptable for non-pharmacy release, the drug companies removed pseudoephedrine from all of their products, swapping it with phenylephrine – a decongestant of questionable value. As this was thought to be much “safer” than pseudoephedrine, the products (at the behest of the drug companies, of course) were allowed on to the open market, rather than being confined to the pharmacist. The loss of business for the pharmacy industry (who relies mostly on over-the-counter sales, rather than drugs to make a profit) was not insubstantial.

Since that time the pharmacy industry has been working on getting their monopoly on cold and flu remedies back. The tack seems to be that these syrups and infusions are “dangerous” for children and therefore should be controlled by the pharmacist. There has been considerable lobbying of medsafe for the current review. There certainly has been some recent literature detailing horror stories of mothers and fathers who have given absurd doses of multiple medicines to children with both harm and even death resulting.

Unfortunately, this sort of barely sane behaviour will not be stopped by placing these medicines in the pharmacy. People who give excessive amounts of multiple brands of the same or similar product invariably buy the products at different places and at different times. People make collections of cold and flu remedies and then, when desperate, take all of them one after another. Adults do this to themselves as well as to their children. I have seen several cases of people who have taken overdoses of paracetamol quite by accident because they somehow did not realise that Codalgin, Pamol, Paradex and Panadol etc all contained paracetamol.

To add to the confusion these medicines (that are so dangerous that only a pharmacist should have control of them) are also supposedly ineffective. One wonders why the pharmacist would want to stock large quantities of a medicine supposedly ineffective – until, that is, one recalls that they also stock substantial quantities of homeopathic medicines…

Here are the actual facts:

  • If you stick to the manufacturers recommendation on a single product you will not overdose your child. If you must add paracetamol, check on the cough syrup label that there is not already paracetamol in it.
  • Adverse reactions other than overdose are extremely rare and usually transient.
  • Useful products are: bromhexine – thins sticky mucus; pholcodeine  and dextromethorphan both cough suppressants (not very good ones, but better than nothing). All other ingredients are dubious (except possibly squill morphine (Gees Linctus) – but I would not recommend that to children).
  • Decongestant nasal sprays like otrivine and drixine are useful but should only be used at night – continuous usage causes rebound congestion (the blocked nose gets worse than before, when it wears off).
  • If in doubt see your doctor – remember it is “free” (paid by taxes) at most GPs for under sixes (Declaration: Yes, I have a pecuniary interest in promoting under six visits!)

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