Science-Based Medicine

Feb 08 2013

Honey Boo Boo

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52 responses so far

52 Responses to “Honey Boo Boo”

1. # lizzon 08 Feb 2013 at 7:06 am

   “I tend to let normal physiologic processes run their course unimpeded as long as they pose to harm to the patient.”

   I’m wondering if you’ve missed out the word “no” ?

2. # The Eventual Docon 08 Feb 2013 at 7:23 am

   Couldn’t an equally valid interpretation of their “data”, such as it is, be that date extract worsens cough?

3. # Aliaon 08 Feb 2013 at 8:12 am

   Over here a popular home treatment for colds, sore throat and cough is so-called “lemonade” – you take a spooful of honey, add juice from a quarter of lemon and a glass of warm water, stir and drink. Well, I do not think it can cure anything, but it does make you feel better – the drink tastes nice and you feel cared for (especially when it’s your mother who brings it to you, saying “drink it, it will make you feel better”).

   Anyway, I have pretty bad experience with coughs. For several years my every wintertime infection looked lik this – a few days of typical cold (slightly elevated temperature, runny nose, nothing serious and resolving on its own) and then three-four weeks of cough. Especially at night. So I did take codeine – it’s available OTC here, in small doses. Otherwise I would be unable to get a good night’s sleep, not to mention my poor husband. And then, for some reason, a few years ago it all changed and I do not get this cough. Don’t know the reason, but sure I’m glad.

4. # cervanteson 08 Feb 2013 at 8:15 am

   Yes, eventual doc, there should have been a no treatment arm.

   I once had a roommate make me a very strong ginger tea with lemon. (You boil the living excrement out of fresh ginger, basically.) It certainly seemed to open up the respiratory passages and calm the cough. Anyway, there’s something to be said for subjective relief.

5. # windrivenon 08 Feb 2013 at 8:34 am

   ” I assume that coughing with infection, like diarrhea, is beneficial. Key to treating all infections is to physically remove it. ”

   So what does one do about the wee beasties ejected during the cough? Small children can’t manage and ignorant morons can’t be bothered to cover their blowholes when they succumb to a paroxysm of hacking. I understand the ‘out with the bad air’ thing but wish to maintain my own ‘in with the good air’. And while walking the streets wearing a surgical mask might be haute couture in Guangdong, in, say, Murfreesboro it might invite the ridicule of one’s neighbors and the attention of a fat sheriff with the IQ of a zipper pull.

   What is one to do?

6. # toffer99on 08 Feb 2013 at 8:46 am

   “The ever questionable Cochrane Reviews” What did you mean by that, please? Perhaps I got hold of the wrong end of the stick, not being a medical professional, but I though Cochrane was the gold standard, the ever-reliable UNQUESTIONABLE upholder of evidence-based medicine?
   Please enlighten the ignorant.

7. # windrivenon 08 Feb 2013 at 8:58 am

   toffer99

   The Cochrane Reviews are notoriously wishy-washy, often calling for more research on even the most obvious quackery.

   Faced with a bloody body Cochrane might give equal weight to the theories that the deceased was stabbed to death … or that he backed into a knife nine times.

8. # Troyotaon 08 Feb 2013 at 9:17 am

   Interesting! This information has implications for my favorite cold remedy, “Gram’s Formula”:

   Place the following in a mug or heavy, heat-proof drinking glass (proportions and quantity per individual taste and needs):

   Bourbon
   Honey
   Lemon juice

   Fill with boiling water and mix; administer in bed or comfortable recliner. No driving!

   I guess I can substitute other sweeteners for the honey, not that I want to….

   Thanks much, this is a great site!

9. # Janeton 08 Feb 2013 at 9:56 am

   I raised my kids in Washington and Oregon–Washington when they were little, where you could get codeine cough syrup at the drugstore by signing your name in a big, important-looking book with a very stern pharmacist glaring at you very paternally. One bottle a year of this stuff (enough for a family of five in a bad cold/flu season), administered at bedtime, gave the kids the chance to sleep, rest, and get well–perhaps faster than without the codeine (due to the rest, not the codeine!)

