What were the three solas that Luther spoke about?

There were three famous "solas" (Latin word for "only") that Martin Luther coined, which ultimately sparked the Reformation. Here they are below, as well as a description of each:

1. Sola Gratia ("only by grace alone"): Luther read scripture verses such as Ephesians 2:8 ("For it is by grace you have been saved..." ESV) and came to believe that it is only through God's grace, not any works a person can do, that salvation is accomplished. One must rely on God's free and infinite grace for his salvation and must not try to add to it through good deeds, giving money, etc.

2. Sola Fide ("only through faith alone"): Luther furthermore believed whole-heartedly that salvation only comes through a person's faith in God. He came to believe this through continuing to read Ephesians 2:8, “For by grace you have been saved through faith. And this is not your own doing; it is the gift of God, not a result of works, so that no one may boast" (ESV). He argued that God's great grace saves sinners, in conjunction with the faith that He also provides. 

3. Sola Scriptura ("only through the Scriptures alone"): Finally, Luther was a strong advocate of the idea that to understand God's grace and to have faith in Him, the common person must be able to have access to God's Word, the Bible. During a time when only the priests and religious teachers could read the Scriptures, Luther, along with other reformers, believed the common man must be able to hear the Word of God in his own language and understand it for himself. He noted verses like 2 Timothy 3:16 which states, "All Scripture is breathed out by God and is profitable for teaching, reproof, for correction, and for training in righteousness" (ESV). Therefore, since every part of Scripture is God's Word, then the common man must be able to hear and understand it to have faith in God. 

How is George Orwell's Animal Farm a satire of the Russian Revolution?

Looking at the characters in Animal Farm is important in understanding how the book satirizes the Russian Revolution. Orwell has deliberately created characters who are based on real figures from the Revolution and we can see this from the very beginning. Old Major, for example, who makes his stirring speech to the animals in Chapter One is based on Karl Marx, the revolutionary thinker and economist. Notice how the pigs transform the content of Old Major's speech into a social system called Animalism. This is a satire of Communism, the system created by Karl Marx which emphasises the exploitation of the working classes and argues that a revolution is the only way to bring about social and economic equality.

Similarly, consider the character of Snowball. One of the leaders of the Rebellion, Snowball is based on Leon Trotksy, a major figure in the Russian Revolution. Just like Trotsky, Snowball provided the ideological framework of the Rebellion. Moreover, his conflict with Napoleon mirrors that of Trotsky with Stalin. Trotsky was expelled from the Soviet Union by Stalin, just like Snowball was run off the farm by Napoleon after he declared his plans for the windmill. 

What does the change in election results suggest about how American society has been altered because of Eckels's error? Is it believable that...

What Eckels's action shows is that one small change can have huge consequences.  The change in the election outcome shows the reader that something as seemingly mundane as a single butterfly death can change the very organizational structure of a country.  

Regarding your second question of whether or not I believe something like that could happen, yes, I believe that it could happen.  What Bradbury builds a fun story around is the concept of "The Butterfly Effect."  It basically says that one small change can have huge impacts on a lot of other things.  

Interestingly, Bradbury is not the man credited with coining this idea.  That recognition goes to Edward Lorenz.  He was a meteorologist in the mid 1900's.  Like all meteorologists, he was working with various weather models and changing data sets to see their effects.  In one such simulation, he changed a minuscule amount of data and discovered that the weather outcome was completely different than the original.  Lorenz then made the interesting connection that a single flap of a butterfly wing could potentially change the outcome of an entire weather system.  He called it "The Butterfly Effect," and the name stuck.

His data driven model supports the idea that small changes can equate to massive changes later.  That's Bradbury's story, so yes, I believe Eckels's actions could have had the narrative results.   

What are emotions?

Introduction

Over the centuries, philosophers, psychologists, and other scholars have debated the nature of emotions, offering a wide range of perspectives and theories. This debate addresses many issues, including basic questions such as why people have emotions and what their function is. Advances in neuroscience have led scientists to attempt to determine the parts of the brain involved in experiencing emotions. Child developmental psychologists address how young children understand others’ emotions, and cognitive psychologists examine how emotion affects memory. Anthropologists and social psychologists investigate whether there are cultural differences in how people experience emotions.

