[amandalotti]

Hey there - I'm that Angelotti :).

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.

[zo1]

>"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.

[sokoloff]

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.

[discostrings]

Hi, and thanks for your reply!

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!