back to article Why does herbal cough syrup work so well? It may be full of morphine

The US Food and Drug Administration (FDA) is sounding alarms after an herbal cough remedy sold throughout the US was found to contain morphine. The FDA said that bottles of Licorice Coughing Liquid made by Chinese-based Ma Ying Long Pharmaceutical Group and distributed by Master Herbs, Inc contain a "camphor compound" whose …

  1. KA1AXY

    In surprising news today

    Chinese made "herbal medicine" contains something not on the list of ingredients.

    Color me shocked...not

    1. Old Handle

      Re: In surprising news today

      But... poppies are an herb.

      1. Pompous Git Silver badge

        Re: In surprising news today

        But... poppies are an herb.

        Lotsa poppies grown in Tasmania -- for codeine. Of course to be consistent, the anti-natural remedy brigade would have to be anti-opiates. They are not because they are merely spouting opinionated nonsense, rather than basing their comments on empirical evidence.

        1. Sir Runcible Spoon Silver badge

          Re: In surprising news today

          "spouting opinionated nonsense"

          Anyone else read that as 'opiated nonsense' ?

        2. CrazyOldCatMan Silver badge

          Re: In surprising news today

          > Lotsa poppies grown in Tasmania -- for codeine

          Hmmm.. codeine.. About the only thing that mediates the pain caused by psoriatic arthritis (especially when combined with ibuprofen).

          Although I've now started on the biological treatments so (hopefully) can reduce my intake.

          1. Vic

            Re: In surprising news today

            About the only thing that mediates the pain caused by psoriatic arthritis (especially when combined with ibuprofen).

            I stick to Ibuprofen when I get a flare-up, but I have found that such attacks are largely avoided by judicious exercise.

            I am mostly afflicted in my hands; I took up playing the guitar, and that has done wonders. I also use Chinese worry balls regularly - they're very useful.

            My knees are kept in reasonable shape by slow walks home from the pub...

            Vic.

            1. x 7

              Re: In surprising news today

              "My knees are kept in reasonable shape by slow walks home from the pub..."

              and I hope with quick walks TO the pub...

      2. FreemonSandlewould

        Re: In surprising news today

        All this hubub about ....competition with the illegal drug cartels. Which of course only helps........the illegal drug cartels. The politicians are on the take.

      3. allthecoolshortnamesweretaken

        Re: In surprising news today

        "But... poppies are an herb."

        So are coca leaves and cola nuts...

      4. captain veg

        an herb

        Just no.

        Either a herb or an 'erb.

        Or possibly Anne Herb.

        -A.

        1. x 7

          Re: an herb

          pronouncing the h in front of words like herb and hotel is just simple pretension

          1. captain veg

            Re: an herb

            Moi?

            -A.

          2. Pompous Git Silver badge

            Re: an herb

            pronouncing the h in front of words like herb and hotel is just simple pretension

            Worse is the pronunciation of the non-existent letter h in front of aitch. A common Australian habit.

          3. KeithR

            Re: an herb

            "pronouncing the h in front of words like herb and hotel is just simple pretension"

            No, it's ENGLISH.

            Seriously - try it. We invented it. It's great.

            (In the Victorian era, the word was pronounced "'erb". but - y'know - well over a hundred years ago...)

            1. x 7

              Re: an herb

              "We invented it. It's great."

              no, actually in this case Samuel Johnson invented it because he preferred the sound, and pretentious prats ever since have followed his lead. That man did more damage to the English language than all other idiots combined

  2. Paul Renault

    They may wish to reword and correct the notice...

    Link to the recall is borked. The correct one is:

    http://www.fda.gov/Safety/Recalls/ucm482524.htm

    http://www.fda.gov/Safety/Recalls/ucm482524.html - doesn't work.

    But really came her to say: "The unware (sic) ingestion of morphine can lead to life-threatening respiratory depression and death."

    So, if you aware that you're taking morphine, it's perfectly safe, eh?

    1. Doctor Syntax Silver badge
      Happy

      Re: They may wish to reword and correct the notice...

      "So, if you aware that you're taking morphine, it's perfectly safe, eh?"

      No, but you'll be aware why you're dead.

    2. This post has been deleted by its author

    3. diodesign (Written by Reg staff) Silver badge

      Re: They may wish to reword and correct the notice...

      Link's fixed. Can you please drop corrections@theregister.co.uk an email if you spot anything broken or wrong, so we can fix it ASAP.

      C.

      1. Gruezi

        Re: They may wish to reword and correct the notice...

        Does that include asking to correct the spelling of "an herb" to the correct UK "a herb"? ;)

        http://www.oxfordlearnersdictionaries.com/definition/english/herb

    4. Anonymous Coward
      Anonymous Coward

      Re: They may wish to reword and correct the notice...

      Well, yes, as long as you don't overdose, Morphine is relatively safe if taken under medical guidance but if you're unaware a medicine contains morphine in unknown concentrations it's entirely possible to overdose on the stuff by accident.

      1. Anonymous Coward
        Anonymous Coward

        Re: They may wish to reword and correct the notice...

        Well, yes, as long as you don't overdose, Morphine is relatively safe if taken under medical guidance but if you're unaware a medicine contains morphine in unknown concentrations it's entirely possible to overdose on the stuff by accident.

        For - let's say 'a physically-healthy person' - it would be pretty hard to accidentally OD on opiates other than injecting or snorting, unless actually trying to die. The main risk of taking enough of what you've been prescribed, to kill pain rather than just alleviate it a little, is that you become addicted that way; and opiate addiction is awful (believe me). Morphine is a cough suppressant - damn good one! - as well as anti-diarrhoeal (e.g. 'kaolin and morphine tincture') and presumably this stuff has the same approx conc.as the kind the chemist sells that is actually labelled as containing such (after all, the Chinese have long been familiar with opium. We Brits saw to that!). You could probably drink the whole bottle and not OD on the morphine; but, speaking personally, I have never got 'high' on opiates (e.g. swigging oramorph). afaik you have to take it straight to the brain for that. Otherwise, supposing there were enough in this stuff to OD on if you drank the whole bottle; sure, it should be labelled. It should be labelled anyway, but if containing that much, should be prescription-only too. However, the main problem, to my mind, is that there are people who do drink entire bottles of this kind of medicine, because half the time syrups that give you a buzz if you drink a lot of it also contain a week or two's worth of paracetamol.