Reasons for Emotions

According to the English naturalist Charles Darwin
and his theory of evolution, one reason people have emotions is because of natural selection. Emotions exist because they enhance the chance of surviving and reproducing. For example, when a deer senses another animal, it reacts with fear and freezes. This reduces its chance of being attacked because animals usually attack in response to motion. When a person freezes in response to a car whizzing by, the fear response may act to save the person’s life. More generally, Dutch psychologist Nico Fridja suggests that emotions are a response to situations in which people need to do something. For example, a negative emotion suggests that something is wrong in the immediate situation and that the person must act to change the situation.

Expressions of emotions also play an important role in communicating information to others. Most people learn to read the expressions of others, infer their emotions, and monitor their behavior as a result. For example, if a person is arguing with someone who begins to raise his or her upper eyelids and show an open, “square” mouth revealing teeth (signs of aggression), then it may be time to end the argument. Nonhuman animals also communicate with emotional expressions, as documented by Darwin. For example, American psychologist Robert Plutchik described a common expression of a cat who has encountered an animal such as a threatening dog. The cat opens its incisors, pulls back its ears, erects the hair on its body, arches its back, and hisses. This expression indicates a mixture of fear and anger, signaling that it may attack the dog and making the cat look larger and more ferocious. As a result, the cat’s emotional expression has adaptive value, as it decreases the chance of its being attacked, which increases the cat’s chances of survival and reproduction. This type of emotional expression is shown by many species of animals. Plutchik notes that humans display a similar emotional expression, in which an increase in apparent size is achieved by expansion of the chest, thrusting the head forward, standing more erect, and sometimes by erection of the hair.

Despite these positive aspects of emotions, a large body of research suggests that emotions interfere with rational decision making by affecting people’s thinking and motivation. However, American psychologists DouglasMedin and Arthur Markman note that some research suggests that emotions play a positive role in decision making. As an example, they describe the research of Portuguese neurologist Antonio Damasio, who suggests that anticipatory somatic feedback (for example, skin conductance response) is necessary for good decision making. He and his colleagues studied patients with damage to their prefrontal cortex (the part of the brain that plays an important role in reasoning, memory, and decision making). These patients, unlike people without such damage, never develop anticipatory skin conductance responses when evaluating risky decisions.

Damasio and his colleagues gave a gambling task to these patients. They were allowed to choose cards from four decks, A, B, C, and D. Choosing either deck A or B resulted in winning one hundred points. However, choosing either deck C or D resulted in winning only fifty points. (Points were converted into play money.) However, every once in a while, the selection of any deck would result in a loss (with deck A or B yielding a loss twice as great as deck C or D). Over the course of the gambling task, choosing from decks C and D yielded more points than choosing from decks A and B. Normal patients were initially attracted to the large number of points provided by decks A and B, but after experiencing “ punishments,” they tended to choose from decks C and D, which provided more points in the long term (over the course of the gambling task). However, patients with prefrontal damage tended to choose from decks A and B more often than from decks C and D. Further studies revealed that prefrontal patients performed poorly on these gambling tasks because they were not sensitive to anticipatory somatic feedback. Furthermore, the prefrontal patients had normal intelligence quotients (IQs) and should have been able to figure out the relative likelihood of the wins and losses in the different decks. Markman and Medin concluded that while emotion may sometimes hinder the making of rational choices, emotions are also sometimes important in correctly evaluating those choices.

Defining Emotions

By trying to understand the differences between emotions and similar concepts such as moods, sensations, temperament, and surprise, researchers can obtain a better understanding of emotions. For example, American psychologist Jeff Larsen and his colleagues suggest that moods tend to be enduring and diffuse, whereas emotions tend to be short-lived and directed at particular objects or situations. English clinical psychologists Mick Power and Tim Dagleish also suggest that moods influence emotions. For instance, a father in a happy mood might not become angry toward his child for dropping her ice-cream cone. However, if the father was in an angry mood, he might become angry.

