Details

Written by: Lucas A. Berenbrok, University of Pittsburgh; Colleen Culley, University of Pittsburgh, and Karen Steinmetz Pater, University of Pittsburgh

Published: 30 October 2023

 

The ramp-up to cold and flu season is a bad time for consumers to learn that some of their most trusted go-to products don’t actually work.

An advisory committee to the U.S. Food and Drug Administration concluded unanimously in September 2023 that phenylephrine – an active ingredient found in popular over-the-counter cough and cold products such as Sudafed PE, Theraflu and NyQuil Severe Cold and Flu – works no better than a placebo when taken orally. The 2023 FDA advisory panel met to review growing evidence that oral phenylephrine is an ineffective treatment for nasal congestion. The committee did not review the effectiveness of phenylephrine nasal spray.

In response, CVS, one of the largest pharmacy chains in America, announced that they will no longer sell products that contain oral phenylephrine as the only active ingredient in its community pharmacies.

To the millions of Americans who will suffer from colds with stuffy noses this fall and winter – many of whom have used products containing phenylephrine for years – the panel’s decision may be startling.

Consumers are likely wondering whether they should stop using over-the-counter products containing phenylephrine, whether the products will still be on the shelves this winter and what other options they might have. Consumers may also question whether combination cough, cold and flu products will still be safe and effective for use at home.

As the FDA considers the advisory committee’s conclusions, oral phenylephrine will still likely be sold at many pharmacies despite the fact that more effective nonprescription medications and nonmedication approaches to relieve congestion exist.

As pharmacists who are focused on patient care in local communities, we have some advice on what to do when you need relief from cold and flu symptoms.

The backstory

As of fall 2023, phenylephrine is listed as the sole active ingredient, or as one of the active ingredients, in thousands of over-the-counter products, including tablets, liquids, nasal sprays, gels and ointments.

The medication, when taken as an oral tablet, oral liquid or nasal spray, has long been used for the temporary relief of sinus or nasal congestion from the common cold or seasonal allergies. Phenylephrine has been the only oral decongestant on pharmacy and grocery store shelves since another popular decongestant, pseudoephedrine, became more regulated and went behind the counter in 2006.

The most recent analysis is not the first time an FDA advisory panel has scrutinized oral phenylephrine. A 2007 panel examining its use concluded that more studies were needed to make a final decision regarding the effectiveness of phenylephrine.

Additional studies since then showed no difference in efficacy between phenylephrine and a placebo, likely because phenylephrine taken by mouth is inactivated in the gut.

Safety concerns

No safety issues with oral phenylephrine alone were documented in the 2023 advisory panel conclusion. However, researchers and advisory panel members have raised concerns about the possibility of products containing ineffective phenylephrine remaining on pharmacy shelves.

Even if oral phenylephrine is safe, taking an ineffective medication could cause consumers to spend money on products that work no better than a placebo. A placebo effect is a well-known phenomenon in which people taking an inactive product may perceive benefit. The placebo tablets used in the phenylephrine studies were the same or similar shape and color as the phenylephrine tablets but without the active ingredient.

The panel also noted the missed opportunities for pharmacists to recommend something more effective for nasal congestion if phenylephrine remains commercially available.

Despite the advisory committee’s conclusions, no official action has been taken by the FDA as of late October 2023. If the agency proposes a change in the availability of phenylephrine, consumers will be asked to weigh in prior to a final ruling.

The story behind pseudoephedrine

Luckily, the nonprescription oral nasal decongestant pseudoephedrine – which is known to be effective – has been commercially available for many years. This drug is available as a single ingredient product or in combination with other ingredients in products marketed to treat sinus congestion.

Pseudoephedrine is a nasal decongestant that is taken by mouth to relieve a stuffy nose. It works by constricting the blood vessels that become enlarged as a result of a cold, flu or seasonal allergies.

But buying products containing pseudoephedrine is not as straightforward as it sounds. Because pseudoephedrine can be used to manufacture the street drug methamphetamine, the FDA requires that it be sold behind the counter and in limited amounts each day and month. It also requires photo identification at the point of sale.