        1. Pompous Git Silver badge

          Re: They may wish to reword and correct the notice...

          half the time syrups that give you a buzz if you drink a lot of it also contain a week or two's worth of paracetamol.

          I think you will find that the buzz comes from ephedrine, or pseudoephedrine these days.

          1. PhilBuk

            Re: They may wish to reword and correct the notice...

            I did a summer job in a Chemists in the 1970s and there was a cough medicine called Collis Brown's Compound. It contained a fair amount of codeine but was sold over the counter without any real restrictions. There were some customers who bought half a dozen bottles a week and were clearly addicted. I was was told later that the manufacturers were forced to reduce or remove the codeine entirely causing a rush to the local GPs for 'nervous' problems.

            Phil.

      2. Pompous Git Silver badge

        Re: They may wish to reword and correct the notice...

        if you're unaware a medicine contains morphine in unknown concentrations it's entirely possible to overdose on the stuff by accident.

        Worse would be becoming addicted. But then you could always take heroin instead. That's what it was promoted as when first introduce -- a cure for morphine addiction.

  3. Oengus
    Coat

    Off to the local Chinese grocery store

    I think I'll just slip out for a few minutes and get a herbal remedy for this throat tickle I'm experiencing.

    Kind of the Reg to post a picture of what to look for...

    Later when stopped for an MDT (Mobile Drug Test)... "Honest Officer. I have never taken drugs in my life. I always go for herbal treatments. See here is the cough medicine and organic brownies I picked up this morning."

    1. Voland's right hand Silver badge

      Re: Off to the local Chinese grocery store

      Curious minds want to know:

      Did you pick up the organic brownies in Prague or Amsterdam? Also, were they from a shop with a big green leaf on the shop sign.

      1. chivo243 Silver badge

        Re: Off to the local Chinese grocery store

        Or Denver

    2. martinusher Silver badge

      Re: Off to the local Chinese grocery store

      Sorry, pal, that won't get you off a DUI in California.

    3. paulc

      Re: Off to the local Chinese grocery store

      just avoid anything with poppy seeds in or on it... seriously...

      http://www.nytimes.com/2005/01/11/health/the-claim-eating-poppy-seeds-can-make-you-fail-a-drug-test.html?_r=0

      http://www.usada.org/can-poppyseeds-cause-a-positive-drug-test/

  4. Schultz
    Boffin

    "...respiratory depression and severe allergic reactions"

    Funny, none of those is a side effect of morphine. Maybe they just made it up or, more plausibly, they simply named side effects from the herbal part of the cough medicine. Similar side effects might be found for a large number of other herbal medicines: natural ingredients are not heavily regulated but can still be a danger to your health. It probably would look somewhat silly if they'd (truthfully) state that morphine is one of the safer ingredients of the concoction :).

    1. Anonymous Coward
      Anonymous Coward

      Re: "...respiratory depression and severe allergic reactions"

      Respiratory depression is a well known side effect of morphine and other opioids, it's how heroin addicts die of overdoses.

      1. Grikath

        Re: "...respiratory depression and severe allergic reactions"

        "Respiratory depression is a well known side effect of morphine and other opioids, it's how heroin addicts die of overdoses."

        yeah.. funny that.. when you overdose, you run into more or less acute side-effects which are detrimental to your health. Whodathunkit... /facepalm.

      2. Schultz

        "Respiratory depression is a well known side effect"

        My bad, didn't read to the bottom of the page. But at least, progression to death is very rare.

    2. Old Handle

      Re: "...respiratory depression and severe allergic reactions"

      Respiratory depression is mentioned you read all the way down to the "for doctors" part. Allergic reactions aren't mentioned, but that isn't generally classed as a "side effect" per se. The fine print at the bottom also specifically says the page may not cover that.

      1. graeme leggett

        Re: "...respiratory depression and severe allergic reactions"

        Side effect listed for patients includes "•shortness of breath".

        The list for patients is the symptoms they might experience, the list for doctors are the underlying "causes" of those symptoms

        1. PhilBuk

          Re: "...respiratory depression and severe allergic reactions"

          I was prescribed Tamedrol for a short period and whilst it was quite pleasant, it came with strict instructions not to combine it with alcohol. Mix the two and you to forget to breathe.

          Phil.

  5. Barry Rueger

    Codeine

    For many years I gave up on buying cough medicine because as far as I could tell it just didn't make any difference.

    Eventually, in the middle a particularity nasty throat condition, I ran into a helpful pharmacist that suggested that I try the Other Cough Medicine behind the counter.

    What she meant was, the syrup with good old fashioned opiate based codeine, instead of the usual "safe" dextromethorphan.

    Wow. what a relief that was! The codeine knocked my cough dead in no time at all, and I had the first good night's sleep in days.

    Although a nurse friend warned me that codeine does have notable side effect - constipation.

    1. ZSn

      a stranger to the toilet

      The poet Coleridge, dependent upon laudanum, was described as 'a stranger to the toilet'. He famously had to ask some guests at a dinner party to give him an enema. If wonder if they ever invited him again.

      Incidentally, don't Google 'a stranger to the toilet' unless you have some mind-bleach to hand.

    2. MrDamage
      Coffee/keyboard

      Re: Codeine

      That side effect would come in handy, if you have need of a cough medicine, and have recently partaken in Taco Bells daily special.

      Icon, cos that what things would look like without the side effect.

      1. Pompous Git Silver badge

        Re: Codeine

        That side effect would come in handy, if you have need of a cough medicine, and have recently partaken in Taco Bells daily special.

        When I were a lad, me Mam had a small bottle of laudanum to relieve "the trots". For a long time I could never fathom the connection with the communists. Grandad was always banging on about "those bloody Trots"! Then it occurred to me they gave him the shits :-)

        1. graeme leggett

          Re: Codeine

          It was a little brown bottle of "Kaolin and morphine" when I was young.

          From a current SmPC "Morphine Hydrochloride 0.458mg per 5ml dose" "Morphine reduces the peristaltic activity of the intestines.