Temperament is more enduring than either emotions or moods, as it is a personality characteristic or trait of a person. Therefore, an angry type of person may become easily upset in many situations in which a happy person would not become upset.

Researchers have argued that surprise is not an emotion. For example, American psychologists Andrew Ortony and Terence Turner note that emotions are characterized by valenced states (positive or negative feelings). However, they point out that surprise is not defined by a valenced state: A person can be surprised about winning a huge prize (a positive feeling), or surprised about the failure of his or her brand-new car to start in the morning (a negative feeling), or be surprised by some highly improbable but personally irrelevant fact such as that all the members of some committee, by chance, share the same birthday (a neutral feeling).

Basic Emotions

Many theories of emotions assume that a small set of basic or fundamental emotions exist. Ortony and Turner suggest a number of reasons why this might be true. Some emotions appear to exist in all cultures and in some nonhuman animals. They also seem universally recognizable by characteristic facial expressions. There might also be a set of basic emotions with biological functions that are particularly important to the survival of the individual and of the species. Finally, some researchers believe that there may be many emotions. If there is a small set of basic emotions, then researchers may be able to understand the larger set of emotions by using the basic emotions as building blocks for constructing nonbasic emotions.

As evidence for the existence of basic emotions, Power and Dagleish cite American psychologist Paul Ekman, who noted that every proponent of the existence of basic emotions who has conducted investigations has obtained evidence for six basic emotions: happiness, surprise, fear, sadness, anger, and disgust (though Ortony and others argue that surprise is not an emotion). They also note that Ekman and his colleagues have shown that different cultures label emotions in the same way. A study authored by Rachael E. Jack, Oliver G. B. Garrod, and Philippe G. Schyns and published in the January 2014 issue of Current Biology, narrowed the scope of basic emotion to just four, finding that the differentiation between fear and surprise, and anger and disgust is likely more social than biological, proposing a revised list of basic emotions: happiness, sadness, surprise/fear, and anger/disgust.

The claim that there are basic emotions is still a controversial and complicated issue. American psychologist Gerald Clore and Ortony argue that contrary to traditional views, emotions do not have clear boundaries or distinctive properties that allow them to be straightforwardly identified. For example, they do not have distinctive facial expressions or physiological states. Emotions do involve facial expressions, psychophysiology, and brain structures, but these properties are not sufficient to characterize basic emotions such as anger or fear. Instead, emotions are more variable.

Similarities and Differences Among Cultures

Scholars are divided on whether emotions are universal or whether they differ across cultures. Defenders of the universalist approach claim that emotions are the product of human evolution and are part of humans’ biological hardware (for example, Ekman and Plutchik). Therefore, cultures have similar experiences and expressions of certain basic emotions. Ekman found his six basic emotions—happiness, sadness, anger, fear, disgust, and surprise—to be universal. In contrast, the cultural relativist approach suggests that experience and expressions of emotions vary considerably and may even be socially constructed. Defenders of this view argue that all emotions are the product of a person’s culture. Social values and cultural beliefs can affect how people express their emotions. Therefore, people in different cultures may have different emotional experiences and reactions to similar social situations.

Researchers have examined how cultural values and beliefs influence emotions. The influential Dutch writer Geert Hofstede developed a set of four dimensions that characterize cultures. The dimension of individualism reflects the extent to which a culture is
individualistic or
collectivistic. An individualistic culture tends to socialize its members to think of themselves as individuals and to give priority to their personal goals (for example, the culture of the United States). A collectivistic culture tends to socialize its members to think of themselves as members of the larger group and to place the group’s concerns before their own (for example, the cultures of China, Japan, and Korea). Power distance reflects the extent to which members of a culture accept unequal distributions of power within institutions and organizations. Uncertainty avoidance reflects the degree to which members share beliefs and build institutions that protect them from discomfort and fear of ambiguous situations. Masculinity characterizes how much the culture values stereotypical masculine qualities (such as financial awards) rather than feminine qualities (such as caring for others).