   Last time I asked my doc here (Wisconsin) for codeine cough syrup, she looked at me like I had just asked her for heroin, and told me how effective the OTC crap is! I will be sure she sees this post and the links.

   I cough all the time because I have allergic asthma. I’m used to people backing away and staring at me with looks that could kill, so now I try to follow my coughs with a chirpy, “it’s just asthma”. I used to treat bad colds with the beverage recommended by Troyota above. It works! How do I know? I ask myself how I feel after I drink it! Myself always says, “better”. Who needs RCT’s? The thing is I really don’t get colds, so Im going to try it (what’s the harm?) for the cough.

10. # stanmrakon 08 Feb 2013 at 10:34 am

    Methinks you may have too much time on your hands. Spending this much time and effort trying to prove that honey works or not proves nothing at all, and never will. Honey is not a drug, for crissake, and you can’t design any legitimate study that examines it in that way and get any reliable conclusion about its benefits. Next time you get a cough, just try it. Some of those things work whether you believe in them or not.

11. # dbeon 08 Feb 2013 at 10:46 am

    @Alia, I had the same thing, but younger. Used to get coughs as a child that were horrible and could get no sleep. Then around 16-17 it all stopped, after that even when sick my cough isn’t bad at all. No idea what changed, other than puberty.

12. # NSCon 08 Feb 2013 at 10:59 am

    Troyota’s treatment works well for me, too. Although in my experience the honey is optional. As is the lemon juice. And the hot water.

13. # windrivenon 08 Feb 2013 at 11:04 am

    @stanmrak

    You just don’t get it, do you? Belief doesn’t enter into the skeptical view except as something to be disdained. There are hypotheses that cannot be tested. The efficacy of honey in the management of coughs in children can.

    “Some of those things work whether you believe in them or not.”

    I have no idea whether or not you meant this ironically. I doubt it as you don’t seem that reflective. So let’s work this through: excision of a ‘hot’ appendix cures appendicitis whether you believe in appendectomy or not. Reiki does not cure appendicitis though it may offer temporary relief if you believe that it will.

    NOTE TO PETER MORAN: stan here is living proof that that sCAM isn’t just a girl thing

14. # Karl Withakayon 08 Feb 2013 at 12:19 pm

    @toffer99

    “Perhaps I got hold of the wrong end of the stick, not being a medical professional, but I though Cochrane was the gold standard, the ever-reliable UNQUESTIONABLE upholder of evidence-based medicine?
    Please enlighten the ignorant.”

    One of the resident bloggers can probably put this better but, here goes:

    That phrasing of your question seems a little over the top, so it causes me to pause to consider the sincerity, but giving you the benefit of the doubt: One of the main differences between Evidence Based Medicine and Science Based Medicine is that EBM doesn’t account for prior plausibility and use Bayesian analysis. For instance, the prior plausibility for homeopathy is incredibly low. For homeopathy to work as advertized, huge swaths of established science regarding physics, chemistry, biology, physiology, etc would have to be wrong. Therefore there is a higher burden of proof to overcome to support claims of efficacy for homeopathy.

    Chocrane frequently refuses to either conclude that a treatment has no evidence for efficacy and its use is therefore not recommended and/or that no further research is warranted. They often point out likely statistical anomalies or signals that fail to achieve statistical significance in the results or even methodological problems as reasons further research is warranted or needed. I had a discussion with someone last year at TAM where they mentioned that a Chochrane review had concluded something was not recommended and no further research was warranted and I remarked that for Chocranne to make such a conclusion, the data must have been historically, overwhelmingly negative, and He agreed.

    Also meta-analyses and systematic reviews are only as good as the studies they include. The meta of crap is not gold.

    To me (and I’m neither a medical professional or a researcher) systematic reviews are best used as a tool to determine what the consensus of available quality research is on a particular topic, while meta-analyses are best used to pool together the data of numerous smaller studies to look for weaker signals that the individual studies were too underpowered to detect. Both require high quality underlying studies, and metas really need very similar methodologies (almost reproduction level studies) in the underlying studies to be able to legitimately pool the data.