          "

          1. CrazyOldCatMan Silver badge

            Re: Codeine

            > It was a little brown bottle of "Kaolin and morphine

            You still can - my local Boots shop (sometimes) has it. My mum swears by it..

        2. RobHib

          @Pompous Git - Re: Codeine

          These days, over-the-counter* Lomotil (aka Co-phenotrope) does the same, it works wonders for the trots and fast, it has come to my aid on multiple occasions, especially when traveling. Lomotil has been around for many years and contains a cleaver combination of the reasonably powerful opiate diphenoxylate (the active ingredient) and a small amount of atropine.

          Diphenoxylate, like laudanum/morphine and other opiates, works very effectively in slowing the intestines/stopping diarrhea but it's still an opiate, thus addictive. To overcome the problem of addiction (or being used as a substitute for morphine/heroin addicts), a precise amount atropine is added to the diphenoxylate. Taken in the correct dose, the Lomotil works wonders, but when it's taken in excess the atropine kicks in making the patient quite ill with nausea and tachycardia. Essentially, the addict cannot consume enough diphenoxylate for a 'high' before the atropine puts him out of action. This cleaver trick means ordinary non-addicted people aren't too inconvenienced when they need it.

          BTW, Lomotil/diphenoxylate is much faster acting and of considerably shorter duration in its effect than that other anti-diarrhea drug loperamide (Imodium), 4-6h vs 24h. IMHO, Lomotil is a much better drug, Imodium takes far too long to kick in and often lasts much longer than necessary thus one ends up with constipation.

          For years, when traveling to strange places, eating strange foods, diphenoxylate and the anti-nausea drug prochlorperazine; aka Stemetil, and the anti-tummy-bug drug metronidazole, aka Flagyl were and still are essential travel companions, in combination they often worked wonders.

          __

          * OTC depends where you live, sometimes it's script only, or script above a certain quantity,

          1. x 7

            Re: @Pompous Git - Codeine

            "For years, when traveling to strange places, eating strange food........ the anti-tummy-bug drug metronidazole, aka Flagyl............ essential travel companions"

            FFS don't try strange drinks with metronidazole - or ANY alcohol at all

    3. Pompous Git Silver badge

      Re: Codeine

      Although a nurse friend warned me that codeine does have notable side effect - constipation.

      Always take Coloxyl with your codeine. Coloxyl with senna if you forget (it's quicker than Coloxyl alone). Old farts know these things...

    4. Anonymous Coward
      Anonymous Coward

      Re: Codeine

      yeah I only ever buy cheapo Pholcodine its a cough suppressant so only "works" with unproductive coughs and its cheap as well.

      The trouble with herbal stuff is that its not regulated in the same way as meds (if at all!) You can go in to Holland and Barret (or other such places) and buy a whole load of herbal (so obviously safe!) crap and you haven't a clue as to what damage it might do you if you take too much or in combination with an other herbal product or med.

      Best stick to Crystals and Homeopathy to be on the safe side!

      1. Pompous Git Silver badge

        Re: Codeine

        The trouble with herbal stuff is that its not regulated in the same way as meds (if at all!) You can go in to Holland and Barret (or other such places) and buy a whole load of herbal (so obviously safe!) crap and you haven't a clue as to what damage it might do you if you take too much or in combination with an other herbal product or med.

        Bullshit! In Australia we have strict labelling laws. If the label on the product doesn't correctly describe the package contents, then the manufacturer is liable for prosecution.* In any event, shopping by reputable brand beats shopping on price. If you purchase something that is obviously unlikely to be as described, then tough titty when it fails to perform.

        * Presumably similar product labelling laws apply elsewhere. If you don't have such laws where you live, then I feel very sorry for you.

        1. Anonymous Coward
          Anonymous Coward

          Re: Codeine

          ermmm might be bullshit in OZ but not in the UK herbal remedies are not tested in the same way as meds. And labelling laws are NOTHING TO DO with clinical testing! People can very easily OD on herbal remedies.

          1. Pompous Git Silver badge

            Re: Codeine

            And labelling laws are NOTHING TO DO with clinical testing! People can very easily OD on herbal remedies.

            I said nothing about testing in relation to labelling laws; they are clearly separate issues. The labelling laws are about whether the product you are buying is as described on the label. The D2/D3 contretemps earlier is a good example. In the past you could sell vitamin D and get away with it. You might hope to be purchasing D3, but what is in the bottle is D2. This switcheroo is illegal here. And the very large online pharmacy I purchase my D3 from doesn't have D2 listed for sale.

            You insist that people OD on natural remedies as if I claimed they don't. Do you have a reading/comprehension difficulty?

            Addressing the testing issue, I would hope that testing of herbal remedies was not done in the same way as prescription meds:

            nonsteroidal antiinflammatory drugs in rheumatoid arthritis Peter C. Gøtzsche, MD,MSc

            Abstract

            Important design aspects were decreasingly reported in NSAID trials over the years, whereas the quality of statistical analysis improved. In half of the trials, the effect variables in the methods and results sections were not the same, and the interpretation of the erythrocyte sedimentation rate in the reports seemed to depend on whether a significant difference was found.

            Statistically significant results appeared in 93 reports (47%). In 73 trials they favored only the new drug, and in 8 only the active control. All 39 trials with a significant difference in side effects favored the new drug. Choice of dose, multiple comparisons, wrong calculation, subgroup and within-groups analyses, wrong sampling units (in 63% of trials for effect variables, in 23% for side effects), change in measurement scale before analysis, baseline difference, and selective reporting of significant results were some of the verified or possible causes for the large proportion of results that favored the new drug.

            Doubtful or invalid statements were found in 76% of the conclusions or abstracts. Bias consistently favored the new drug in 81 trials, and the control in only one trial.

            It is not obvious how a reliable meta-analysis could be done in these trials.

            doi:10.1016/0197-2456(89)90017-2

            http://www.sciencedirect.com/science/article/pii/0197245689900172

          2. Graeme Mudie
            WTF?

            Re: Codeine

            That all changed in 2004 - herbal medicines in Europe (yes, including the UK) have to be tested for effectiveness and for the level of active ingredient in the herbs for a shop to be able to sell that to you as herbal remedies.