If the FDA acts on the advisory committee’s conclusions that oral phenylephrine is not an effective nasal decongestant, pseudoephedrine may be the only remaining oral medication available without a prescription to treat nasal congestion. Here are some things to know about pseudoephedrine:

• Pseudoephedrine should not be used in doses higher than those that are recommended on the label. Use of products containing pseudoephedrine should be stopped and a health care provider consulted if dizziness, nervousness or sleeplessness occurs.

• Pseudoephedrine should not be used by consumers with heart disease, high blood pressure, thyroid disease, diabetes or an enlarged prostate without talking with a health care provider like a pharmacist or a physician.

• Products with pseudoephedrine should not be used while taking, or within two weeks of stopping, a prescription monoamine oxidase inhibitor, which is most commonly used to treat for depression or Parkinson’s disease.

Other treatments

In addition to oral pseudoephedrine, medicated nasal sprays – including those containing phenylephrine or oxymetazoline as active ingredients – can also relieve nasal congestion. These products are sold under the brand name Afrin and others.

However, medications are not the only way to relieve congestion. Some non-drug approaches include hot, steamy showers, safe use of neti pots, vaporizers or humidifiers, saline nasal spray and applying a warm, moist washcloth to the face. All of these non-drug approaches can help sooth the nasal passage to provide temporary relief from congestion. If symptoms of congestion continue for more than two weeks, or if signs of an infection arise, go see your doctor.

Since products containing oral phenylephrine will remain on the market for the time being, it is critical for consumers to read the labels of over-the-counter products and review the active ingredients and their risks.

You should talk with your pharmacist about your symptoms, medical conditions and the other medications you’re taking prior to purchasing any over-the-counter product. Your pharmacist will help you determine if your symptoms can be managed with self-care or if you need to see a physician.

Lucas A. Berenbrok, Associate Professor of Pharmacy and Therapeutics, University of Pittsburgh; Colleen Culley, Associate Professor of Pharmacy, University of Pittsburgh, and Karen Steinmetz Pater, Associate Professor of Pharmacy, University of Pittsburgh

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Details

Written by: Angela De Palma-Dow

Published: 29 October 2023

Dear Lady of the Lake,

Do you have any spooky or scary stories to tell about Lakes or Clear Lake? It’s the season, afterall. Thank you for your column!

— Looking for Lake Lore Laura


Dear Laura,

Thank you for reaching out about this! It is the spooky season and it's a great time to share stories and haunted legends about lakes. Unfortunately, I don’t yet have a library on haunted stories about Clear Lake, but I am compiling that list with the help of some local friends!

First I will describe some of the science behind water, and why, in its basic elemental form, it has so much perceived potential to be linked to the paranormal. This column will merge the science with the spiritual, if you will. Feel free to explore more of the science on your own, and take what you want of the spiritual, if you believe in that sort of thing, of course.

Water and energy

You may have heard many things that refer to water as special, in particular, the water molecule is unique. It is polar, meaning it has both negative (oxygen atom) and positive (hydrogen atoms) charges, and due to this polarity water molecules can bond strongly with other polar molecules, including other waters.

Water is so strongly attached to itself that it can dissolve substances like sugars and salts. That’s a main reason why it’s so valuable to human, animal, and plant metabolisms - the water molecules can dissolve and bind needed nutrients and mobilize them through blood and plant tissues.

When water moves from state to state, energy becomes released or absorbed, which can influence the environment directly in the vicinity of the water. Think of humidity and warmth when water is heated.

Because a water molecule is so strongly attached to itself, it’s very hard to break apart, and requires a high boiling point to change from a liquid to a gas. During this process, the water bonds are broken and free oxygen and hydrogen atoms are released into the atmosphere as steam. This is related to the specific heat of water.

Specific heat is defined as the amount of heat needed to increase 1 gram 1 degree Celsius. How much heat it takes to heat one degree is also called heat capacity with good reason. It takes a lot of energy to break these bonds and heat water to a change of state. Anyone who has boiled a pot of water on an old, electric stove top knows, it takes a lot of time and energy to heat water to 100 degrees Celsius or boiling!

In contrast, the forming of bonds releases energy. The cooling and condensation of steam creates water, forms the water molecule, which releases energy such as heat. Maybe this is why cool damp places are known to have higher spooky, haunted activity, because the ongoing condensation condition provides ample excess energy for spirits to tap into? Maybe?

