- Editorial: Is a Long-Time Cold Medicine Really Dangerous?

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Editorial: Is a Long-Time Cold Medicine Really Dangerous?


      Americans swallow about 6 billion doses every year of a medicine known as PPA, either to fight colds or to suppress hunger. Phenylpropanolamine has been in such medicines for a half-century, but a new review by a panel of scientists assembled by the Food and Drug Administration (FDA) has generated headlines suggesting PPA may increase the risk of stroke. Are trusted medicines such as Robitussin, Alka Seltzer Plus and Contac truly dangerous? This is one health story where it is wise to read the fine print and withhold judgment.

      Over the years, the FDA has periodically received reports from hospitals that have cared for stroke victims who had recently taken medicine containing PPA. A total of 44 such reports made it to the FDA over a period of three decades -- not a lot given how common this medicine is, but enough for the FDA, appropriately, to look into the matter further.

      This kind of science, however, is inherently fuzzy. Researchers can''t construct a carefully controlled study placing thousands of people on various regimens of PPA and placebos. Rather, they have to tease from previous stroke cases some possible correlations between the victims'' medicine habits and their condition. To do this, an FDA panel compared 702 hemorrhagic (brain bleeding) stroke victims with 1,376 men and women whose health conditions and medicine choices were monitored for five years. In this "control" group, only 13 men ended up using a medicine containing any PPA, not enough for the FDA panel to conclude anything. Twenty women took PPA, including one who used it as an appetite suppressant.

      From this data came the FDA panel''s conclusion that women taking PPA as a diet suppressant may be increasing their chances of this form of rare stroke fifteenfold. Young women using PPA for the first time may be increasing risk of stroke threefold.

      Given that medicines containing PPA are likely in the medicine cabinets of many, if not most, Americans, this is the kind of health story that hits home. It''s also the kind that can confuse more than enlighten. Constructing a fair study, then teasing appropriate findings from the data, is difficult even for the experts. This study has yet to face the peer review process of independent experts or been published in a journal. For all of these reasons, readers should consider these headlines the first tidbits of information, and by no means the last.

      In the meantime, consumers should apply some common sense. Taking the same medicine daily for weeks or months at a time to lose weight seems more likely to cause side effects than occasionally taking the same medicine for a cold. That said, just because a medicine is sold over the counter doesn''t make it necessarily safe. With better information, society may some day be able to better weigh the risks and benefits of PPA.


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