Canadian psychologist Ulrich Schimmack found differences in how some cultures recognize emotions. For example, individualistic cultures were better at recognizing facial expressions of happiness than collectivistic cultures (though it is not clear why). Cultures high in uncertainty avoidance were less accurate at identifying fear. Schimmack suggests that this finding supports American psychologist David Matsumoto’s hypothesis that cultures high in uncertainty avoidance have formed institutions to minimize fear, which may explain why they have difficulty identifying fear compared with cultures that are not high in uncertainty avoidance.

Some research suggests that there are both universal and cultural differences in recognizing and communicating emotions. When people were asked to identify emotions in other people, they were always able to outperform anyone making random guesses; however, Hillary Elfenbein and Nalini Ambady found that they were more accurate at identifying emotions when the emotions were expressed by members of their own culture rather than by members of a different culture. These researchers concluded that expressions of emotions are largely universal, but the subtle differences that exist across cultures challenge effective communication. For example, they suggested that people visiting a different country often intuit that their basic communication signals tend to be misinterpreted more often by people of a different country than people of their own.

On the basis of these and other findings, Elfenbein and Ambady developed the dialect theory of emotional expressions. The theory proposes that people’s culture shapes their emotional expressions in a way that creates subtle differences in their appearance compared with the appearances of people from other cultures. Cultural differences in emotional expression also result from display rules—informal nonverbal rules about socially acceptable ways to use and control expressions. For example, most American women are likely to cry if a loved one dies in a war; however, Ekman reported that samurai women would smile rather than cry so as to conform to a display rule that women should hide distress and show joy in public.

Theories of How Emotions Are Experienced

Many theories of emotions have been proposed. Almost all the theories in the last few centuries have been influenced by the work of philosophers such as Aristotle, Baruch Spinoza, and William Lyons. Some of the theories have been particularly influential in the study of emotion. The James-Lange theory of emotion was independently developed by two nineteenth century scholars, William James and Carl Lange. It states that as a response to experiences in a particular situation, the autonomic nervous system produces physiological changes such as muscle tension, increase in heart rate, perspiration, and dryness of the mouth. Emotions are feelings that come about as the result of these physiological changes. For example, a person who starts crying infers that he or she is sad because of the crying, and not the other way around. To most people this view of emotions is counterintuitive and goes against common sense.

The James-Lange theory was challenged in the 1920s by the physiologists Walter Bradford Cannon and Philip Bard. The Cannon-Bard theory of emotion suggested that emotions cause physiological change (a view that is opposite of the James-Lange theory). For example, if a person sees a strange man outside the window late at night, that person might experience the emotion of fear, which causes physiological changes such as trembling and sweating.

Perhaps the most important theory of emotions is appraisal theory, of which there are a number of variations. An important assumption shared by all appraisal theories is that the experience of an emotion is the result of how people interpret, evaluate, or appraise a particular situation. Put more simply, people decide to feel an emotion after interpreting or explaining what just happened. Differences in how people appraise the same situation can lead them to experience different emotions. For example, if an average skier and an expert skier are skiing down a mountain and come on a very steep slope, the expert skier interprets the upcoming situation as an exciting challenge and consequently experiences happiness. However, the average skier, who lacks the skill to tackle such a slope, interprets the situation as being dangerous and experiences fear. Also, the mental processes that a person uses to appraise a situation need not be slow, deliberate, or conscious. Appraisal of a situation and its resulting emotion can occur rapidly and unconsciously.

Psychologists Clore and Ortony have proposed an appraisal theory that involves two kinds of mental processes: a relatively slow reasoning process and a faster associative process. These processes serve different adaptive functions. The associative process prepares a person for a developing situation (such as hearing a loud animal noise). It is based on responses such as reflexes, release of adrenalin, and so on, that according to Clore and Ortony often get the emotional process started. The reasoning process is similar to the mental processes of other appraisal theories.

Bibliography

Ekman, Paul, and Wallace V. Friesen. Unmasking the Face: A Guide to Recognizing Emotions from Facial Cues. Englewood Cliffs: Prentice Hall, 1975. Print.