Since it takes so much energy to heat water, water is known to hold heat very well, and is rather stable to changing temperatures. That’s why during the first few cold weeks of the fall or winter season, the lake is still relatively warm in temperature, compared to the air.

When the water surface is warmer than the air, the water evaporates and as it cools in the air, it condenses and turns into fog droplets. This cycle will continue until the day temperatures have warmed to match the surface water temps or, in some parts of the Country, the lake freezes over.

This fog layer, called steam fog, when combined with turbulent winds that push across the water, produce whirling, spiraling, steam or fog devils (similar to dust devils).

What a perfect scene, this eerie, misty fog that settles during autumn over lakes, making spectral and mysterious stories of the deep that much more believable!

Energy of water and potential for paranormal

So we learned that water contains energy, and it either releases or absorbs energy when changing the state of water.

This ties into the first law of thermodynamics that energy can neither be created nor destroyed, so if water holds energy, and there is a change of state that releases that energy, then that energy has to go somewhere. Here enters the theory that the energy contained in water helps to serve as a conduit for the paranormal activity. With the science explained, we can see how and why water has been used to emphasize and accentuate stories of the unexplained.

Additional theories suggest that mineral waters, which are salts dissolved in water, act as an electric conduit, making the movement and mobilization of “spiritual” energy easier, much like electrical energy or electrical conductivity. But does the idea of salted water being a paranormal pathway really hold water?

Think the Bermuda triangle, the area between the island of Bermuda, Miami,FL and San Jaun, Puerto Rico, which is responsible for an unusually large number of unexplained disappearances of ships and planes. In the ocean, there are many myths and legends about ghost ships, sunken and lost cities, haunting singing sirens, and sailors who saw mythical creatures, while at sea.

Is this the result of water as a conduit to another ghostly world due to its special, chemical properties? Or just fantastical fiction because the larger and darker a body of water, the more spooky space our imaginations can travel? I will let you decide.

Should you need more explanation about the physics about ghosts being able, or not being able to, use the energy around us, I would strongly suggest this blog post by Pancake Gravy on “The Thermodynamics of Ghost Hunting.” Very well written, scientifically prudent, and interesting. Full disclosure and warning, warning you, it is maximum level nerd-fodder. 

Spiritual and Healing properties of water

Of course water has been associated with positive, spiritual healing acoss space and time, among practically every culture that has existed near a hot, or healing spring. In addition to the need for freshwater for drinking and cooking, indigenous cultures around the world, from the Maori on New Zealand’s Lake Rotorua, to the Greenlandic Inuits and Dasko Island, and tribes throughout North and South America, all held hot springs in high regard and relied on them for spiritual and domestic purposes.

Healing springs are even a staple of past and current Lake County tourism! In western civilization, the tales around healing springs included the idea that ailments, illnesses, sicknesses, even human disabilities like blindness, could be healed simply by visiting and dipping in the blessed water believed to be magic, or containing special properties to heal.

At the time, the healing properties of springs were considered magic, or a gift from god, or a higher, divine force. Of course now we know that there were many logical reasons that people felt healed and healthier after indulging in the springs.

Usually hot or cold healing springs were located in remote rural or mountain locations, or desert retreats. Once people left the crowded, cramped, urban areas, they were less likely to share germs, or breathe in stuffy air that was congested with oil and wood smoke from the indoor burning of candles and fires. Anyone would undoubtedly feel better after leaving that environment, even if you had to endure a 6 week wagon or buggy ride!

Additionally, the water sources from these springs, usually artisan, were filtered after percolating through the ground and were not contaminated by human or animal feces, as most the surface and well water sources near busy urban centers were before proper water sanitation treatments were employed.

Another thing to consider is that usually springs, and hot springs more often, contain sulfur, salts and other minerals. Hot springs improve many functions of the human condition, including increased circulation, improve blood flow, softens and exfoliates skin, and the antifungal and antibacterial properties of hot springs mineral waters would help to rid the body of any lice, parasites, and skin irritations.

Before bathtubs and showers were in every house, most people didn’t bathe that often, so a deep, rejuvenating warm bath that lasted over a week or month-long visit at the hot springs obviously did wonders to improve the general health of the visitors.

