A reader writes:

A reader states, "Sudafed, etc. isn't effective anyway. Use a freaking neti pot, eat right, use steam and hot baths if you have a bad cold." Really?

Here's a study that counters that point. The conclusion was, "The results demonstrate that pseudoephedrine is a safe and effective treatment for nasal congestion associated with URTI. The results from the laboratory study on day 1 demonstrate by both objective and subjective measures of nasal congestion that a single dose of 60 mg pseudoephedrine is superior to placebo treatment."

Another writes:

While those who have an occasional cold might not mind going to a doctor for a prescription, those of us suffering from allergies more than half the year feel differently. Personally, there are literally weeks out of the year I would be debilitated without pseudo.  Nothing else helps (and yes, before other readers chime in, I've had scratch tests, shots, etc).  Nothing else works on those bad days.


I do use a neti pot, thankyouverymuch, and yes it is effective. But it serves a different purpose at a different stage in a sinus infection.  The pot won't do squat if your head is truly congested because there is literally no place for the water to go.  After a couple doses of Sudafed, those passages will clear up enough for the rinse to flow, and within a few minutes you'll be able to hock out that kaleidoscope of colors so familiar to sinus sufferers.


As a third-year medical student (and pharmacology doesn't get any more fresh than now for anyone not a pharmacologist), I can tell you that your reader's statement is completely and utterly wrong on virtually every point.  Neti pots are only marginally effective, and have been shown conclusively to actually increase the likelihood of additional colds (Nsouli TM, et al "Long-term use of nasal saline irrigation: Harmful or helpful?" ACAAI2009; Abstract O32.) I will, however, concede that steam can be helpful for relieving symptoms, which is all Sudafed does.

Sudafed has a known chemical pathway that is extremely effective at relieving nasal congestion by inducing vasoconstriction in the vessels of the nose, preventing fluids from emerging into your nasal cavity, which is the origin of that stuffed up feeling.  It also does this without severe tissue damage (a-la neti pot).  The same stimulating nature that stops fluids from getting into your nose counteracts the malaise that illness induces, producing relief of both a specific symptom and the general feeling of being "sick."     

I also take issue with this idea that drug companies are monstrous.  Drug companies are companies.  Some parts do amazing things, some parts do terrible things, but without them many people (for instance, you, Andrew) would not be alive.


It is one thing to pull a drug off the market because it is not effective or has detrimental side-effects for the patients for whom it's prescribed.  But to remove it entirely because it's abused by others makes no sense and is unfair.  There are many drugs that are available only by prescription that are also abused, yet the patients who need them still have access, despite others' abuse.

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