Jack, Rachael E., Oliver G. B. Garrod, and Philippe G. Schyns. "Dynamic Facial Expressions of Emotion Transmit an Evolving Hierarchy of Signals over Time." Current Biology 24.2 (2014): 187–92. Print.

Lewis, Michael, Jeanette M. Haviland-Jones, and Lisa Feldman Barrett, eds. Handbook of Emotions. 3d ed. New York: Guilford, 2008. Print.

Ortony, Andrew, Gerald L. Clore, and Allan Collins. The Cognitive Structure of Emotions. New York: Cambridge UP, 1988. Print.

Plutchik, Robert. Emotions and Life: Perspectives from Psychology, Biology, and Evolution. Washington: American Psychological Association, 2003. Print.

Power, Mick J., and Tim Dalgleish. Cognition and Emotion: From Order to Disorder. Hove: Psychology Press, 2008. Print.

Sieb, Richard. "The Emergence of Emotions." Activitas Nervosa Superior 55.4 (2013): 115–45. Print.

Wassmann, Claudia. "'Picturesque Incisiveness': Explaining the Celebrity of James's Theory of Emotion." Jour. of the History of the Behavioral Sciences 50.2 (2014): 166–88. Print.

Who is Nathaniel Eaton?

Your question may refer to several people.

The first schoolmaster of Harvard College was named Nathaniel Eaton, and he lived from 1610 to 1674. He was an Englishman by birth and attended the Westminster School and Trinity College, Cambridge. In the 1630's he traveled to New England and took up work with Harvard College. He was a cruel schoolmaster and embezzled money from the school, so he was ordered to step down and pay a fine.

Another Nathaniel Eaton, still living, is an actor, journalist, and is best known for his co-authorship of the film Which Way, Por Favor?

Finally, your question may refer to a character in the book, The Witch of Blackbird Pond. Nathaniel ("Nat") Eaton is the son of a ship captain and love interest of the main character, Kit Tyler. He is a very spirited and joking young man who doesn't fear the risk of getting into trouble.

Why did Gatsby switch cars?

From what I can see, your answer lies in Chapter Seven. In this chapter, Daisy suggests that everyone should go into town.

Meanwhile, the atmosphere in Tom and Daisy's house is charged with a percolating tension that threatens to erupt into outward conflict. At lunch, Daisy is brazenly affectionate with Gatsby; she doesn't bother to hide the fact that she's infatuated with her lover.

For his part, Tom senses that Daisy is past all pretense when it comes to Gatsby, and he's definitely angry about being so obviously cuckolded. It's Tom who suggests that he and Gatsby switch cars. Meanwhile, Gatsby isn't too keen on the idea; he's just a tad uncomfortable with the idea of driving his lover's husband's car. Gatsby finds himself in a difficult position; if he objects, Tom is the kind of man who has no qualms about making an embarrassing scene. If Gatsby consents, he's playing into Tom's hands and publicly consenting to being emasculated in front of Daisy.

Since it's a no-win situation for Gatsby, he decides to cut his losses and to let sleeping dogs lie. He reluctantly consents to let Tom drive his car, while Tom drives his. For his part, Tom feels a need to exert himself in order to salvage what masculine pride he has left. After bullying his way through the exchange, Tom, calling his rival's car a "circus wagon," attempts to get Daisy to ride with him in Gatsby's car. However, Daisy evades her husband's grasp and decides to ride with Gatsby in Tom's car.

Daisy leaves Tom aghast and furious at her blatant disrespect. It's obvious that Tom meant to embarrass Gatsby, but the tables have now been turned on him. So, in truth, Gatsby only consented to switch cars with Tom because the latter pressured him into doing so.

What are over-the-counter medications?

Indications and Procedures

Drugs or medications that can be purchased directly, without a prescription, are called over-the-counter (OTC) medications or drugs. These medications may be suggested by physicians or simply purchased for consumption as a result of self-diagnosis and self-prescription. Most of the common OTC medications are used to treat common ailments such as cold and fever symptoms, headache, coughs, and similar complaints. Such self-treatment may be initiated at will and discontinued at any time.

