Americans expect things to work. A car should start every time with a turn of the key or a push of a button. If the Internet goes down, they get upset. When an ATM doesn’t work, it’s an outrage.

Why don’t people demand the same reliability from the health care system? Most people assume that pharmaceuticals and other health interventions work just like flipping a light switch.

Over many decades, Americans have spent billions of dollars on multi-symptom cough and cold remedies to relieve nasal congestion. These include some very familiar and popular brand name products like Sudafed PE, Advil Sinus Congestion & Pain, and Mucinex Sinus Max.

The ingredient that was supposed to ease breathing was phenylephrine. Last year, the Food and Drug Administration admitted that oral phenylephrine is not an effective decongestant. It proposed removing this compound from most over-the-counter products.

Scientists have known that oral phenylephrine is ineffective as a decongestant for decades. Consumer Reports published a negative evaluation of this drug more than 50 years ago. Despite this and other evidence, the FDA dawdled, and Americans spent money on questionable products.

Another example of a compound that may be less effective than people imagine might be fluoride added to water. Most people believe that fluoridated tap water protects people from cavities. It does, but the level of protection is surprisingly low.

The Cochrane Collaboration consists of independent health care experts working as volunteers to assess the benefits and risks of health interventions. In October 2024, this respected organization published its latest evaluation of community fluoridated water (CWF).

The researchers found “a difference in dmft [decayed, missing or filled teeth] of approximately one-quarter of a tooth in favor of CWF: This effect estimate includes the possibility of benefit and no benefit” (Cochrane Database of Systematic Reviews, Oct. 4, 2024). We suspect that most Americans believe fluoridated water is much more effective than that.

In another arena, people with high cholesterol are often prescribed a statin-type cholesterol-lowering medication. The most popular is atorvastatin (Lipitor). At last count, about 28 million Americans were taking this drug. The expectation is that this drug will prevent a lot of heart attacks and save millions of lives.

Years ago, when Lipitor was a best-selling brand name drug, the manufacturer ran ads that stated, “In patients with multiple risk factors for heart disease, Lipitor reduces risk of heart attack by 36%*.” We suspect that many people took that to mean that 36 people out of 100 taking Lipitor would avoid a heart attack they would otherwise have suffered. However, a few readers might have checked the asterisk. In small print at the bottom of the page, the ad stated: “That means in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor.” That’s a lot less impressive.

The take-home message of these examples — phenylephrine, fluoride in water, and statins to prevent first heart attacks — is to be better informed about the actual efficacy of anything you put in your body. Health care professionals have a responsibility to be completely transparent about both benefits and risks. Patients should request details that will help them make a realistic assessment of whether or not a particular therapy will help them stay healthy.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com.