15. # Karl Withakayon 08 Feb 2013 at 12:22 pm

    … a little more on systematic and meta reviews:

    They’re not supposed to be the Facts of Life theme song:

    You take the good, you take the bad,
    you take them both and there you have
    a systematic review.

16. # DevoutCatalyston 08 Feb 2013 at 12:30 pm

    NOTE TO WINDRIVEN: Unless Stanleyetta shortened it to stan to avoid getting hit on by skeptics…

17. # DevoutCatalyston 08 Feb 2013 at 12:30 pm

    Smiley fail…

18. # RUNon 08 Feb 2013 at 12:32 pm

    A question: There has been a lot of ‘buzz’ in the media about more benefits using raw honey vs the processed honey we buy in the stores. Is there research comparing the two, are there significant differences? The studies that were mentioned in this article, did they use raw or processed?

19. # elburtoon 08 Feb 2013 at 12:34 pm

    “Some of those things work whether you believe in them or not.”

    Stan there, missing the point of research by so much that if the point is in Glasgow, he’s in Kazakhstan.

    Science isn’t god, or the tooth fairy, or the magical levitating three-toed sloth of Costa Rica. It’s not a question of believing whatever you want to without evidence, relying solely on happy thoughts and warm fuzzies,

    Cold hard facts, statistics, research and results that can be reproduced and replicated. Science there. Not a man in black invoking a sky fairy, or someone in tie-dye preaching the virtues of crystals and otter eyelashes, or whatever the current fad is.

    If you’re impersonating a stunted wooligan, then bravo! You’re at the top of your game. If you really believe that clicking your ruby slippers together three times will cure all that ails you, well, you’ve been failed by society and whatever education system turned you out.

20. # mousethatroaredon 08 Feb 2013 at 12:37 pm

    When I’ve taken the kids into the doctor for cold/flulike/persistant cough symptoms, after they’ve ruled out concerning infections, they usually make comfort recommendations. Those are; nasal saline washes if the child will tolerate them, lots of liquids, warm lemon/honey drinks, humidifier in room at night. I believe the idea is preventing the mucus membranes from getting too dry and irritated, thus cutting down on coughing. Just anecdotally, the humidifier seems most helpful. Can’t really say about the other recommendations.

    I occassionally get the asthma post virus coughing fits. Besides using the emergency inhaler, any drinks that clear and moisten my throat seem to help. Cabonated drinks, hot citrus teas, ginger syrup drinks, chicken soup, etc. Also anything that relieves nasal congestion helps my cough as well…cuts down on mouth breathing and dryness/irritation, I’d guess.

21. # windrivenon 08 Feb 2013 at 12:46 pm

    @elburto

    What the world needs is an emoticon for a ‘high five’! Nicely stated.

    @DevoutCatalyst

    Smiley not required

    @Karl

    ” The meta of crap is not gold.” !!!

    All in all, a fabulous Friday at SBM.

22. # LovleAnjelon 08 Feb 2013 at 1:20 pm

    I’m pleased hear I am not the only person who regularly enjoys PB&H sandwiches.

23. # Xplodyncowon 08 Feb 2013 at 1:33 pm

    Spending this much time and effort trying to prove that honey works or not proves nothing at all, and never will. [. . .] Some of those things work whether you believe in them or not.

    Because, see, it’s my own perception that matters. Not reality. I mean, duh.

24. # DugganSCon 08 Feb 2013 at 1:38 pm

    I haven’t found honey to be an especially effective cough suppressant, but it does tend to coat the throat, making my coughs less painful.

25. # WilliamLawrenceUtridgeon 08 Feb 2013 at 1:49 pm

    Methinks you may have too much time on your hands. Spending this much time and effort trying to prove that honey works or not proves nothing at all, and never will. Honey is not a drug, for crissake, and you can’t design any legitimate study that examines it in that way and get any reliable conclusion about its benefits. Next time you get a cough, just try it. Some of those things work whether you believe in them or not.

    Thus missing the point that interpretation of scientific literature is a skeptical and intellecutal exercise capable of illustrating broader points than the mere topic-specific empirical one.