          3. John Brown (no body) Silver badge

            Re: Codeine

            "And labelling laws are NOTHING TO DO with clinical testing! "

            Correct, they are labelled as food products, ie an ingredients list and must be "safe" for human consumption and that's about it. They also have to be very careful about making medical claims without actual evidence and lots of "may" and "might" in the marketing etc.

    5. GlenP Silver badge
      Coat

      Re: Codeine

      Codeine definitely does cause constipation.

      Even worse is the opposite effect when you stop taking it!

      Sorry - gotta run.

    6. Anonymous Coward
      Anonymous Coward

      Re: Codeine

      Codeine works great for coughs which is why it was originally used. As with all medication don't take it like it is a meal or a drink.

    7. CrazyOldCatMan Silver badge

      Re: Codeine

      > codeine does have notable side effect - constipation.

      Only for the first year or so. After that, not so much.

  6. Trixr Bronze badge

    And actually, in terms of intractable coughs, morphine is not "snake oil". Any opiate does an excellent job of suppressing coughs. Of course, often you actually want the cough to do its job, but I've had one or two bouts where the cough was the problem, rather than the underlying lurgie.

    Unidentified substances in your cough syrup aren't the way to go, however. I just pop a couple of Panadeine unless you can get a doctor to prescribe the good stuff (syrup with codeine).

    1. ZSn

      70s child

      As a child in the 70s I remember taking cough medicine with morphine in it. It stopped my cough and according to my mother also stopped my hyperactivity in its tracks. I'm not sure what the dosage was but it was probably pretty potent.

      1. PNGuinn
        Happy

        Re: 70s child

        Best cough mixture I ever used was as a kid in the 70's. Sold by the coop chemist. I think it was called mentholated balsam. I don't know about the opiates, but it contained creosote. Tasted gorgeous.

        1. Anonymous Coward
          Anonymous Coward

          Re: 70s child

          I remember my mum giving me friar's balsam back in the 70's. You're meant to put it in water and inhale it, but she once gave it to me on a spoon!!!!!!!!!

        2. KeithR

          Re: 70s child

          "mentholated balsam"

          Arrggghh!!

          Like sucking old rope or licking a railway sleeper!

    2. Pompous Git Silver badge

      Of course, often you actually want the cough to do its job

      And for that it's pretty hard to beat senega and ammonia. Breathing the effusions from a jug full of steaming hot water with a few drops of eucalyptus oil also works well for both types of cough.

      1. David Pollard

        eucalyptus oil for emphysema

        The commercial product 'Olbas Oil', available at most supermarket pharmacies, contains a mixture of plant oils such as peppermint along with eucalyptus and is efficacious for me with few side effects; though it is quite strong and stings a bit if you get it on a sensitive area of skin.

        N-acetyl-cysteine also seems to help me cope with emphysema. I learned about it here:

        http://www.medicine.ox.ac.uk/bandolier/band81/b81-2.html

        It's sad that Bandolier is no longer in existence, for they did good reviews on somewhat similar lines to Cochrane in the search for evidence based medicine. Their commentaries on a range off alternative medicines, included in the overall index under the heading 'Complementary', seems to me to be as good as you can get. There do seem to have been a few medics who were neither in thrall to Big Pharma nor to quackery.

        http://www.medicine.ox.ac.uk/bandolier/knowledge.html

        I wonder how much the NHS would save and how much overall health might benefit if work similar to theirs were to be extended and made easily available.

        1. Doctor_Wibble

          Re: eucalyptus oil for emphysema

          > ... 'Olbas Oil', ... efficacious for me with few side effects

          When half a bottle of it is tipped on to a hot radiator at the back of a lecture theatre, it's very efficacious indeed for the mood of everyone, starting at the back and moving forwards like a slowly drifting blanket of gentle giggling. I understand this was the intended purpose, so in this instance I think 'side effects' would be classed as 'none', except for the odd eased sinus or two.

          1. Pompous Git Silver badge

            Re: eucalyptus oil for emphysema

            very efficacious indeed for the mood of everyone, starting at the back and moving forwards like a slowly drifting blanket of gentle giggling

            That reminded me of many a pleasant evening many years ago when Terry Cashion was the head of Tasmania's drug squad. Once a week, he used to convene a meeting to educate them who needed to know about the dangers of marijuana and how to detect its use. This latter was achieved by Terry setting light to a large bowl of dope to familiarise those present with the odour of its burning. One of the participants remarked to me some months after the weekly sessions finished how much they missed them. "We used to enjoy ourselves so much. All that fun and laughter!"

            On one particularly memorable evening, Terry spiked a largish lump of hash, ignited it and this was passed around for everyone to sniff. Never one to miss an opportunity, one participant I won't name took a really deep inhalation. The dude next to him said: "Careful, you'll get stoned." The sniffer responded: "I know, I know" and took another deep sniff.

    3. Anonymous Coward
      Anonymous Coward

      same here. Had a nasty cough last year that turned in to a chest infection. Coughing up green shite for weeks

      1. Vic

        Had a nasty cough last year that turned in to a chest infection.

        Many (most? Dunno.) coughs are caused by bacteria-filled mucus from a head cold trickling down the back of the throat. Aside from never sniffing, I have found the best preventative against this is strong spirit[1] administered neat just before bed-time :-)

        Vic.

        [1] I tend to favour Stroh 80 for this, although it is both expensive and hard to come by in this country...

        1. x 7

          Hey Vic

          when you had that nasty cold you should have rubbed your chest and bits with Vicks

        2. x 7

          " I have found the best preventative against this is strong spirit[1] administered neat just before bed-time :-)"

          Administered? I never liked pouring spirits up my nose. I prefer to be more conventional and just drink my whisky

          1. Pompous Git Silver badge

            I prefer to be more conventional and just drink my whisky

            Me too :-)

            http://larkdistillery.com/products/

            Bill Lark commenced his whisky business after travelling to Scotland to learn what he needed to know about distilling. These days the Scots hire Bill to go to Scotland to teach them.

