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You can’t beat the common cold, and that’s a fact

>> Disclaimer: nothing in this post is meant to be taken as medical advice. Always consult your own provider.

For those of us dedicated to supporting science-based medicine and fighting the ever-widening reach of sCAM, pseudoscience, and health fraud, finding a new woo-filled claim or a dangerous, evidence-lacking trend to write about is relatively easy. Many of us may not realize, however, that some of the most commonly used and recommended treatments, one of which at least is probably sitting in your medicine cabinet as you read this, is equally devoid of evidence to support its use.

Every drug store has row upon row of medicines designed to treat or prevent an acute upper respiratory tract infection, otherwise known as the common cold. Despite this, very few are able to live up to their promise. In most cases, particularly where children are concerned, the side effects of these medicines can be worse than the symptoms they are intended to treat. Because I am a pediatrician, and because the evidence for cough and cold medicines (I will refer to them here as CCMs) for children is particularly absent and because adverse events due to CCMs are most frequently seen in children, I will focus mainly on this population.

The common cold – a (brief) overview

The term “cold” refers to a complex of signs and symptoms sharing similar characteristics but which may be caused by a variety of different viruses. Usually referred to by clinicians as viral upper respiratory tract infections (URIs), the very familiar features of the common cold include runny nose, nasal congestion, sneezing, cough, and sometimes sore throat and watery eyes. Colds may also be associated with systemic signs and symptoms, such as fever, chills, malaise, and body aches, though these are more typically seen in influenza, or “flu-like syndromes” caused by other viruses. At least 50% of colds are caused by rhinoviruses, of which there are approximately 100 serotypes. Other viruses that can cause colds include adenoviruses, enteroviruses, the respiratory syncytial virus (RSV), coronavirus, influenza and parainfluenza viruses, and human metapneumovirus (hMPV). Rhinoviruses survive best at the cooler temperatures found in the nose as opposed to the warm depths of the body, which is why the primary signs and symptoms of infection occur there. Other viruses can cause disease more systemically, and therefore are capable of producing more severe illness. The typical cold worsens for the first 3-4 days, plateaus for 1-2 days, and then improves over another 3-4 days. Most colds have resolved or significantly improved by day 7-10 of the illness.

An illness begging for a cure

Despite the relatively brief, self-limited, and generally benign nature of colds, they can be extremely uncomfortable nuisances, resulting in a staggering number of missed days from work and school. It is not surprising that many people are willing to try and pay for almost anything to relieve the annoying symptoms of the common cold, resulting in an estimated expenditure of close to $3 billion for over-the-counter CCMs in the US annually. Almost everyone has a favorite over-the-counter (OTC) or home remedy for the common cold. My mother always started me on 1,000mg daily of vitamin C at the onset of any cold symptoms (usually in the form of acerola with rose hips). Unfortunately, notwithstanding all of the marketing, hype and near universal belief in at least some form of cold remedy, there is little to no evidence supporting the efficacy of most CCMs.

The lack of efficacy of CCMs is not surprising when one considers the pathophysiology of common cold symptoms. Those familiar and annoying signs and symptoms are primarily a result of our body’s own inflammatory response to the viral destruction of infected cells in our upper airway. By the time this inflammation has begun, the progression of the illness and the resulting symptoms is inevitable. Our immune system (with the exception of those with congenital or acquired immunodeficiencies) is usually quite capable of rapidly countering the upper airway invasion by these viruses with this robust (though uncomfortable) inflammatory response. Most of the anecdotally reported benefits of CCMs are likely attributable to the self-limited nature of colds – a result our body’s own ability to clear the virus and repair the damage.

