A Stitch in Haste

The Senate is prepared to turn decongestants into a controlled substance --

The legislation would require stores to sell Sudafed, Nyquil and other medicines containing pseudoephedrine only from behind the pharmacy counter. In makeshift labs across the country, the ingredient has been extracted and used to cook meth.

Consumers would have to show a photo ID, sign a log, and be limited to 7.5 grams — or about 250 30-milligram pills — in a 30-day period. Computer tracking would prevent customers from exceeding the limit at other stores, according to the bipartisan bill co-sponsored by Sens. Dianne Feinstein, D-Calif., and Jim Talent, R-Mo.

Some meth labs might — might — be inconvenienced somewhat by this law; I don't know enough chemistry to comment on alternatives to pseudoephedrine in meth or the potential of meth labs morphing into pseudoephedrine labs. I would tend to doubt the restriction's efficacy — demand is very good at creating its own supply.

And yes, 250 pills per month should be enough to satisfy anyone's personal needs for decongestant. So, nominally, the law might not seem too inconvenient.

Nevertheless, there is no doubt, none whatsoever, that lawful sales of these decongestants will fall, and perhaps even plummet. Think the corner bodega or gas station convenience counter is going to bother with this new registry? They'll just stop selling the medication outright. Online merchants such as drugstore.com may also have to forego sales. Libertarians and other privacy fetishists may refuse to submit to the recordkeeping requirements (I sure will).

And even for those who, in these War on Terror times, might not see the big deal in flashing an ID to get some Sudafed, having to stand on line — the pharmacist's line, mind you, not the cashier — and having to go through all the motions, will simply not be worth it. Finally, might pseudoephedrine decongestants become more expensive, since the incidental costs of selling them will increase?

Even if you're not at all sympathetic to the big greedy pharmaceutical companies that make pseudoephedrine products or the big greedy retailers and drugstore chains that sell them, you certainly should be sympathetic to all those stuffed-up people, who have no intention of committing any crime and simply want to partake of one of the great achievements of modern civilization — symptom relief — but will choose not to, because it is now too much of a hassle.

You can't put a price tag on a stuffy nose, or a headache, or heartburn, or athlete's foot. But they have a cost nonetheless. Less access to pseudoephedrine means more nasal congestion, which means less utility among those afflicted with it. Innocent people are made worse off, no different than if you slapped a new tax on the pills.

But that doesn't matter in the Politics of the Warm Fuzzy Feeling. The politicians "did something" — they saw what was easy to see (i.e., the benefits) and ignored what was easy to ignore (i.e., the costs).

Which all too often is all that's required.

Now if you'll excuse me, I have to go stockpile some Sudafed.

UPDATE #1: Walgreens is pre-capitulating and restricting pseudoephedrine sales.

UPDATE #2: Be sure to review John Tierney's excellent critique of the War on Meth.

UPDATE #3: Oregon has taken the next step on the reductio ad absurdum path and now requires a prescription to acquire over-the-counter decongestants:

Tom Holt, executive director of the Oregon State Pharmacy Association, said he thinks the law will drive pseudoephedrine-containing products off the market within a year or two.

Assuming of course that pseudo-ephedrine isn't banned outright before then. (Hat tip to Hit & Run.)

UPDATE #4: The Senate passed the measure by unanimous consent. Not a single voice of reason. How depressing. The bill remains pending in the House.

Back in July I blogged about a proposal to restrict the sale of decongestants containing pseudoephedrine -- which can be used to make methamphetamine -- to behind pharmacist counters. These proposals limit the quantity law-abiding citizens can buy, require them to show ID, and record their purchases for future use by law enforcement agencies.

Several states have passed similar restrictions, and now Congress is moving toward a federal rule.