Today, we still can see, and feel, the health benefits, from a good hot spring treatment, and some even use cold plunges as a way to improve inflammation and muscle soreness, among other benefits.

Haunted Lakes and other bodies of water

Now that we have investigated the science behind water, and how it might, or might not, be associated with paranormal activities, I wanted to share three small stories about haunted lakes and water bodies.

Lake Morena, the most remote reservoir in San Diego County, is reportedly the most haunted lake in California. Part of the San Diego County Park System, is a family-friendly location for camping, boating, fishing, and hiking. The hauntings include campers hearing footsteps outside their cabins and tents, but not discovering any prints the next morning and floating apparitions of babies in white gowns.

Theories suggest that the spirits are angry villagers that were killed during the floods of 1916 because of Charles Hatfield, or the “Rainmaker” activities. This connection might be a stretch, but regardless, the legends and stories of Lake Morena live on and continue to this day.

This next one, The Brookdale Lodge, is not about a lake, but about a hotel in the Santa Cruz mountains that is famous for being built on top of a bubbling brook. Perhaps the constantly flowing creek water provides the spirits the energy they need to give this location as one of the most haunted hotels in California.

The Brook Room was built around the bubbling Clear Creek, which apparently is the only one like it in the world. Apparently, a previous owners niece died by falling into the stream, and several other reported deaths on the property contribute to the activity and stories. <>

The Lodge is also famous for visiting celebrity guests such as Herbert Hoover, Marilyn Monroe, James Dean, and others. Could the stream, with its continuous flow of ambiance and energy be helping the spirits live on at Brookdale?

Santa Cruz isn’t too far a drive from Lake County, perhaps one day we will find out.

The last story I will share is about Lake Tahoe. This story is sourced from the Haunted Lakes book by E.S. Evans even though there are apparently many myths and legends about our deep sister lake to the east.

The haunted story is really quite sad, about Lotta Crabtree and her husband John, who were deeply in love and lived on Lake Tahoe. One day John never came home and Lotta spent the rest of her life searching for him, until she passed on. The haunting stories usually involve a woman in white on the shores of the Lake looking for someone. Could this spirit be Lotta looking for her lost love?

Of note: When I searched for “Actress Lotta Crabtree” on wikipedia, it reported she never married and died in Boston in 1924.

So, Laura, I hope you have enjoyed some of the science behind scary water and these few lake lore and water-centric ghost stories. As I mentioned, I am building up my haunted tales for Clear Lake which I hope to be able to share with you in future years during this very chilling time of year.

Sincerely,

Lady of the Lake

Angela De Palma-Dow is a limnologist (limnology = study of fresh inland waters) who lives and works in Lake County. Born in Northern California, she has a Master of Science from Michigan State University. She is a Certified Lake Manager from the North American Lake Management Society, or NALMS, and she is the current president/chair of the California chapter of the Society for Freshwater Science. She can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it.. 

Details

Written by: NATIONAL OCEANIC AND ATMOSPHERIC ORGANIZATION

Published: 29 October 2023

This year, El Nino is in place heading into winter for the first time in four years, driving the outlook for warmer-than-average temperatures for the northern tier of the continental United States, according to NOAA’s U.S. Winter Outlook released by the Climate Prediction Center — a division of the National Weather Service.

“These outlooks provide critical guidance on the upcoming season for many industries and sectors of our economy, from energy producers to commodities markets to agricultural interests to tourism,” said Sarah Kapnick, Ph.D., NOAA chief scientist. “With a strengthening El Nino and more potential climate extremes in an already record-breaking year, we’re lucky to have scientists like those at the Climate Prediction Center helping to build a Weather and Climate-Ready Nation by providing critical operational seasonal climate predictions.”

From December through February, NOAA predicts wetter-than-average conditions for northern Alaska, portions of the West, the southern Plains, Southeast, Gulf Coast and lower mid-Atlantic and drier-than-average conditions across the northern tier of the U.S., especially in the northern Rockies and High Plains and near the Great Lakes.

“An enhanced southern jet stream and associated moisture often present during strong El Nino events supports high odds for above-average precipitation for the Gulf Coast, lower Mississippi Valley and Southeast states this winter,” said Jon Gottschalck, chief of the Operational Prediction Branch of the Climate Prediction Center.