Not only is scientific evidence for the efficacy of CCMs lacking, their use in children is responsible for significant morbidity and even mortality. Every year in the US, over 7,000 children under the age of 12 are brought to emergency rooms as a result of an adverse event from a CCM. This is largely a result of incorrect dosing or frequency of administration. One study demonstrated that only 30% of parents were able to both accurately measure and correctly dose OTC CCMs for their child. Also contributing to the occurrence of adverse events is the fact that many children’s CCMs are “multi-symptom” products, containing several different drugs. When parents give more than one medication to their child simultaneously, they may be inadvertently overdosing at least one of these components. For example, many “multi-symptom” CCMs contain acetaminophen as a fever reducer. Unaware of this, parents often simultaneously give their children acetaminophen as a separate medication, resulting in potentially dangerous overdosing.

Common treatments for a common illness

By far, the most common diagnosis I make each day in my practice as a pediatrician is “viral URI”, otherwise known as the common cold. And every day, many times per day, I am asked by parents what they can give their suffering child to make them better faster. And every day, many times per day, my advice is far from modern or high-tech. That is because I am trying, as best as I can, to limit my advice to that which can be supported by the best science-based evidence. Too often, that leaves parents dissatisfied and sometimes even frustrated or angry. Some parents are thankful, however, for my honesty and for staying true to my oath to “first do no harm”. But the number of children who are prescribed or who are given OTC CCMs in the US is truly staggering. Every week approximately 10% of children (that’s over 82 million according to the 2012 US census) take these medicines without evidence of efficacy, and at significant risk.

In October of 2007, concerned about the lack of evidence supporting the efficacy of CCMs in children, and out of a growing concern about the safety of these products, the FDA’s Nonprescription Drugs Committee and Pediatric Advisory Committee unanimously recommended against the use of CCMs in children under 2 years of age. In response, US manufacturers voluntarily withdrew those products marketed for infants under age 2. In 2008, manufacturers revised their labeling to warn against use by children under age 4. Though a majority of the original FDA Advisory Committee members voted against the use of CCMs in children under age 6 years, the FDA has not yet officially ruled on that recommendation. The American Academy of Pediatrics, however, has officially recommended against their use in children under 6 years of age.

Even though the majority of randomized controlled trials show no difference in endpoints when CCMs are compared to placebo, and despite the potential for serious adverse events, these products remain ubiquitous on pharmacy shelves, and parents and many pediatric practitioners still turn to them for treating colds in children. Though the labeling changes noted above have resulted in a significant decline in reported adverse events from CCMs in children under 4, their use remains high.

The A-to-Z of OTC CCMs

Analgesics/antipyretics
In my practice, I find that parents frequently give acetaminophen or ibuprofen to their children with colds as if it were some sort of cure-all elixir. Although they may help with fever or muscle aches, they do not affect the upper respiratory signs and symptoms of a cold. Acetaminophen may actually suppress virus-neutralizing antibodies, potentially prolonging viral shedding and cold symptoms.

Antibiotics and antivirals
Being caused by viruses, it should be of no surprise that antibiotics do nothing for treatment of the common cold. There are upper respiratory tract infections for which antibiotics may be indicated, for example some ear and sinus infections, which are potential complications of colds. However, what we all know as the common cold is not treatable with antibiotics. Unfortunately, treatment of colds with antibiotics is not uncommon, and has contributed (along with the addition of antibiotics to livestock feed) to the very dangerous reality of antibiotic resistance. But that is a topic for another post.

There are major obstacles to the development of an effective antiviral agent for colds. These include the enormous number of viruses and virus serotypes that are known to cause colds, and the ease with which these viruses mutate and thus potentially evade any drug with which they may interact. For similar reasons, the development of a vaccine against the common cold remains elusive. One antiviral agent, pleconaril, has shown some promise in preliminary studies (mostly in adults), but was rejected by the FDA in 2002 due to its poor side effect profile.

Antihistamines
Some studies have demonstrated a modest decrease in sneezing and runny nose with the use of antihistamines in adults. While these drugs are helpful for the treatment of allergies, the signs and symptoms of which can resemble a cold, they have not been found to be effective when used to treat colds in children. Many OTC products marketed for use in children as “multi-symptom” cough and cold medicines contain first-generation antihistamines, which can have significant anticholinergic side effects. These can include gastrointestinal upset, dry mouth, increased heart rate, and even cardiac arrhythmias, central nervous system depression (or excitation), hallucinations, and respiratory depression.