            1. x 7

              Tasmanian Whisky

              Mr Git, thanks for the link - thats a new one on me. Any idea if they're exporting it to the UK?

              1. Pompous Git Silver badge

                Re: Tasmanian Whisky

                Any idea if they're exporting it to the UK?

                No idea. Try marketing@larkdistillery.com.au. I don't see Bill very often now that I'm retired otherwise I'd just ask him when we next met at a social gathering. You could also try Sullivans Cove.

                http://sullivanscovewhisky.com/

                Theirs is supposedly better than Bill Lark's having won World's Best Malt twice now, but I have yet to imbibe both on the same occasion. Truth be told I don't drink much spirits these days* and have enough malt and Armagnac to last us for several years. My regular tipple is chardonnay or sauvignon blanc mostly from the Nelson and Marlborough districts of New Zealand.

                Sullivan's Cove: office@tasmaniadistillery.com.au

                * Long gone are the days when 14 standard drinks was a good start to the evening rather than a week's supply...

  7. Anonymous Coward
    Anonymous Coward

    Tip of the iceberg

    Look forward to plenty more of this type of thing as we rely ever more on the Chinese for food production.

    1. KA1AXY

      Re: Tip of the iceberg

      "We"???

      I've got all the lead and melamine I need in my diet already

  8. Duncan Macdonald Silver badge
    Pint

    Kaolin and Morphine anyone ?

    Still available as a treatment for upset stomach

    see http://www.chemistdirect.co.uk/kaolin-morphine-mixture/prd-o2d

    (no prescription needed)

    Low levels of morphine are present in a number of treatments and a few milligrams is highly unlikely to have any adverse effects.

    1. Alan Newbury
      Childcatcher

      Re: Kaolin and Morphine anyone ?

      Remember being dosed with that as a child...

      1. a_yank_lurker Silver badge

        Re: Kaolin and Morphine anyone ?

        Are you from Middle Georgia, the kaolin capital of the US?

    2. Anonymous Coward
      Anonymous Coward

      Re: Kaolin and Morphine anyone ?

      It was well known (I am assured) in my impetuous roof, that leaving a bottle of KM to settle was an effort free wa of separating certain pleasant ingredients.

    3. Pen-y-gors Silver badge

      Re: Kaolin and Morphine anyone ?

      I remember buying a bottle back in the early eighties when I'd ingested some dodgy food with seriously bad effects. Slightly zonked already from lack of sleep, and started knocking it back without worrying about quantities (I think about half a bottle in eight hours). Worked wonders but I did have some very very strange dreams...

      1. paulc

        Re: Kaolin and Morphine anyone ?

        you can still buy it, just you have to ask the pharmacist for it as it's kept back in the locked cupboards... Can't get it over the shelf...

    4. Anonymous Coward
      Anonymous Coward

      Re: Kaolin and Morphine anyone ?

      yeah entrosan (spelling) I think its called in the UK anyway. I remember back in the late 80's having really bad stomach ache so I dosed up on Entrosan for a few days, did sod all. Not surprising really as it turns out I had appendicitis, landed up spending Xmas 1987 in hospital!

      1. Pompous Git Silver badge

        Re: Kaolin and Morphine anyone ?

        Not surprising really as it turns out I had appendicitis, landed up spending Xmas 1987 in hospital!

        Consider yourself lucky. Back in the 70s, a certain Mr Law cut the leg off an appendicitis patient here in Tasmania. Poor bugger woke up minus a leg and still had an intact appendix.

  9. publius

    Snake oil?

    It's important to remember the enormous history of herbal remedies Chinese practitioners have amassed over the millenia. Snake oil was the right medicine if it was made from the RIGHT snake. When that practice was transferred to the US of A 150 years ago, some unscrupulous people substituted local "snakes" for the real thing. Sham products have been around forever. "Caveat emptor" is just as important now as it was when the Romans coined the phrase at least two thousand years ago.

  10. Anonymous Coward
    Anonymous Coward

    Alternate and Traditional Medicine

    Time to label Alt Med as:

    - Likely to be a placebo

    - Potentially dangerous (see article)

    - Ineffective

    - Unregulated

    - Home-spun hokum

    - All of the above

    Consult a professional health provider.

    1. Pompous Git Silver badge

      Re: Alternate and Traditional Medicine

      Consult a professional health provider.

      I do and she disagrees with you. She is a fully qualified pharmacist. Are you? Quite often she will recommend an alternative to the usual products of big pharma because they are usually as effective and often a lot cheaper. Another benefit is they are usually free of unpleasant "side-effects".

      1. Anonymous Coward
        Anonymous Coward

        Re: Alternate and Traditional Medicine

        "big pharma"

        LOL

        That's a Godwin!

        PS: Free of "side-effects" is often because there's no actual efficacy in the potions.

        1. Pompous Git Silver badge

          Re: Alternate and Traditional Medicine

          Free of "side-effects" is often because there's no actual efficacy in the potions.

          Citation! If they are ineffective as you say, why are they suggested by doctors and pharmacists? Why do the medical journals publish papers on their effectiveness? See citations I have given elsewhere in this thread.

          1. Anonymous Coward
            Anonymous Coward

            Re: Alternate and Traditional Medicine

            "why are they suggested by doctors and pharmacists?" = logical fallacy: argument from authority.

            Citation not required, look up Homeopathy.

            Try: http://www.doeshomeopathywork.com/

            1. Pompous Git Silver badge

              Re: Alternate and Traditional Medicine

              Citation not required, look up Homeopathy.

              Where did I mention homeopathy? Straw man argument. I'm talking allopathic effects as reported in reputable journals. Citation that these results are bogus is definitely required. Put up, or shut up.

            2. Pompous Git Silver badge

              Re: Alternate and Traditional Medicine

              "why are they suggested by doctors and pharmacists?" = logical fallacy: argument from authority.

              Since you obviously wouldn't consider taking the advice of doctors and pharmacists then, who do you take your drug advice from? Enquiring minds...