NOAA forecasters, in collaboration with the National Integrated Drought Information System (NIDIS), continue to monitor extreme, ongoing drought conditions that have persisted through the southern and central U.S. and worsening drought in Hawaii.

“According to the Oct. 17 U.S. Drought Monitor, a third of the country, including Puerto Rico, is in drought,” said Brad Pugh, operational drought lead with NOAA’s Climate Prediction Center. “During late October, heavy precipitation is likely to result in drought improvement for the central U.S. El Nino with its enhanced precipitation is expected to provide drought relief to the southern U.S. during the next few months.”

Temperature

• Warmer-than-average temperatures are favored across the northern tier of the U.S. and much of the Far West.
• The greatest odds for warmer-than-average conditions are in Alaska, the Pacific Northwest and northern New England.
• Near-normal seasonal mean temperatures are most likely for a region from the south-central Rockies to the southern Plains.
• Remaining areas fall into the category of equal chances for below-, near-, or above-average seasonal mean temperatures.

Precipitation

• Wetter-than-average conditions are most likely in northern Alaska, some areas of the West from parts of California to the south-central Rockies, the southern Plains, Gulf Coast, Southeast and lower mid-Atlantic.
• The greatest odds for drier-than-average conditions are forecast in portions of the northern Rockies and central Great Lakes region, especially for Michigan and northern Ohio and Indiana.
• Much of the central portion of the U.S. falls into the category of equal chances for below-, near-, or above-average seasonal total precipitation.

Drought

• Widespread extreme to exceptional drought continues to persist across much of the South, and portions of the central U.S.
• Drought conditions are expected to improve across the Southeast, the Gulf Coast (including the lower Mississippi Valley), and Texas due to the expected wetter-than-average forecast.
• Drought conditions are expected to persist for the northern Rockies, northern Great Plains, and portions of the desert Southwest this winter.
• Drought development could occur in the interior Pacific Northwest given the chance for drier-than-average conditions.
• Drought is likely to persist or develop across Hawaii.

About NOAA's seasonal outlooks

NOAA’s seasonal outlooks provide the likelihood that temperatures and total precipitation amounts will be above-, near- or below-average, and how drought conditions are anticipated to change in the months ahead. The outlook does not project seasonal snowfall accumulations as snow forecasts are generally not predictable more than a week in advance.

NOAA’s Climate Prediction Center updates the three-month outlook each month. The next update will be available Nov. 16.

Seasonal outlooks help communities prepare for what is likely to come in the months ahead and minimize weather's impacts on lives and livelihoods. Resources such as drought.gov and climate.gov provide comprehensive tools to better understand and plan for climate-driven hazards. Empowering people with actionable forecasts, seasonal predictions and winter weather safety tips is key to NOAA’s effort to build a more Weather- and Climate-Ready Nation.

Winter forecasting tools: Here’s what’s new at NOAA this year

This winter, NOAA will implement a series of upgrades and improvements. In November, the experimental Probabilistic Winter Storm Severity Index (WSSI-P) will become operational.

The product will enhance communication with external partners, media and the general public by graphically depicting the likelihood of potential societal impacts due to expected winter hazards over a 7-day period.

This is complemented by a version of the Winter Storm Severity Index (WSSI) based on the official National Weather Service forecast of the most likely conditions over the next three days.

NOAA’s Weather Prediction and Climate Prediction Centers will continue to use Winter Key Messages, which highlight the agency’s most essential information for upcoming winter weather, including extreme cold and heavy snow potential. These can be found under “Top Stories” on the Weather Prediction Center’s and Climate Prediction Center’s websites.

This winter, NOAA will complete its implementation of Impact-Based Warning Tags for Snow Squall Warnings. Snow Squall Warnings are warnings issued for short duration intense bursts of snow and wind leading to whiteout visibility and possible flash freezes on roads.

To distinguish high-impact snow squalls, the National Weather Service will issue impact-based Snow Squall Warnings using the “Significant” tag for events that pose a substantial threat to safe travel.

Wireless Emergency Alerts, emergency messages sent by authorized government alerting authorities through wireless carriers, will be limited to only high-impact Snow Squall Warnings with the Snow Squall Impact Tag of “Significant.”