Antitussives (cough medicines)
When I was training, I was taught never to treat a cough because coughing is a protective mechanism which clears the airway of mucus and pathogens. At that time, however, we weren’t aware that it probably didn’t matter, since no cough medicines have been shown to actually work better than placebo. But because they do contain drugs, however, they can have potentially serious side effects.

Dextromethorphan (think Robitussin-DM) is one of the most common “cough suppressants” on the market. It is a narcotic derivative which, when dosed correctly, has a low potential for side effects. At higher doses, however, it can have serious effects on the central nervous system, including hallucinations and dissociative states. Because of this, dextromethorphan has become a drug of abuse. Unfortunately, it doesn’t actually work. In a 2004 study, neither dextromethorphan nor the antihistamine diphenhydramine was found to outperform placebo at improving nighttime cough or sleep difficulty in children with colds. Other studies have shown that increasing the dose of dextromethorphan does not improve its efficacy, and can result in an increased risk of side effects. There is some evidence that dextromethorphan may even be responsible for some infant deaths.

Codeine has been used for a long time to treat cough in children despite no evidence that it is actually superior to placebo for this purpose. Codeine is an opioid compound that is converted in the liver to morphine, its active metabolite. Central nervous system effects of codeine are well described, as are serious, sometimes deadly events in infants and children. Individuals who are genetically predisposed to rapidly metabolize codeine into morphine are at particularly high risk of serious adverse events from the use of codeine-containing products. The American Academy of Pediatrics recently reaffirmed its prior policy statement that there are no well-controlled scientific studies to support the efficacy and safety of codeine for the treatment of cough in children, and that the use of codeine-containing products should therefore be avoided.

Aromatic vapor therapies
Vapor therapies containing some combination of menthol, camphor, and eucalyptus oil (such as Vicks VapoRub) are commonly used to treat cold symptoms in infants and children (though they are not recommended for use in children under the age of 2 years). These products are typically placed on the chest, neck, or under the nostrils (I have also encountered parents who swear by placing it on the soles of their infant’s feet). One study looking at inhalation of menthol vapor in school-age children showed no improvement over control in terms of cough or nasal airway flow or volume, though interestingly there was an improvement in the perception of nasal patency. Another study of colds in school-age children compared Vicks VapoRub, petrolatum, and no treatment. Parents gave Vicks the highest score in improving their child’s night time cough, congestion, and sleep difficulty. For obvious reasons this was not a blinded study, and the survey results should be interpreted in that light. After treating an 18 month old child with severe respiratory distress believed to be triggered by the application of Vicks VapoRub under her nostrils, a group from Wake Forest University School of Medicine studied the effect of this product on an experimental animal airway model. They found that Vicks increased mucin secretion and tracheal mucociliary transport velocity, and decreased ciliary beat frequency. Based on their findings, the authors hypothesized that Vicks may actually lead to mucus obstruction of small airways and increased nasal resistance to air flow.

CAM
There are so many so-called complementary and alternative therapies that are claimed to prevent and treat colds that I cannot possibly do justice to a discussion of them all here. I do discuss Echinacea below because this is the most commonly used and most studied CAM modality for treating colds. I will not even discuss homeopathy as there is no scientific plausibility for its efficacy.

Decongestants
These drugs (pseudoephedrine and phenylephrine) act on the sympathetic nervous system to cause constriction of capillaries, thereby decreasing swelling of the nasal and sinus mucosa. In adults, pseudoephedrine has been shown to decrease mucus production and runny nose. Similar evidence has not been demonstrated for phenylephrine, even though this drug has been steadily replacing pseudoephedrine in many products. This is because products containing pseudoephedrine can now only be sold at the pharmacy counter in an effort to prevent their use in the production of methamphetamine. There are no studies demonstrating the efficacy of decongestants in children, and dosing has been extrapolated from adult trials. One study by Hutten et al. and another by Clemens et al. found no difference between an oral antihistamine-decongestant combination containing phenylephrine and placebo. There are no studies on the use of pseudoephedrine in children. Unfortunately, the action of these drugs on the nervous system can produce serious side effects, including elevation of blood pressure, sleeplessness, headache, nausea, vomiting, and even cardiac arrhythmias and seizures. One drug once commonly used in OTC cough and cold medications, phenylpropanolamine, was taken off the market in 2000 because it could cause potentially fatal intracranial hemorrhages.

