Today in Science: Decongestants are a waste of money

January 18, 2024: How a pharmacist determined that a common decongestant doesn't work, the biggest cells in the body are the most uncommon and AI can predict when someone will die. 
Andrea Gawrylewski, Chief Newsletter Editor
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Dummy Decongestants

Last fall, an advisory panel for the FDA concluded that phenylephrine, a common ingredient in over-the-counter oral decongestant medicines, was ineffective at reducing congestion and recommended the compound be pulled from shelves (the FDA must still issue a ruling to restrict the sale of the ingredient). It took nearly 20 years of campaigning to get to this point, Randy Hatton, a clinical professor in the College of Pharmacy at the University of Florida, writes for us. He, with colleagues and students, conducted an extensive review of the efficacy of the compound and found little evidence that it does what it says. They repeatedly contacted the FDA, submitted petitions, and worked with congressional representatives, requesting the ingredient be evaluated and removed from shelves.  

Why this matters: Phenylephrine's approval for the market was essentially grandfathered in, since the compound is covered by a slow-moving review process the FDA applies to older over-the-counter medicines. In the meantime, consumers have been wasting money for nearly two decades on a medicine that doesn't work, says Hatton.

What the experts say: "The FDA needs more funding to look at these old drugs. We need public funds to support independent researchers who want to examine these products objectively," writes Hatton. "Nonprescription drugs must be effective—not just safe."

Cell Count

A mathematical principle called Zipf's law states that when something's size is doubled, that thing becomes about half as common, and it applies to cities and corporations and even salaries and musical notes. Researchers have now found that it also applies to the cells in the human body, where the smallest cells (red blood cells) are the most common and largest (muscle cells) are the least common.

The numbers: Circulating erythrocytes (called red blood cells) number 19,200 billion and are the most common cell type in the human body. Myocytes in the thigh muscle, on the other hand, are the largest cell type, but only number 87 billion in the body. Some cell types, like neural and glial cells which make up brain matter, have the largest diversity of size and abundance.

Why this matters: Knowing the frequency of a particular cell type in the body could help explain certain body systems and hard-to-count cell types, the researchers say. The study suggests, for instance, that immune cells called lymphocytes are far more common than biologists realized.
Credit: Jen Christiansen; "The Human Cell Count and Size Distribution," by Ian A. Hatton et al., in PNAS, Vol. 120; September 2023 (data)
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We are in the depths of cold and flu season. If you or a loved one is beset by congestion, you can get pseudoephedrine behind the pharmacy counter or a nasal spray containing oxymetazoline. Read more helpful tips on easing snuffy, runny noses here
I hope you stay healthy all winter long. Reach out with feedback or suggestions by emailing: newsletters@sciam.com. See you tomorrow!
—Andrea Gawrylewski, Chief Newsletter Editor
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