          2. LHGFLICOD
            Devil

            Re: Alternate and Traditional Medicine

            Problem with citing a single study is there is usually an equal and opposite study, looking just at Glucosamine sulfate the full text of the study referenced is available here as a pdf here http://www.oarsijournal.com/article/S1063-4584%2805%2980007-X/pdf a brief look suggests it is a reasonably well run study however of you head over to http://www.arthritisresearchuk.org/arthritis-information/complementary-and-alternative-medicines/cam-report/complementary-medicines-for-osteoarthritis.aspx an analysis of multiple studies shows that its effects are uncertain.

            Also as its a dietary supplement there are issues with over use (people taking more than the recommended safe levels) which could potentially increase the risks of diabetes (ref http://www.ncbi.nlm.nih.gov/pubmed/20923823 full text available free of charge).

            Also commercially available glucosomine products are not what you would call natural being ground up shellfish shells that are then subject to various chemical processes.

            This isn't to say the products of 'big pharama' are any better as there is a tendency to hide or not publish research that is negative or indicates problems.

            1. Pompous Git Silver badge

              Re: Alternate and Traditional Medicine

              an analysis of multiple studies shows that its effects are uncertain.

              For better or worse, depending on your POV, we are all different. Genetically that is. It's hardly surprising then that we differ in our reactions to the various substances we ingest. It would appear that I am one of the fortunate ~40% that benefit from glucosamine. I have a friend that was unfortunate to take Vioxx. He had five heart attacks as a result. There has never been suggested AFAIK a link between glucosamine use and heart disease.

              Overuse of dietary supplements is not unique. Overuse of prescription pharmaceuticals is also a problem.

            2. graeme leggett

              Re: Alternate and Traditional Medicine

              My question re the glucosamine vs ibuprofen example would be "is glucosamine as good as or better than the current recommended treatment?" ie have we moved on from use of ibuprofen for symptom management in that case.

              Another thought that touches back on the quality of products is that if eg glucosamine is accepted as a medicinal treatment, then it needs licensing and suitable distribution as a medicine not flogged from Holland and Barretts as a "supplement" and that moves it into the pharma industry's sphere and it's no longer "alternative medicine".

              1. Pompous Git Silver badge

                Re: Alternate and Traditional Medicine

                My question re the glucosamine vs ibuprofen example would be "is glucosamine as good as or better than the current recommended treatment?" ie have we moved on from use of ibuprofen for symptom management in that case.

                No glucosamine is not "as good as" a NSAID; they are different. I take a daily slow release NSAID (Naproxen) which is a lot easier than taking Ibuprofen four times a day. It also appears to have fewer, or less pronounced side-effects. Unfortunately, it's insufficient for the level of chronic pain I suffer (osteoarthritic).

                As I pointed out elsewhere, ~40% of the population benefit from glucosamine. That benefit is less than the benefit from Naproxen, but the results are additive. That is, I am in less pain when taking both than when taking either alone. Ditto for curcumin. Curcumin has an additional benefit in that it inhibits cancer. See:

                http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/can-turmeric-prevent-bowel-cancer

                Most of the doctors I have been interacting with over the last decade or two refer to the herbals as complementary medicines. That is they are used in conjunction with conventional pharmaceuticals rather than the magic bullet approach favoured until quite recently. In this respect it's not dissimilar to farming where we gave up on magic bullets and looked at using a range of strategies for pest control back in the 1990s.

                The magic bullet approach has a severe problem in that while the magic bullet it works it's all sweetness and light. Then suddenly something in the system changes and the magic bullet fails spectacularly. Targeting a problem with multiple strategies means if one fails you are not left high and dry.

              2. Pompous Git Silver badge

                Re: Alternate and Traditional Medicine

                Another thought that touches back on the quality of products is that if eg glucosamine is accepted as a medicinal treatment, then it needs licensing and suitable distribution as a medicine not flogged from Holland and Barretts as a "supplement" and that moves it into the pharma industry's sphere and it's no longer "alternative medicine".

                The problem here is that registering a pharmaceutical is eyewateringly expensive. Thus registering a product that is already generic only benefits your competitors; your costs go up, but theirs don't. Obviously this didn't apply in the past. We have many registered plant extracts in common use: ephedrine (ephedra), digitalis (foxglove), alliicin (garlic), morphine (opium poppy)... There are more than a hundred.

                The pharmaceutical industry focusses on identifying the active ingredient in the effective plants, then attempts with varying degrees of success to create a variant that they can patent. A problem here is identifying the active ingredient. Plants contain ever so many chemicals and sometimes the pharmacological effect is very likely due to multiple chemicals.

                Then there is the problem of an illegal plant being the only known source of a cure. Cannabis contains two classes of pharmacologically active compounds: cannabinols and cannabinoids. Cannabinols are what creates the stone that hippies (and others) are so fond of. Cannabinoids OTOH are a potent anti-inflammatory and a good friend, a retired anaesthetist, recalls cannabis use in anaesthesia in the UK well into the 1970s.

                Recently, cannabis rich in cannabinoids has been discovered to prevent potentially fatal seizures in juveniles that are not controlled by any known registered pharmaceutical. The Tasmanian government has taken the view that sufferers can await the arrival of registered cannabinoids. The police I am happy to report have taken the view that these children do not deserve to suffer, or die and are pointedly ignoring this unauthorised use.

                A Canadian business recently approached the Tasmanian government for permission to grow and manufacture cannabinoids, but were refused. The reason for choosing Tasmania is that we already produce a great deal of thebaine (raw ingredient for codeine) and have decades of experience in growing Class A drugs and controlling public access. So it goes...

                1. x 7

                  Re: Alternate and Traditional Medicine

                  the annoying thing is this cannabinoid research has been going on for years, and keeps getting cut for no real reason

                  I was selling intermediates for manufacturing such products into R&D companies in California 30 years ago, the end product WORKED (pain killer for end stage cancer) but production was never followed through. Bloody frustrating in all ways

                  1. Pompous Git Silver badge

                    Re: Alternate and Traditional Medicine

                    the annoying thing is this cannabinoid research has been going on for years, and keeps getting cut for no real reason

                    Back in the early 70s we used to have private parties at a hired a venue where we ate gourmet Asian tucker and smoked dope. The gatherings were large enough that had a bust occurred, there would have been insufficient room in the lockup for us all. Our legal advisor ended up as a supreme court judge.