Echinacea
Echinacea is frequently touted as an effective, natural cold remedy. There are many published studies on the use of Echinacea for both treating and preventing colds. Most of these studies have significant methodological flaws. They also utilize different parts of the plant and at different doses, have produced conflicting results, and are difficult to interpret as a whole. The highest quality study to date, however, demonstrated no benefit over placebo in treating or preventing symptoms of the common cold in young adults.

Expectorants
Guaifenesin is the most common drug marketed as an expectorant. These agents purportedly work by drawing water into mucus, thinning it out and thus aiding clearance from the airway. It is found in products such as Mucinex, Robitussin DAC, Benalyin, and DayQuil mucus control. In one study, adults with colds reported subjective improvement in the thickness and quantity of sputum, but no decrease in cough. There are no studies demonstrating the efficacy of guaifenesin in children.

Honey
Perhaps the most promising treatment for cold related cough in children is turning out to be the golden sweet elixir, honey. In a well-designed, randomized, partially double-blind study, children receiving buckwheat honey showed significant improvement in cough symptom score compared to those receiving dextromethorphan or placebo. Another study demonstrates that honey given at bedtime was more effective than placebo in reducing the frequency and severity of nighttime cough. This was true whether the honey administered was eucalyptus, labiatae, or citrus honey. A criticism of other studies looking at the efficacy of honey has been the lack of a similarly sweet and viscous control group. In this study, the placebo compound was made from dates, and had similar sweetness, appearance, and texture.

>> Note: it is important to remember that honey should never be given to infants under 12 months of age due to the risk of botulism.

Probiotics
Probiotics have been in the news quite a bit lately for a variety of applications, including for the prevention of colds in children. A study of young children at a day care center in China found that those who received daily Lactobacillus acidophilus NCFM for 6 months had lower fever and less runny nose and cough during colds, as well as shorter colds and a reduced chance of being prescribed an antibiotic compared to those receiving placebo. Study children also missed fewer school days during colds. A recent Cochrane meta-analysis of randomized controlled trials exploring the use of probiotics in children found that they may significantly reduce the likelihood of developing a cold or requiring an antibiotic. One criticism of this analysis was the heterogeneity amongst the studies reviewed for the primary outcome of number of colds in children. It was also unclear which probiotic might be conferring the protection from colds. It was suggested that the heterogeneity of the study outcome findings might be due to the fact that the immune-modulating effects of probiotics are likely to be species- and strain-specific. The current consensus is that more data for specific probiotic species and strains is required before generalized recommendations can be made.

Saline nasal sprays and washes
Perhaps the most commonly used treatment for colds in infants is the application of saline drops and sprays to the nasal passages, often followed by bulb suction. Though this is not likely to result in anything more than transient improvement in nasal obstruction, one study looked at symptomatic relief during a cold as well as prevention of colds in children receiving instillation of nasal saline wash. Their result showed significant improvement in sore throat, cough, nasal obstruction, and secretions when given as treatment for a cold, as well as fewer illness days, school absences, and complications in children receiving the saline as a preventative.

Zinc
While zinc has the ability to inhibit rhinovirus replication in the test tube, clinical trials for the treatment of colds have been disappointing. While there was a very modest improvement in symptom score in one study of adults, the benefit was seen only when zinc was taken in large doses 5-6 times per day. At these doses, GI side effects were significant and patients complained of a bad taste in their mouth. Needless to say, 5-6 times per day dosing with these side effects would preclude this as a viable option in children. Additionally, a well-designed, randomized, double-masked, placebo-controlled study demonstrated no effectiveness of zinc on cold symptoms in children and adolescents.

