GoKawiilThese Tylenol and DayQuil pills may look different, but their ingredient lists don’t. (Photo by Matthew Healey/MediaNews Group/Boston Herald via Getty Images)
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.
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.
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.
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.
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Nearly every product in the cold and flu aisle is like this, as are many in quite a few other aisles.
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?
Well, the analogy breaks down along three lines:
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.
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