    Honey also carries risks, in the form of anaphylaxis, contamination, botulism and general risk of infectious disease (honey is pasteurized for a reason, though primarily to kill yeast).

    The irony of posting a comment criticizing a blog post for wasting time is truly a source of delight It goes beyond irony, into ununoctiumy.

26. # Calli Arcaleon 08 Feb 2013 at 5:18 pm

    There is no way almost every parent, unless blind and anosmiac, would not know if their child received honey.

    I disagree. Given the widespread adulteration of honey with corn syrup (in a surprising number of cases, 100% corn syrup), I’d say that there must be an awful lot of people who can’t tell they’ve been given something that isn’t honey, or else the lid would’ve been blown off of that scam a long time ago. That’s not to say you can’t tell the difference; just that most people don’t seem to be aware of the differences or at least are easily fooled.

    I do have to agree that if honey is no better than dextromethorphan, that means it’s no use at all as a cough suppressant. Some have talked about its bacteriostatic properties, though. Are those of any use?

27. # liladyon 08 Feb 2013 at 6:09 pm

    @ Troyota: “Grams Formula”? Isn’t that the same as a “Hot Toddy”?

    http://www.sippitysup.com/hot-toddy-cocktail-cold-flu-season

    ` Five years ago I contracted pertussis and it was not *women’s intuition* that propelled me into my doctor’s office for a nasopharyngeal swab to “confirm” my diagnosis. Even before the results were available, I was put on a short course of an antibiotic, to decrease the chance that I would infect anyone else.

    I suffered through 8 weeks of rib-cracking painful coughing spells. A bronchodilator and two huge bottles of prescribed codeine cough syrup, enabled me (and my husband), to get some sleep.

    Windriven…”The Cochrane Reviews are notoriously wishy-washy, often calling for more research on even the most obvious quackery.

    Faced with a bloody body Cochrane might give equal weight to the theories that the deceased was stabbed to death … or that he backed into a knife nine times.”

    Heh, heh, I just might steal that one.

28. # Janeton 08 Feb 2013 at 6:16 pm

    @Calli

    Yeah, but they didn’t give the kids corn syrup–they gave them some horrible-sounding brown date syrupy stuff. I like date, but date syrup doesn’t sound so good, maybe I’m wrong, though and it’s yummy. o_o

29. # Anthropologist Undergroundon 08 Feb 2013 at 7:03 pm

    Our pediatrician’s website hosts a panicked parent window where sleep-deprived, panicked parents can click in the dead of night (the exact time that very small babies suddenly become worryingly ill in my experience) for general advice about when to chill out until the next business day and when to wake up the doc on call. The host of this service is called Pediatric Web, and recommends honey for cough. I can attest to the power of the placebo and throat-coating effects of this sweet, sleepytime nectar.

30. # pmoranon 08 Feb 2013 at 7:10 pm

    Someone, and I can’t find the quote, suggested I thought the placebo effect was the patient lying to themselves and/or to their doctors. Not quite. People will convince themselves that they are better when they are not and report the imagined improvement to their doctors.

    Here is the quote, from me. ” Nybgrus and Mark Crislip are trying to claim that placebo responses are entirely due to biased reporting (or as close that it doesn’t matter), essentially patients lying about how they now feel in order to please the doctors, and Steve Novella is not far from the same position.” (If any of you doubt that these positions were advanced I DO have the relevant quotes)

    It is true that patients can convince themselves they are better “when they are not”. Even obviously declining cancer patients can do this, but that merely demonstrates the power of the human mind where perceptions are concerned, as often displayed in demonstrations of human suggestibility. It in no way undermines placebo theory as usually conceived. The placebo IS about perceptions, and the focus of the mind, and the “endorphogenic” sensation of having done something useful, and other matters.

    So this study raises two quite separate questions. Does honey have a specific effect on cough? Probably not, unless, possibly (still) as a lingering distraction from a ticklish throat.

    The other question is “might this, even so, be a useful thing for a parent or patient to do for an annoying cough?”

    These are both legitimate scientific questions, but looking at quite different aspects of medicine.