                    The first such event was opened with a speech from one Michael Field. He had just been fired from his position as a teacher for possession and he made two promises. He would become premier of Tasmania and he would legalise dope. He kept the first promise, but alas not the second.

      2. BebopWeBop Silver badge
        Facepalm

        Re: Alternate and Traditional Medicine

        Quite often she will recommend an alternative to the usual products of big pharma because they are usually as effective and often a lot cheaper.

        See point about placebo above. And I suppose though that she knows enough not to dish out St Johns Wort (which does have pharmacological effects - http://www.drugs.com/npp/st-john-s-wort.html) without an appropriate warning.

        1. BebopWeBop Silver badge

          Re: Alternate and Traditional Medicine

          But I suppose that an expensive placebo may well be more effective than a cheap one?

        2. Pompous Git Silver badge

          Re: Alternate and Traditional Medicine

          See point about placebo above. And I suppose though that she knows enough not to dish out St Johns Wort (which does have pharmacological effects - http://www.drugs.com/npp/st-john-s-wort.html) without an appropriate warning.

          Curcumin (herbal): Pharmacology of diferuloyl methane (curcumin), a non-steroidal anti-inflammatory agent*

          http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7158.1973.tb09131.x/abstract

          Glucosamine (herbal): Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee

          http://www.sciencedirect.com/science/article/pii/S106345840580007X

          Omega-3 Fatty Acids -- Current Status in Cardiovascular Medicine

          http://link.springer.com/article/10.2165/00003495-199447030-00003

          et cetera

          Why don't you present some nice empirical evidence that the effects reported at the links above are merely "placebo effect"?

          And yes, she is well-informed about the effects of St John's Wort and many more pharmaceuticals besides. Why do you imply she may not?

      3. Pompous Git Silver badge

        Re: Alternate and Traditional Medicine

        How very odd! When my pharmacist recommends a herbal it's thumbs down. When I recommend the herbal prescribed at the Royal Hobart Hospital (senna) it's thumbs up.

    2. Vic

      Re: Alternate and Traditional Medicine

      Likely to be a placebo

      So what if it is?

      I read a report some while back about drug trials. The problem, apparently, is not proving that the drug is effective - that's easy - it's proving that it is more effective than the placebo...

      Rumyodin was a placebo. That didn't stop it being *incredibly* effective.

      Vic.

  11. Anonymous Coward
    Anonymous Coward

    What's the harm?

    Where to start?

    In this case, plenty.

    1. Pompous Git Silver badge

      Re: What's the harm?

      Of course the alternatives to snake oil, up until the 1960s even, were calomel and arsenic. The pharmacists of the 19th and 20th century dispensed many mercurials, not just calomel. Calomel pills were used in acute and chronic diseases and as a diuretic drug before the organomercurials appeared in the 1920s. Skin diseases were treated with ointments or plasters of the mercurials or quicksilver. Death by calomel poisoning was particularly unpleasant. Teething powder containing calomel wasn't banned in the UK until after I was born. At that time 10% of babies whose mothers administered the teething powder were killed by it.

      The cure for arsenic poisoning was more arsenic. Before Silent Spring makes for an interesting read:

      http://www.amazon.com/Before-Silent-Spring-Pesticides-Princeton/dp/0691618291

      The author doesn't confine himself to the use of arsenic in agriculture; he provides a comprehensive account of its widespread and often injudicious use by the medical profession.

      1. graeme leggett

        Re: What's the harm?

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173747/

        Suggests only 1 in 500 exposed to mercuric teething powders developed Pink disease of which "10-33%" instances were fatal.

  12. figure 11

    Proper cough medicine is easily obtainable

    Gee's linctus is still around, chock full of lovely opium and very effective at suppressing your coughs.

  13. phil dude
    Joke

    no natural compounds please.

    We only want molecules that can be patented, then sold on at huge mark ups....

    Just remember kids, almost* every approved pharmaceutical is the worst pseudo-functional copy of the natural molecule that does the job.

    I should get T-shirts made...

    P.

    *there are actual biologicals (antibodies, enzymes, modified cells) that are really expensive and made of the real biomolecule. But their expense means that a cheaper chemical made version nearly always gets chosen first. And non-human copies are cheaper too...

  14. channel extended

    The best from when I was a lad.

    Was a 50/50 mix of honey and whiskey. After you passed out who cares if you cough?

    1. Michael Thibault

      Re: The best from when I was a lad.

      ObPedant: 'when I were a lad'

      The last thing I remember before the being-unconscious part was laughing. Ah, memories! Sadly, too few of that particular kind.

  15. Pompous Git Silver badge

    Natural versus synthetic

    Interesting conversation with my sister, a nurse with a Masters in neurology. She poses a couple of pertinent questions. We take a magnesium supplement to prevent that most debilitating of old-age tribulations, night-cramps. Magnesium is of course a naturally occurring element. What would a synthetic magnesium atom possess that a naturally occurring one does not? If it's neutron number, the effect will presumably be no different unless it be hormesis from radiation. If the proton number is different, then it's no longer a magnesium atom. If the effect of preventing agonising cramps is the placebo effect, who gives a flying fuck? One no longer suffers agonising pain.

    A similar argument applies to vitamin D3 (calciferol). Both my sister and I are normally deficient in D3 despite being keen gardeners and avoiding the cancer council's stupidity of "Slip, slap, slop"*. We supplement our D3 with capsules of D3-rich fish oil, presumably made from cod livers. Is there really a source od synthetic D3 and is it cheaper than the naturally occurring D3? Why would correcting a D3 deficiency with D3 constitute a "placebo effect"? I know that you can obtain synthetic vitamin D, but that's D2 and far less effective than D3.

    * The Cancer Council in Australia has gone to almost inordinate lengths to discourage children from going out in the sun, and if they do to use the strongest possible sunscreen. The result, as reported by the Menzies Research Centre, has been widespread rickets in Australian and particulalrly Tasmanian children. Here's a paper about D3 supplementation:

    Vitamin D supplementation for improving bone mineral density in children

    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006944/full

    1. Anonymous Coward
      Anonymous Coward

      Re: Natural versus synthetic

      Search on D2 D3 bio-availability and see what you get

      eg http://www.ncbi.nlm.nih.gov/pubmed/24001747

      1. Pompous Git Silver badge

        Re: Natural versus synthetic

        Search on D2 D3 bio-availability and see what you get

        "Vitamin D3 increases the total 25(OH)D concentration more than vitamin D2. Vitamin D2 supplementation was associated with a decrease in 25(OH)D3, which can explain the different effect on total 25(OH)D."