Prevention is the best medicine

The common cold is caused by a large number of different viruses and virus serotypes, and these viruses mutate rapidly in the human host. This makes finding effective treatments and vaccines elusive. Since finding a cure for the common cold is unlikely, the best approach is to prevent infection. Spread of inflection occurs primarily via aerosol droplet (from sneezing and coughing) or by touching a contaminated object or person and then auto-inoculating oneself (by then touching the nose or eyes for example). There is scant evidence to support any dietary or medicinal prophylaxis for the common cold. If one existed, it would need to be taken chronically to be effective, and the risk-benefit ratio would have to be very low. The best way to prevent the common cold is to limit transmission. That means frequent hand washing, staying away from others as much as possible when sick, and avoidance of those with colds. The now-ubiquitous use of alcohol-based hand sanitizers does not prevent secondary transmission of colds due to rhinovirus (the most common cause of colds in children), and “antibacterial” soaps (usually containing triclosan or triclocarban) have no evidence of efficacy for preventing colds, and are now under close scrutiny by the FDA.

Modern medicine is sometimes quite limited in its capabilities. We need to be honest and humble when faced with these limitations. This, ultimately, is what distinguishes science-based medicine from pseudoscience and belief.

Posted in: Pharmaceuticals, Science and Medicine

Leave a Comment (73) ↓

73 thoughts on “You can’t beat the common cold, and that’s a fact

  1. windriven says:

    The Chinese study is, of course, a single study but the results are pretty impressive:

    “Relative to the placebo group, single and combination probiotics reduced fever incidence by 53.0% (P = .0085) and 72.7% (P = .0009), coughing incidence by 41.4% (P = .027) and 62.1% (P = .005), and rhinorrhea incidence by 28.2% (P = .68) and 58.8% (P = .03), respectively. Fever, coughing, and rhinorrhea duration was decreased significantly, relative to placebo, by 32% (single strain; P = .0023) and 48% (strain combination; P < .001). Antibiotic use incidence was reduced, relative to placebo, by 68.4% (single strain; P = .0002) and 84.2% (strain combination; P < .0001). Subjects receiving probiotic products had significant reductions in days absent from group child care, by 31.8% (single strain; P = .002) and 27.7% (strain combination; P < .001), compared with subjects receiving placebo treatment. "

    I was able to find a couple more recent studies that find similar benefits.

    I wonder if anyone has proposed a reasonable mechanism of action?

    1. windriven says:

      Sorry, early in the morning here. The penultimate sentence above should have read

      I was able to find a couple more recent studies that found similar benefits here and here.

      1. mousethatroared says:

        Hey Windriven, your second link’s not working, by the way.

        I’ve read some really interesting studies on probiotics and prevention or symptom relief of various illnesses. I haven’t read this one yet, though. The problem generally is, the studies mostly seem to be done with specific amounts of specific organisms. The participants are often consuming a serving or more of the probiotic material (usually yogurt) daily. But going out and buying yogurt that you know contains those particular organisms in that amout appears to be kinda difficult. There are purely probiotic products that list the organism. But, because they DSHEA products, the reliability is not good, I’ve heard testing has shown they often don’t contain what they say.

        But, I’m not a probiotic expert. Maybe I am missing something.

        Kinda a bummer :( Maybe we’ll see better probiotic testing and availibity, as needed, in the future.

        1. windriven says:

          Don’t know why the link failed – probably because I hate HTML and it hates me back ;-)

          But any interested party can search PubMed with using rhinovirus and probiotic – I think that’s what I used.

          1. mousethatroared says:

            I hate it more…really isn’t there an app for that yet?

            thanks for the search term!

            Since September I suspect I have had cold symptoms more days than not. If I could find a reliable preventative or symptom relief, that doesn’t have atrocious side effects, I would be all over it.

        2. Denise says:

          I’ve been curious about taking probiotics on a daily basis. If they colonize the gut as is claimed, why do you have to keep taking them?