Dozens of pharmaceutical companies produce and market hundreds of drugs for sale as over-the-counter medications, but they fall into only a few categories. The basic types of OTC medications, along with some brand examples, include analgesics (Advil, Tylenol), antacids (Milk of Magnesia), antidiarrheal medications (Imodium), antifungal agents (Tinactin), antihistamines (Benadryl), antiacne treatments (Clearasil), anti-inflammatory drugs (Motrin), decongestants (Sudafed), motion sickness (Meclizine), laxatives (Metamucil, Dulcolax), dandruff treatments (Selsun Blue), expectorants (Robitussin), hair
growth formulas (Rogaine), and sleep
aids (L-Tryptophan).

The most frequently used category of OTC medications is analgesics, which are more popularly known as painkillers. Analgesics include a diverse group of drugs that are used to relieve soreness, general body pain, and headaches. Probably the most common analgesic is aspirin, which is part of a group of medications termed nonsteroidal anti-inflammatory drugs (NSAIDs) that chemically affect the central and possibly the peripheral nervous system by leading to a decrease in prostaglandin production. Many analgesics are used in combination with other drugs such as vasoconstriction drugs that contain pseudoephedrine, which is especially important for the relief of sinus congestion, and in combination with antihistamine drugs, which relieve the worst symptoms of allergy.

Decongestants
must certainly rank as the second most common category of OTC medications. Generally, decongestants are taken to relieve nasal congestion and allied symptoms of colds and flu by acting to reduce swelling of the mucous membranes of the nasal passageways. A recurring problem with most nasal decongestants is that they increase hypertension, but this effect is lessened by including one or more antihistamines in the preparation. The brand name drug Dimetapp, for example, is both an antihistamine and a decongestant, while various Tylenol products may contain drugs that collectively work to soothe sore throat, relieve nasal congestion, or suppress coughing.

Despite the fact that over-the-counter drugs are available to everyone, their marketing and use is restricted by the Food and Drug Administration (FDA) in the United States and similar agencies with regulatory powers in many other countries. The FDA mandates ingredients and labeling of OTC drugs and specifies rigid testing and safety standards that must be met prior to marketing. Pharmaceutical companies must apply to the New Drug Agency (NDA) for the approval of drugs. The NDA specifies testing requirements prior to issuing a license for the sales and marketing of the proposed new drug. Following approval, the FDA regularly reviews and maintains the right to remove or restrict marketing and sales of OTC drugs that create adverse side affects or are potentially addictive.

Following discovery, testing, and FDA approval of a new drug, it is given a unique trade name or brand name. The pharmaceutical company is awarded an exclusive patent to manufacture and market the drug for a specified period of time, usually seventeen years in the United States but of variable length in other countries. At the end of this time, the company no longer has proprietary rights to the drug, which may then be manufactured and marketed by other pharmaceutical companies. These drug companies may choose to market the drug under a new brand name of their choosing but not under the original label, which may still be manufactured by the original pharmaceutical company that designed and patented the drug. Spin-off products of these companies must still pass rigid FDA quality control standards which demonstrate that their product contains sufficient amounts of the active ingredients to promote bioequivalency before it can be marketed as an OTC medication—that is, the new drug has to be the therapeutic equal of the original drug.

Drugs manufactured by other pharmaceutical companies following patent expiration are typically called generic drugs and are strictly regulated by the U.S. Drug Price Competition and Patent Term Restoration Act (also known as the Hatch-Waxman Act), which was enacted in 1984. Tylenol, for example, is the exclusive brand name of an analgesic over-the-counter medication that contains the active chemical ingredient acetaminophen. Following the release of its patent, many other pharmaceutical companies started marketing pain relief drugs containing products for pain relief under the their own trade name or brand name. These copies are considered generic drugs and provide the consumer with a wide choice of the most popular drugs, usually at greatly reduced cost.