    (Note to Windriven, Stanmrak may be trying to clumsily get across a similar “girly” point

31. # Lytrigianon 08 Feb 2013 at 7:13 pm

    Hot toddies were my grandma’s formula too.

    I don’t know if they help my coughs or not, but after 2 or 3 of them I don’t really care.

32. # windrivenon 08 Feb 2013 at 7:52 pm

    @pmoran

    “Stanmrak may be trying to clumsily get across a similar “girly” point ”

    Possibly, but I’ve never known him to show subtlety or nuance. Still, we can hope.

33. # Harriet Hallon 08 Feb 2013 at 8:59 pm

    Mark makes the CAM apologists look silly. The ones who claim doctors only treat the symptoms and insist on writing prescriptions for everything. No shill for Big Pharma would say the things he has said about fever and cough.

34. # Quillon 08 Feb 2013 at 9:46 pm

    “Hot toddies were my grandma’s formula too.
    I don’t know if they help my coughs or not, but after 2 or 3 of them I don’t really care.”

    Exactly so and I won’t care a bit what a well-done study says, unless it confirms my Toddy Bias. I shall also start paying serious attention to Cochrane Reviews when they get jiggy with bourbon studies.

35. # liladyon 09 Feb 2013 at 12:48 am

    Honey for an infant’s cough? That’s a major no-no…

    http://www.mayoclinic.com/health/infant-botulism/HQ00854

    Poor babies can’t even have a hot toddy.

36. # Anthropologist Undergroundon 09 Feb 2013 at 11:59 am

    @ lilady: re botulism in honey. You’re right, of course. I should have clarified. Pediatric Web does mention not to give it to kids under 1 year. I do think they should include a hot toddy recipe for panicked parents!

37. # RobLLon 10 Feb 2013 at 12:40 am

    Cough 16 hours a day as needed (on the likelihood that coughing is functional)

    Enough codeine (I use C-3s, and a portion thereof as cough lessens) to get enough sleep at night.

    C-3s (300 mg acet. and 30 mg codeine) are the cheapest and likely most effective. The syrup is mostly sugary crap.

38. # pharmavixenon 10 Feb 2013 at 12:11 pm

    I helped write the formulary for our organization, and we excluded dextromethorphan because of its dubious efficacy and its (tiny) potential for abuse – at high doses, it has ketamine-type effects, probably by the same mechanism as ketamine; ie, agonism @ the NMDA receptor. Our catchement area includes many people with substance abuse problems. Also, we treat many major mental illnesses, and DM has a (tiny) risk of serotonin syndrome when taken with SSRIs. And we hand out SSRIs like candy around here.

    But this current cough-cold-flu season has brought us a flurry of non-formulary drug request forms from physicians asking us to include DM syrup in the formulary. I have suggested guaeifenesin (Robitussin) syrup instead, with the rationale that at least we are giving our patients a placebo that is entirely harmless.

    As the point person for drug information, I am getting innundated with requests to justify the exclusion of DM. Like Mark’s research found, the evidence for its worthlessness is solid. But some of the other pharmacists are pressuring me to cave to the physicians and include DM as the path of least resistance. After all, DM is cheap, and its risks are tiny enough to be almost theoretical.

    It hasn’t been settled yet, but when evidence-based medicine comes up against institutional politics, I don’t think it’s the patients who win.

39. # Perky Skepticon 11 Feb 2013 at 12:11 am

    Thank you, pharmavixen! I knew DM is off my list because of SSRI use, but I had no idea *why*! Thanks for shedding some light. Then I googled “serotonin syndrome” and found it indistinguishable from “a day in the life of a freelancer,” and think I’m going to have some of Gram’s Remedy and go to bed now!

    windriven– Murfreesboro? Are you in Tennessee, by chance?

    Also, even though I have a botany background and am over the age of twelve, I maintain no one should ever, ever call it “labiatae honey”. Because… just because.