          Personally, I took three whole bottles of progressively more expensive pills last year following some antibiotics, with no improvement at all to my digestive symptoms. Sometime after that I ate quite a bit of ordinary supermarket yogurt – not for therapeutic reasons, just because I was in the mood for it. The yogurt seemed to have had a positive effect that the pills didn’t. And the last bottle of pills supposedly had 8 strains and cost $22.

          1. WilliamLawrenceUtridge says:

            I recently bought a bottle of probotics that cost $40 and contained five milliliters of fluid. That’s eight bucks per mL. Outrageous! And I couldn’t get the last mL out of the bottle! The difference being, this bottle actually advertised, without the quack miranda warning, explicit benefits, and was for a strain of bacteria that pubmed indicated had considerable research behind it (Lactobacillus reuteri Protectis).

    2. Paul Beach says:

      In the discussion section:

      “Regarding the potential mechanisms through which the reductions in respiratory symptoms and antibiotic usage could be explained, an immune-enhancing effect is a likely explanation, because numerous studies with various probiotic bacteria have demonstrated their ability to modulate immune responses through interactions with toll-like receptors.15–17 Winkler et al18 showed that a probiotic combination combined with vitamins and minerals reduced the duration and severity of common cold symptoms and also enhanced cellular immunity. Importantly, some of the rationale for choosing the strains in this study was based on a demonstrated ability to stimulate dendritic cell regulatory functions.19″

      1. windriven says:

        Molecular biology is to me as statistics is to mouse. I never took so much as a single semester in school so the ignorance is self-inflicted.

        1. mousethatroared says:

          Windriven, you can’t compare a lack of one class in high school or college to my monumental lack of math skills.

          I have been working on my poor math skills since elementary school, when teachers would alternately deride me for not trying and pity me for my incredible lack of “getting it” when I did try. This, along side my tendency to transpose numbers and symbols (say or write 57 when the actual number is 75 or substitute plus for minus, etc.) Lead to a school career where I managed to get mostly C’s in the lowest math classes available, while not learning one thing. Not, I think, because the teachers were lazy and ‘passed me along” but because it was genuinely painful for a math competence person to watch me attempt to figure out a problem. They might try to explain a problem, but soon they would be grimacing and turning red and I would never hear from them again. They just want it all to stop.

          I will admit, there was a brief time, were I broke protocol and achieved an A in geometry theorems. The only semester which incorporated words into the curriculum. (I remember it well) That soon passed. No one was surprised at the subsequent decline of math skill. I received much support in becoming an artist and never going near a math textbook again (at least when anyone was watching).

          So, for me, ignorance of statistic is not so much self-inflicted as self-defense.

          Now I cut up math textbooks and shape them into representations of living creatures and plants…go figure. It’s all very personal narrative. Sometimes engineers and scientists see my work and think they have met a kindred spirit. How do I tell them, not so much?

          Sorry for the unrequested autobiography, I’m procrastinating cleaning my studio.

          1. goodnightirene says:

            Oh, Mouse, you stole my biography! I feel sure that if I had a brain scan, the math lobe would be missing completely. I have been kicked out of Algebra three times into below 100 level courses,from there into “special” classes, and then into private tutoring, which only resulted in some poor grad student tearing his hair out.

            And I can’t draw either.

            1. mousethatroared says:

              Ha, nice to know I’m not alone. I’ve often wondered if there’s some sort of faulty fuse in my brain.

    3. Andrey Pavlov says:

      @windriven:

      I have difficulty trusting anything coming out of China. There is way too much evidence of them actively tampering with data, publishing garbage intentionally, literally paying people to write anything just to increase the number of publications coming out of China, and having poor research practices and methodologies at baseline on all research (not just acupuncture and TCM). For me, the prior probability that a study is in some way significantly flawed is just so high that anything that seems even mildly surprising seems unlikely to be true and not worth my time to dissect and discover if it really is or not. It actually sucks, because no doubt there are bound to be some interesting and useful studies out of China that I will totally miss out on and discount, but the odds of wasting my time separating the wheat from the chaff is just too high.

