Monday, June 21

Coughin’ Your Way Into A Coffin During The Government Shutdown

Several weeks ago, as this “Skeptic’s Column” column is written (14 Jan), I came down over the weekend with my usual annual case of the “cruds”:  stuffy nose, scratchy throat, sinus drainage, etc., etc. No fever, but inside my head, I could hear the wheezing, especially as I lay in bed at night. It sounded like a gunny-sack filled with cats being tortured. (Apologies to cat lovers. I am one. But it sounded like it sounded. So sue me.) Worst of all, I could only log perhaps 2 hours sleep per night. The tortured-cat symphony kept me awake.

So next morning, I hauled my sleep-deprived, zombie-ized, bleary-eyed, Walking Dead carcass into one of those walk-in clinics a couple miles from my house. (My wife drove the car. I did not trust myself.) The doctor on duty took my temp and blood pressure, asked about my symptoms, listened to all relevant body noises, and prescribed a codeine-based cough syrup and some tiny little pearl-like pills that shut down the cough with extreme prejudice. (I had taken both during several bouts with the same virus over the last several winters. They work like garlic on a vampire.) The cough syrup also included an expectorant, i.e., something to encourage my lungs to cough up the gunk that was clogging my airway that caused the coughing and the tortured-cat noises. It worked. I am fine now. In 2 days, except for a nose that was still leaking like Akaka Falls on the Big Island, I was back to normal. But then I got to thinking about that experience, and the prescription meds. I realized that this time, something new was added: the government shutdown. Following are some of the unsettling questions that occurred to me.

o Given that the US government, presumably including the Food and Drug Administration (FDA), was shut down, could I expect that my expectorant would be inspected? If not, could I expect that my expectorant would not be inspected?  Probably, in the interest of safety, it might be best to expect that my expectorant would not be inspected, due to the paucity of expectorant inspectors. So what should I expect from my expectorant if my expectorant had not been inspected by expectorant inspectors? In fact, what can anyone expect from a non-inspected expectorant? What clinical specs should one employ when using a non-inspected expectorant?

o For pregnant women, in the absence of the FDA, what should they expect from a non-inspected expectorant? I.e., if a woman is expecting, what should such an expectant woman expect from her expectorant, regardless of whether her expectorant is inspected or non-inspected? Moreover, that question applies regardless of pregnancy status:  what should any woman expect when she uses a non-inspected expectorant, regardless of whether she is using a non-inspected expectorant or an inspected expectorant, regardless of whether she is expecting or not expecting? What should she expect from her expectorant, expecting or not and whether her expectorant is inspected or not?

o As of the writing of this column, the government shutdown remains in effect. Presumably, that also means that the FDA is not doing its job, at least vis a vis the inspection of expectorants, and that, in consequence, it is not clear when we may realistically expect the expectorant inspectors to return to work and do their legally mandated jobs of inspecting expectorants? (One would think that, given his persistent case of the sniffles, President Trump would have a vested personal interest in assuring the inspection of all cold-related remedies, including the inspection of expectorants, and doing so with all deliberate ... ahem ... speed. At least, if I add-'er-all up, that is the conclusion your Ever-Faithful Skeptic-in-Residence reaches.) What should the public expect regarding the probable return of expectorant inspectors, and what should patients, especially those taking expectorants, expect regarding inspection of expectorants? In particular, would the expectorant-consuming public be justified in expecting that even the most zealous and professionally dedicated expectorant inspectors would only resume work at a pace that could be described as “phlegmatic” … so to speak … as it were? What kind of action would be required, both legally and informally, to induce the FDA to – as it were – cough up predictive statistics about the professional performance of recalled expectorant inspectors? Until those statistics about expectorant inspectors’ efficiency are provided, both the expectorant industry and the Federal government have the expectorant-using public by the throat … as it were. Like any large bureaucracy, the FDA would probably not welcome what it would regard as intrusive demands for transparency. Therefore, it should be made limpidly clear to the FDA -- and I mean all the little "boogers" at the FDA -- that, especially in the matter of the inspection of expectorants, the feeling is "mucus". Anything less stringent? No ... "snot" fair!

o To be sure, most cases of inspected-expectorant deprivation could be expected to be somewhere between non-existent and trivial. But in other cases, more severe cases, the consequences of inspected-expectorant deprivation could be catastrophic:  too much coughin’ can on occasion land one in a coffin. In cases where expectorant deprivation is most extreme. death could be the result. I could easily envision, e.g., Dan Brown or Joan Didion writing a semi-fictitious / semi-historical novel about such an apocalyptic consequence ensuing from protracted use of non-inspected expectorants for a long period of time. Perhaps a working title for such a novel would be Great Expectorations.

But ... wait a minute ... I have a faint memory rattling around in my persistently virus-befuddled mind to the effect that somewhere, someone, sometime, maybe in the middle-1800s, once wrote a long novel with almost exactly that title. Which literary personage could I be thinking of? As Mr. Spock said on a certain Star Trek episode -- "The Devil in the Dark," if memory serves -- "I would prefer to cogitate the possibilities for a time".

But for now, the name of the mystery novelist beats the dickens outta me!

James R. Cowles

Image credits

Sneeze ... McFarlandMo ... CC BY 2.0
Cold remedies ... Pixnio ... Public domain
Cold remedies with Jameson ... John Verive ... CC BY-SA 2.0
Robitussin ... Mike Mozart ... CC BY 2.0
Accidental coughing ... Gabbo ... Creative Commons Attribution-Share Alike 2.0 Generic
Virus photomicrograph ... Pixabay ... Public domain

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