40. # dandoveron 11 Feb 2013 at 11:26 am

    If there are benefits to suppressing the cough associated with acute respiratory infections I can’t find any …

    My wife has definitely found the benefit to suppressing my cough when she is trying to sleep next to me

41. # Calli Arcaleon 11 Feb 2013 at 1:34 pm

    lilady:
    It’s only raw honey that is a problem with respect to botulism. In the US, honey is mostly sold raw, but I understand that in other countries it is often pasteurized, which should kill the little nasties. I’ve often wondered why it’s seen as better to stick a label on it that says “don’t give to babies” rather than to pasteurize it. They’re heating it anyway to make it easier to bottle; they might as well heat it a little more and actually kill the germs. It’s not like the flavor’s going to change as long as you’re not getting it hot enough to start cooking the sugar. Of course, someone is bound to object that this would destroy its natural healthful magic….

42. # pmoranon 11 Feb 2013 at 5:52 pm

    It hasn’t been settled yet, but when evidence-based medicine comes up against institutional politics, I don’t think it’s the patients who win.

    “Institutional politics”? Why blame this? I suspect, since you go on to suggest “a safer placebo”, you know that these doctors are responding to the very simplest of medical pressures, the “unmet medical needs” that I have been suggesting should be contributing more to our understanding of why people (and some doctors) turn to CAM.

    The advent of of evidence-based medicine has not been all sweetness and light for medical practice. This much-lauded facet of modern medicine has no ability in and of itself to produce new and better treatments of anything. It “merely” helps test them out.

    Yet it has had the effect of seriously reducing prescribing options for many symptoms. It has become so strongly prohibitive of non-EBM-prescribing, that we now see fit to frown upon the use of honey for a child’s cough through it not being shown to work clearly better than placebo..

    Cough is also just one of many instances where we have gone so far as to very extensively prescribe certain treatments, only to then either take them away, or made them very hard to get for one reason or another. This has happened with anxiolytics and other mood-modifying drugs (e.g. opiates and cocaine ), sleeping pills, stimulants such as amphetamines, the once ubiquitous “tonics”, and also recently a variety of appetite suppressants.

    It took us most of a century to discover that there are few free lunches in pharmacology, but all the while we were unwittingly holding out the promise of much nicer and more trouble-free lives for everyone just around the corner. “All your ills will have an answer” it seemed.

    So, we have limited right to get grumpy obout unreasonable public expectations when we ourselves have been permitting them to be aroused. These are one of many factors making the public receptive to less than honest medical claims .

    As some other commenters have hinted, there is a desperate need for an effective cough suppressant. It does not need to work as well as a rib fracture does, and thereby increase the risk of pneumonia — if that was ever a serious concern with the usual outpatient use of cough suppressants.

    I am not pretending there is an easy or correct answer to this. But it surely helps if we fully understand the terrain in which we are working.

43. # David Gorskion 11 Feb 2013 at 6:01 pm

    The advent of of evidence-based medicine has not been all sweetness and light for medical practice. This much-lauded facet of modern medicine has no ability in and of itself to produce new and better treatments of anything. It “merely” helps test them out.

    Nonsense, Peter. There’s no “merely” about it, and remember that EBM (even more so SBM) includes the whole gamut from preclinical research to randomized clinical trials to meta-analyses. We at SBM quibble about the emphasis placed on basic science considerations, but to imply that the EBM infrastructure is incapable of producing new or better treatments is just plain wrong. It is now the primary scientific framework through which new and better treatments make their way from idea to clinical trials.

44. # pmoranon 11 Feb 2013 at 7:34 pm

    Well, I suppose you can define anything in any way you want, David, but SBM itself came into existence to try and divert the emphasis of EBM away from clinical studies, specifically the placebo-controlled RCT, which we ourselves were up until then referring to as the “gold standard” of evidence.

    .About the only relevance of the distinction is in relation to the positive studies now appearing for unlikely CAM methods, although rarely SBM looks to soften the very strong prohibitive aspects of EBM and allow for some small practitioner discretion.

    My comments referred to pharmacology where EBM can mean little else other than clinical studies. The quotation marks around “merely” were clearly intended to be ironic, allowing for the importance of clinical studies in optimising medical treatment even if they cannot, as is quite obvious but rarely stated, generate new therapeutic ideas.