Manufacture and marketing of a generic drug by new companies usually means that their product costs considerably less, partly because of competition but mostly because the new drug companies did not bear the initial costs of development, marketing, and promotion that were part of the original financial investment of the parent company. Furthermore, manufacturers of generic drugs enjoy all the benefits of prior marketing, public acceptance, and possibly dependence on the most popular OTC medications. Generally, however, the parent company enjoys a certain competitive advantage of brand name recognition that promotes continued use of their marketed product, thereby reducing the impact of cheaper competition.

Over-the-counter medications may take the form of packets, tablets, capsules, pills, drops or droplets, ointments, inhalants, lotions, creams, suppositories, or syrups. Except for creams and topical ointments, OTC medications are administered orally, in contrast to drugs that are taken by injection. This mode of delivery places natural limits on their therapeutic effectiveness in several ways.

After being swallowed, OTC medications pass down the esophagus, through the stomach, and into the small intestine, where they are digested and absorbed. This mode of delivery requires a certain time interval between oral intake of the drug and its arrival in the bloodstream that transports it to target cells, tissues, and organs, thus delaying the effects of the drug. Tablets or capsules sometimes get stuck in the back of the mouth or on the lining of the esophagus, where they start to dissolve. When this happens, the ingredients may cause irritation, nausea, and sometimes vomiting, and the therapeutic value is lost. Furthermore, a certain amount of each key ingredient will be destroyed by the digestive enzymes of the gastrointestinal system, may be metabolized by cells of the intestinal epithelia, or may simply pass through the gut without being absorbed. Even following absorption into the blood, a certain amount of the drug may be lost because liver and other body cells set about removing foreign substances in the blood almost as soon as they are detected, generally by metabolizing the ingredient into a harmless chemical that will be excreted into the bile or be removed by the kidneys. This process explains
why all drugs, including OTC medications, must be taken in repeated doses at regularly prescribed intervals in order to obtain maximum therapeutic value.

A final factor complicating delivery efficiency and thus the therapeutic value of OTC medications involves their packaging. Capsules, tablets, and pills in particular all contain substances in addition to the chemical ingredient, such as coatings, fillers, stabilizers, and often color additives. These substances, called excipients, do not contribute to the actual working of the drug itself, but they often modify both the rate and the extent of dissolution of the drug as it travels the gastrointestinal tract. While most excipients ultimately reduce the overall degree of delivery, some have important functions of permitting them to transit through the stomach, which has limited absorption ability, and into the small intestine, where chemical dissolution and absorption occurs at an optimum rate. For some drugs, the natural limits placed on delivery efficiency by gastrointestinal processes and excipient components can be sharply reduced by placing the capsule or tablet directly under the tongue, thus entirely bypassing the alimentary tract.

Uses and Complications

Primarily because of liability issues, all OTC medications include labels that are sometimes extensive. Label components typically consist of a list of one or more symptoms addressed by the medication, active ingredients contained in the drug, warnings, directions for use, and the date after which the medication should be discarded. For example, the label on a common OTC medication used to treat severe colds notes that it is to be used to relieve symptoms of nasal congestion, cough, sore throat, runny nose, headache and body ache, and fever. Directions for use are specific as to number of times a day, hours between use, and factors involving taking the medication, such as with or without glasses of water prior to or following administration and limits regarding food intake.

Most labels also carry prominent warnings regarding use with respect to age, alcohol consumption, sedatives or tranquilizers, and combinations of medications. Most over-the-counter medications also state that use should be continued only for a specified time and that, if symptoms persist, the user should stop taking the medication and consult a physician. Finally, the user is usually cautioned to stop taking the OTC medication immediately if headache, rash, nausea, or similar symptoms appear. Despite these warnings, even commonly used OTC medications pose certain health hazards, and the user is advised to take these medications with full recognition of potential problems.

In the United States, while the FDA periodically issues warnings regarding OTC medications, their actual use by consumers normally is not regulated, documented, or monitored. This has led to a number of concerns regarding real and potential overuse of OTC drugs, particularly for reasons unrelated to their medicinal intent. It has also led directly to the modification of certain OTC medications to engineer drugs that are highly addictive.