The especially annoying part? It's part of the PATRIOT Act:

[O]fficials at the Food and Drug Administration have quietly fought such proposals, arguing that most methamphetamine is imported and that restricting cold medicines would lead to unneeded suffering among patients in need.
...
Dan Troy, former general counsel of the food and drug agency, countered that cold sufferers would have a harder time getting relief as a result of the legislation. "I think it's very sad when you punish the good and the needy because of a few bad actors," Mr. Troy said.
...
"The restrictions on Sudafed, although somewhat onerous, aren't that bad," Dr. William Schreiber, an internist in Louisville, Ky., where such restrictions are already in place, said, adding, "anything that goes about limiting the production of meth probably has to be done."

Read that last sentence again: anything that in any way reduces meth production by any amount "has to be done." Damn the costs, look only at the purported benefits, no matter how puny.

More:

Sales of pseudoephedrine products topped $580 million in 2004 and have not grown appreciably in recent years, suggesting that any diversion of the product for methamphetamine production is a relatively small part of overall sales.

Again, the image of meth chemists buying case after case, truckload after truckload, of Sudafed is a fallacy (dare one say a lie?).

Finally:

Sudafed and similar medicines are widely sold in convenience stores and pharmacies. The new legislation will probably mean that far fewer stores will offer the drugs, said Steve Francesco, an expert in over-the-counter drug marketing.

So an entire legal revenue stream for convenience stores, airport shops and countless other venues is summarily denied them in the name of the new "War on Meth." And countless millions of cold sufferers will now have to proceed, not to the nearest convenience store, but to a bona fide pharmacist (or, more likely, just stay home and suffer).

Because, again, the costs don't matter. No cost is too high, no measure unwarranted, if it might stop some meth chemists (no matter how few) somewhere (no matter how scarce) from producing some quantity (no matter how little) of meth.

After all, what's a little nasal congestion, right? (After all, Americans only suffer a billion colds a year.)

"I like a cold because I get to do my favorite drug, which is NyQuil. I love that stuff! What do the rest of you use? Robitussin? Why do you bother? Non-narcotic sissy-pansy bullshit!"
--Lewis Black

Doctors now say over-the-counter cough syrups simply don't work:

Despite the billions of dollars spent every year in this country on over-the-counter cough syrups, most such medicines do little if anything to relieve coughs, the nation's chest physicians say.

Over-the-counter cough syrups generally contain drugs in too low a dose to be effective, or contain combinations of drugs that have never been proven to treat coughs, said Dr. Richard Irwin, chairman of a cough guidelines committee for the American College of Chest Physicians.
...
Some over-the-counter cough syrups contain two drugs that have been shown to help relieve coughs caused by colds -- codeine and dextromethorphan -- but generally the doses are too small to be effective, Irwin said. Dextromethorphan is in Robitussin, a top-selling over-the-counter cough syrup.

Always bet on Black...

The empire strikes back:

[Dextromethorphan] is among Robitussin ingredients that the Food and Drug Administration has found to be safe and effective, said Francis Sullivan, a spokesman for Wyeth Consumer Healthcare, which makes Robitussin. Sullivan said Robitussin "wouldn't be a top brand if people didn't feel it was efficacious."

Perhaps, but people also spend lots of money on weight-loss pills. And nutraceuticals. And psychics. "Feeling" that something is "efficacious" doesn't make it so. Just because I believe in capitalism doesn't mean I'm impressed with the decision-making intelligence of the median consumer, and especially not the decision-making intelligence of the median consumer afflicted with a chest cold.

In any case, anyone care to guess how long it will be before some ambitious plaintiffs attorney (or consumer advocacy group) tries to put together a class action against Wyeth and the other cough syrup makers for false advertising or fraudulent labeling, or at least tries to force a shakedown in which the companies cough up contribute to some children's health fund or UNICEF or something? That's the easy scenario. The real question is whether any grandstanding hack politicians or bureaucrats will push to ban cough syrup. Stranger things have happened.

More thoughts at Hokum-Balderdash Assay. Meanwhile, here's another fan of NyQuil.

I've blogged previously about what I call the War on Sniffles — heavily restricting or even outright banning over-the-counter decongestants that can be used, in bulk, to manufacture methamphetamine.