45. # Naradon 11 Feb 2013 at 7:47 pm

    I helped write the formulary for our organization, and we excluded dextromethorphan because of its dubious efficacy and its (tiny) potential for abuse – at high doses, it has ketamine-type effects, probably by the same mechanism as ketamine; ie, agonism @ the NMDA receptor.

    While I’ve never had ketamine, I’ve tried high-dose dextromethorphan way back when it could be obtained in gelcaps. The (quite unpleasant) experience did not jibe with any accounts of ketamine use that I’ve encountered, perhaps due to activity at PCP-2 and σ-1. Ketamine and DXM’s metabolite, dextrorphan, are NMDA antagonists, BTW.

46. # pharmavixenon 11 Feb 2013 at 9:00 pm

    “The (quite unpleasant) experience did not jibe with any accounts of ketamine use that I’ve encountered, perhaps due to activity at PCP-2 and σ-1. Ketamine and DXM’s metabolite, dextrorphan, are NMDA antagonists, BTW.”

    Yes. Typo. And yes. All the accounts of DM intoxication I have heard/read make it sound like it has about the same abuse potential as nutmeg.

    @pmoran: while SBM is our platonic ideal, we all work in reality-based medicine, or all the limitations of our practice settings. In the specific case of cough, codeine works well, but my pts are inmates in a jail, with a propensity for drug abuse. If we started handing out codeine for coughs, everybody would have a permanent cold (except for the gangsters, who sell drugs but take pride in not using them).

    Kinda o/t, but does anybody have experience with treating the coughs caused by smoking crack? I did a lit search and found nothing. Our dr treats it like asthma – steroid inhalers + short-acting beta agonist inhaler (or sometimes Symbicort).

47. # BlueJeanon 12 Feb 2013 at 12:51 am

    Your mechanism of action search is a little underwhelming… My understanding is that honey is supposed to soothe a cough and a sore throat as a demulcent. I can’t imagine the effect lasts very long, if there is a significant effect, but maybe long enough to get to sleep after a long day.

48. # kathyon 12 Feb 2013 at 3:25 am

    Perky – “I maintain no one should ever, ever call it “labiatae honey”. Because… just because.”

    “A taste of honey.
    Tasting much sweeter than wine.
    I dream of your first kiss …”

    LOL! So you know what “labiate” means.

49. # mousethatroaredon 12 Feb 2013 at 6:33 am

    @ Pharmavixen – In your original post, I thought the demands for dextrorphan were patient driven (doctor’s giving in to patient demands) but given your patients that seems less likely. I don’t get it. Are the doctors convinced it actually works? Is it a ‘if it ain’t broke don’t fix it’ unwillingness to change? Does the dextrorphan have some other benefit, like making people sleepy, which could help with a cough?

50. # Mark Crislipon 12 Feb 2013 at 10:19 am

    Infectious coughs are generated in the airway, not the throat.
    Sure hope honey isn’t getting in the airway.

51. # mousethatroaredon 12 Feb 2013 at 10:36 am

    Mark Crislip
    ‘Infectious coughs are generated in the airway, not the throat.
    Sure hope honey isn’t getting in the airway.’

    I’m confused. Are those coughs that hang on for 2 or 3 weeks after the cold or flu, infectious coughs? I thought they were just due to general post infection irritation of the throat and airway. If it was only airway generated, then a drink of water would do nothing to sooth that dry/hacky cough I get at bedtime after a cold. But it really does and really, I’m not inhaling the water.

    Also, I thought that those post infection coughs weren’t communicable…at least that’s what our pediatrician said. When you say infectious, do you mean that it still spreads virus/bacteria? Or are we only talking about coughs that one gets at the beginning of an infection?

    Sorry to be a pain. but it really does seem like things that sooth the throat (hard candy, etc) cut down on that dry coughing reflex thingy.

52. # Aliaon 12 Feb 2013 at 2:55 pm

    @mousethatroared “Sorry to be a pain. but it really does seem like things that sooth the throat (hard candy, etc) cut down on that dry coughing reflex thingy.”

    I agree, they seem to be helping me, too. Not as good as codeine, but very useful if I got a coughing fit in the cinema or while lecturing my students, for example.