Because their use is unregulated—or, more correctly, cannot be regulated—over-the-counter medications can be deliberately abused. Overdosing with certain types of painkillers, for example, has become a frequent method of suicide attempt. The use of Tylenol in suicide attempts is increasing. Tylenol overdosing causes the destruction of liver cells that synthesize blood coagulants. Loss of these blood coagulants results in uncontrolled bleeding, most evidently through the eyes, nose, and mouth but also internally. Internal bleeding continues until death occurs, usually within a few days following onset.

Perhaps the most egregious misuse of OTC medications is to induce or achieve temporary “highs” that parallel those obtained by use of street or hard drugs. Cough suppressants that contain the drug dextromethorphan, for example, affect the central nervous system and can be used as mood-altering drugs that cause brain damage and even death at high doses. An even more serious abuse is the cooking of common drugs to obtain the highly addictive drug methamphetamine, popularly called meth. Also known as ice or speed, meth is a highly addictive drug that is often devastating and sometimes deadly. In some regions of the United States, it ranks with heroin and cocaine as the popular drug of choice. Record growth in use and the ability to cook meth from readily obtained OTC drugs has led to the creation of National Methamphetamine Awareness Day to draw attention at all levels to this problem.

This cooking process involves the conversion of certain OTC medications into meth. Some other sources for cooking meth include diet aids, tincture of iodine or other iodine solutions, and household cleaning solutions. In response to the widespread home manufacture of meth, a national federal law was enacted to require pharmacies to check photo identification and keep records of over-the-counter sales of cold medications that contain pseudoephedrine and ephedrine, which are the two popular ingredients in many cold medications. By-products of in-home meth cooking labs are garbage cans filled with Sudafed packages and a distinct odor of cat urine. The cooking process itself releases potentially harmful toxic chemicals that can pose serious health hazards to lungs and the respiratory system and also poses the risk of fire.

Perspective and Prospects

Originally, OTC medications were available for purchase only at pharmacies, along with physician-prescribed drugs. Today, a varied selection of OTC medications is available at many retail outlets, including supermarkets, food stores, and even convenience stores, although pharmacies still continue to offer the greatest selection. This can lead to a confusion of terms, as such medications or drugs are often no longer sold “over the counter” but instead can be found on shelves alongside other items for sale.

To complicate matters, certain drugs are offered as OTC medications at low dosages but must be obtained by prescription at higher dosages. For example, the popular analgesic ibuprofen (Advil, Motrin) can be purchased as an OTC medication at dosages of less than 200 milligrams, but higher dosages can be obtained only via prescription. Similarly, the antidiarrheal medication Imodium, an opiate, is available as an OTC medication in liquid form, while tablets of Imodium are available only by prescription.

The status of over-the-counter medications may change over time, depending on effectiveness and safety issues. While some OTC drugs are removed from the general market following various concerns regarding safety, other drugs are transferred from prescription drugs to OTC medications. Examples include the antihistamine drug Benadryl, which is used to relieve symptoms of allergy and guard against allergic reactions, and the painkiller ibuprofen, both of which were, until recently, sold as prescription drugs only but are now available as OTC medications.

While the distribution and sale of over-the-counter medications is strictly regulated by state and federal laws in the United States, certain drugs that are deemed harmless may be offered for sale as medical cures for many ailments and thereby compete with OTC medications. These so-called miracle drugs have become increasingly popular because of the Web, which opens the door to purchases without prescription. Media promotions also sometimes offer these medications, complete with testimonials that dramatically describe their success as a cure-all for ailments. These types of medications are often labeled “quack” drugs. They pose a threat to users of prescription and OTC medications in several ways. First, they are generally useless, offering a nonexistent cure for health problems. Second, they are manufactured without regard to quality control measures that legitimate drug manufacturers must follow. Third, time may be lost in using the quack drug, especially if the condition is chronic and the symptoms need to be treated immediately. Finally, while some may be harmless, other quack drugs contain chemical ingredients that are potentially dangerous when used in combination with genuine over-the-counter medications.

Bibliography

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