        Why on earth would I want to decrease my D3 levels by taking D2 instead? Are you a complete fucking moron? The sole purpose of taking D3 is to increase the level of D3, not decrease it.

        1. graeme leggett

          Re: Natural versus synthetic

          That one was a test on "healthy volunteers",

          This http://www.ncbi.nlm.nih.gov/pubmed/23386645 is interesting because "Of the adults, 82% were vitamin D insufficient (....) at the start of the study"

          The conclusion of the paper is that " ingestion of 1000 IU vitamin D2 or vitamin D3 for 11 weeks was effective in raising total serum concentrations of 25(OH)D"

          1. Pompous Git Silver badge

            Re: Natural versus synthetic

            The conclusion of the paper is that " ingestion of 1000 IU vitamin D2 or vitamin D3 for 11 weeks was effective in raising total serum concentrations of 25(OH)D"

            Vitamin D2 250 capsules 1,000 IU each $35.95 [250,000 IU)

            Vitamin D3 240 capsules 5,000 IU each $17.15 [1,200,000 IU]

            Purchasing D2 might have a bit of an impact on the effectiveness of the contents of my wallet!

  16. Trygve Henriksen

    The best cough syrup I've used is something pharmacies make and sell here in Norway.

    'Bergensk Brystbalsam' (Bergen Chest balm, or something like that when translated)

    Licorice, honey, Star anise oil, camphor, some sort of alcohol to keep it all dissolved and distilled water.

    1. Arc_Light
      Boffin

      (Ahem)

      ...and the best cough suppressant I've ever used is dark chocolate - the higher the cocoa content, the better. This is because cocoa contains theobromine (caffeine minus an N-methyl, kills dogs, etc., etc.), and theobromine has been shown to work as well as or better than codeine when it comes to cough suppression, without the side effects; the study in question is here:

      https://www.ncbi.nlm.nih.gov/pubmed/15548587

      More work has been done since then (search Pubmed and you'll find it), all of which supports its efficacy. In case you're wondering how much theobromine chocolate could possibly have in it, go here:

      http://ndb.nal.usda.gov/ndb/nutrients/index

      ...select theobromine as the first nutrient (it's the last one on the drop-down list), sort by nutrient content, measure by 100 g (apples-to-apples and all) and see for yourself. Yes, there is enough for this in dark chocolate to really work; there is a reason the scientific name of the cocoa plant is what it is.

      So, if anyone is looking for something natural, effective, and free of nasty side effects, my recommendation is what I refer to as my "medicinal chocolate" (Lindt's 99% cocoa bar or equivalent). It's bitter enough that you avoid the one major side effect, i.e. eating too much chocolate, and it has a much lower vapor pressure than other forms of chocolate, meaning you'll have it when you need it. I've found that sucking on a few squares of that stuff kills my cough for hours. Of course, if you can't stomach this and would instead prefer to go to a lower cocoa content, by all means - just remember, you must eat more of it to get the same effect. This is essential. Essential!

      (You're welcome)

      Arc_Light

      1. Trygve Henriksen

        Re: (Ahem)

        Dark chocolate?

        'Not wanting more chocolate' is classed as a serious side effect...

        I think they sell 80% at a local store...

        (I'll be stocking up, just in case)

  17. Stumpy Pepys

    Alternative cough medicine

    I won't repeat what everyone has already said about placebos and untested medicine. The thing is, though, there isn't really any evidence that the active ingredients of conventional cough medicine—such as dextromorphan—are effective either. The whole cough-medicine industry is essentially built on products that don't work.

    Say what you like about morphine, but it will stop you coughing. :-)

    (To add to the debate, I was once prescribed dihydrocodeine for a back injury and can confirm the constipation was shocking. Marvellous stuff though.)

    1. Richard 81

      Re: Alternative cough medicine

      It's fairly clear that morphine does work though. The problem is the lack of disclosure and regulation.

      If someone's prescribed a morphine based drug, or one that interacts with morphine, and doesn't tell their doctor that they're also taking this then they could find themselves in serious difficulties. Patients often don't think about this when taking "natural" remedies, because they're "natural" so they can't possibly be harmful.

      1. Anonymous Coward
        Anonymous Coward

        Re: Alternative cough medicine

        Spot on!

      2. Pompous Git Silver badge

        Re: Alternative cough medicine

        Patients often don't think about this when taking "natural" remedies, because they're "natural" so they can't possibly be harmful.

        That would be wilful withholding of information here in Australia where it's SOP to ask patients what OTC drugs they take, as well as prescription drugs. And they don't just ask you once, it's many, many times as I have discovered since my heart problems arose seven years ago. I now carry several copies of a written list.

  18. MarthaFarqhar

    http://www.pharmacyfirst.co.uk//index.php?productId=9210&sort_by=relevancy&_a=viewProd was a popular remedy but it seems you can only get it online now as it contains opium tincture.

  19. Joefish
    Paris Hilton

    Probably better for you than modern cough mixture

    Which according to the animations on the TV ads somehow goes down your trachea when swallowed and fills your lungs...

    1. graeme leggett

      Re: Probably better for you than modern cough mixture

      the cheap end of the market for cough mixture is citric acid solution with glycerol etc

      ie a bottled version of honey and lemon.

      I found Haribo (other brands of jelly confectionary are available) sour sweets quite effective when driving.

  20. DouglasB

    Sorry to see a good product pulled

    I've used this cough syrup and it does work. If there is an opioid in it, it must be a trace amount from one of the ingredients. "Full of morphine" in the title, does grab attention but is likely an overstatement. Shame the product is being withdrawn. As implied in the article, it doesn't get you high. Works better than the chemical soups sold OTC, that often don't work, or are determined to cause medical problems a few years down the road. Sorry to see it pulled.

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