Well, let's see — with all the required "post hoc ergo propter hoc" boilerplate — how well such programs have worked:

In the seven months since Iowa passed a law restricting the sale of cold medicines used to make methamphetamine, seizures of homemade methamphetamine laboratories have dropped to just 20 a month from 120.
...
But [officials are] now worried about a new problem: the drop in home-cooked methamphetamine has been met by a new flood of crystal methamphetamine coming largely from Mexico.
...
The University of Iowa Burn Center, which in 2004 spent $2.8 million treating people whose skin had been scorched off by the toxic chemicals used to make methamphetamine at home, says it now sees hardly any cases of that sort. Drug treatment centers, on the other hand, say they are treating just as many or more methamphetamine addicts.

And although child welfare officials say they are removing fewer children from homes where parents are cooking the drug, the number of children being removed from homes where parents are using it has more than made up the difference.

Any sophomore economics student knows the concept of "substitution effects." Raise taxes on beer, and some people will switch to distilled spirits. Ban smoking, and some people will use chewing tobacco. Make it impossible to manufacture homemade meth, and some people will switch to ice.

Which is not to say that the net effect will always be bad. But it does mean that the extent such a program is "good" will always be overstated.

And of course, all the people who go without their decongestants, either because they refuse to submit to having their purchases tracked or simply because they don't want to go through the hassle of dealing with a pharmacist, incur the cost of this policy too. But all those sniffles will never make their way into a government cost-benefit analyis of a decongestant restriction.

When supply is curtailed, demand doesn't simply pack up and go home. New supply — sometimes worse supply — simply fills the void.

Stated differently, be careful what you try to ban — you might succeed.

More thoughts at Hit & Run.

To review: In one of the more egregious examples of the Politics of the Warm Fuzzy Feeling, the federal government now requires law-abiding people to show ID when they buy even modest amounts of decongestants containing pseudoephedrine, and to have those purchases logged. The goal is to curb the manufacture of illegal methamphetamine. The pesky facts that:

• vast quantities of decongestant — more than can be casually purchased at a pharmacy — are needed to manufacture meth


• alternative methods of manufacturing meth are now available that do not require pseudoephedrine at all


• almost all meth production occurs outside the United States


• many people will simply forego the hassle and suffer needlessly

are all conveniently blanked out. You don't want the drug dealers to win, do you?

And what's a mere entry in a notebook behind the pharmacist's counter, right?

Wrong:

Detective Brian Lewis returns to his desk after lunch, scanning e-mails he missed.

One catches his eye: It says a suspected member of a methamphetamine ring bought a box of Sudafed at 1:34 p.m. at a CVS pharmacy.

Minutes later, Lewis is in his truck, circling the parking lot, searching for the woman.

So decongestant purchases are in fact often not "merely" being recorded on paper for future reference, but actively monitored electronically and automatically transmitted to law enforcement. Despite the fact that no illegal activity has occurred.

A perfectly legal transaction that, without more, could not possibly be connected to a crime, is now actively transmitted to law enforcement.

Not only that, but that same perfectly legal, objectively innocuous purchase is now, apparently*, probable cause to pursue and detain (not to mention access DMV records — the detective was looking for the "suspect's" license plate in the pharmacy parking lot).

You can craft your own slippery slope scenario extrapolating from this fact pattern. Rent the movie "Airport" from Netflix? Have the TSA instantly notified. Want to see "Naked Boys Singing" but left off the last word from your Google search? The child pornography unit at the FBI will now have their eye on you. And so on. (Don't forget Googling "using Sudafed to manufacture meth" to research a libertarian-minded blogpost — uh oh!)

The notion that legal activities should be casually monitored, curbed or banned in the name of crime prevention, public safety or national security, with little or no consideration of the costs in terms of lost civil liberties (and to dismiss dissenters as "whiners"), is the siren song of those who would myopically destroy the American way of life in order to save it.

Via FourthAmendment.com.

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*It's possible that in this instance the "suspect" was on probation or parole with specific instructions never to buy pseudoephedrine products. That would be a slightly different fact pattern, but not very.