Should DayQuil be legal? - by Eli Richman - The Argument

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Should DayQuil be legal?<br>The combo drug grift is dangerous

Eli Richman<br>Jul 06, 2026

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These Tylenol and DayQuil pills may look different, but their ingredient lists don’t. (Photo by Matthew Healey/MediaNews Group/Boston Herald via Getty Images)<br>If you walk down the cold and flu aisle at CVS and start looking closely at labels, you will count about 100 products and around six active ingredients. This is the meat and potatoes of the over-the-counter drug industry, which specializes in taking three generic medications and two placebos that cost 5 cents each individually and selling the combination product for $35.<br>Take your standard 12-ounce bottle of DayQuil, which costs around $15 at CVS. The entire bottle contains a small amount of acetaminophen (Tylenol) and two other ingredients that are supposed to help with your cough and congestion — dextromethorphan and phenylephrine — but in reality do nothing.<br>Most studies have found that dextromethorphan performs the same as a placebo and some suggested it was worse than honey. Oral phenylephrine is so ineffective that the Food and Drug Administration (FDA) proposed removing it from the market — it is now nearly three years into the glacial regulatory process of actually doing so.<br>So the only ingredient that’s doing anything in that bottle of DayQuil makes up just 2% of the bottle: the roughly 8 grams of acetaminophen, which separately would run you about 16 cents at Costco. Even if you opted for the $10 store-brand version of DayQuil, that’s more than a 6,000% markup rate.<br>Share<br>Nearly every product in the cold and flu aisle is like this, as are many in quite a few other aisles.<br>Now, in some ways, this resembles other industries; consumers pay through the nose for convenience all the time. How is this any different from customers paying a markup for a fruit salad at the grocery store?<br>Well, the analogy breaks down along three lines:<br>Grocery store customers typically pay four to 12 times as much for precut fruit as they would for the same quantity of unprepared fruit. That’s a lot, but still a far cry from 60 to 100 times more.

Most of the fruit you get in a fruit salad actually is fruit, rather than, say, fruit-shaped rocks. But many of the active ingredients you get in these combo drugs don’t do anything helpful.

No one is going to the hospital because they ate too much melon. But combo drugs are huge contributors to unintentional overdoses.

The placebos hiding in your medicine cabinet

DayQuil is hardly alone in packaging placebos in its products. The ineffective dextromethorphan is in all sorts of cough medication, from Robitussin to certain Tylenol and Mucinex formulations. You’ll also find lots of cough medication with guaifenesin, which has similarly thin scientific backing.<br>But the biggest offender, by far, is oral phenylephrine, which we can find in many combos besides DayQuil. Not only is the FDA clear-eyed about its ineffectiveness, the drug’s manufacturer is using it to actively mislead consumers.

Historically, Sudafed has contained pseudoephedrine, the wonder drug equally good at clearing congestion and making crystal meth. That Breaking Bad association meant that even though it was an over-the-counter drug, to get it, you had to talk to a pharmacist and give them your name, fingerprints, Social Security number, and custody of your firstborn child. This type of red tape ate into Big Pharma’s profit margins.<br>So what’s a struggling multibillion-dollar pharmaceutical company to do? Well, if you’re Sudafed, you find a placebo that sounds a little like pseudoephedrine, give it a practically identical name and branding campaign, put it on the shelf with the rest of the cold and flu drugs, and watch the dollars flow in.

Corporate needs you to find the difference between this picture and this picture. (Source: Sudafed)<br>“It is one of the most egregious examples of stupidity in the whole world of over-the-counter combination pills,” said Dr. Jerry Avorn, drug policy researcher at Harvard and author of the recent book Rethinking Medications.<br>Avorn is especially frustrated with the industry’s role in keeping phenylephrine on the shelf: “The pushback of the over-the-counter drug industry against obvious scientific data that this stuff is useless, and the FDA’s repeated inability to get it out of pills, is just one of the more astonishing examples of how over-the-counter drugs and science often have nothing to do with each other.”<br>The FDA is supposed to evaluate a potential drug for both effectiveness and safety before allowing a drugmaker to bring it to market. But that process has broken down over the last 40-odd years.1<br>Seeing new drugs come to market is, of course, very exciting — particularly if they promise to help patients suffering from diseases for which we do not already have good treatments. But that promise can only be fulfilled if the drugs actually work. And...