      To be clear it has nothing to do with it be China specifically (i.e. not racism). It is just a reflection of the reality of things.

      1. windriven says:

        I lived in China for a couple of years and I certainly understand your skepticism. It is a fascinating culture but in some ways so alien that it rankles. Rumor and fact are often weighted similarly in decision-making processes. Actions that we would consider grossly unethical – like tweaking data to better approximate the desired outcome – aren’t as reviled as they are here. Connections and teacher-student relationships can dwarf facts and principles. That is why I included the two more recent (non-Chinese) studies as they showed similar results.

      2. Helen says:

        See if the study has been replicated in Japan. Japan and China compete with each other in medical research, so Japanese researchSouth Korea may also be a source of verification. Basic research is drastically underfunded, but there are a lot of studies on what happens when innovative therapies interact with real patients and doctors.

        South Korea may also be a source for research as a traditional Korean diet contains many probiotic foods, and these are heavily regulated which means research into which bacteria are healthy, which are harmful, and what conditions encourage healthy bacteria.

        Another question is which probiotics are in the study. There are many different kinds of bacteria in our bodies.

      3. WilliamLawrenceUtridge says:

        Questioning the record of Chinese publications might not be as racist as one might fear; Fang Zhouzi won the John Maddox Prize from Sense About Science for dedicating much of his time to exposing incompetence, fakery and fraud in Chinese science and popular science, and he goes into the systematic incentives that exist to make such questionable practices more likely. Fervent nationalism and the bruising fall from being the most advanced nation in the world for over two thousand years don’t help. Joseph Needham’s work is most humbling for anyone with European roots. Simon Winchester wrote a fantastic biography of the man, very entertaining.

        1. Sawyer says:

          Yet another topic I’m dying to see a SBM post on! What countries have the best track records of publishing reliable research, and why do some fall behind? I think everyone is vaguely aware that acupuncture/homeopathy have their strongholds, but what about bias in mainstream research?

          I’ve heard rumors from both Chinese and Korean grad students that expectations of scientists are “different” back home. I’ve never got a clear explanation of what that entails.

  2. goodnightirene says:

    The plethora of products–especially for children–for colds can only be attributed to , just about the most evil thing ever unleashed on a rather unsuspecting population (I was going to say ignorant population, but I hate to blame the victims).

    Other things seem to have changed as well, but I’ve learned here not to take my perceptions at face value. My kids has a cold or two per school year, but now I hear the neighbors and grandkids tell me about a state of pretty much constant illness throughout the school year with many sick days. I’m not sure how to find data about this and maybe modern parents just pay more attention to their children’s symptoms since they see stuff all over the stores to “treat” them with.

    Anyway, these products simply didn’t exist when my children were young and so we smeared on some Vapo Rub, gave a dose of honey (glad to hear that one has stood the test of science), read an extra story, and brought lots of tea and water (with a straw!) to the bedside. We didn’t allow TV for kids who were home from school (books were allowed), and found that we seemed to have fewer sick days than people who did.

    Last time this was a topic, I looked at kids cold remedies and found myself rather in shock t the prices–no wonder both parents have to work. Sadly I also saw numerous parents loading their baskets with this junk–including the dreaded Os…?—-the duck liver stuff, can’t spell it off the top of my head.

    1. mousethatroared says:

      What? What?! Is the most evil thing unleashed on an unsuspecting population?

      1. windriven says:

        My bet is television with its constant marketing directed at children.

        1. mousethatroared says:

          Oh, of course. One of the four horsemen of the apocalypse. TV, the Internet, College Sports and RoboCalls

          1. goodnightirene says:

            It said MARKETING (I tried to make it BOLD, but it disappeared instead).

            I can’t do much with computers either!

            (Marketing is evil! It exists for the sold purpose of making people want things they don’t need through psychological manipulation. Evil.)

            1. mousethatroared says:

              Ahhh, marketing. That fits too.

    2. windriven says:

      “gave a dose of honey”

      My grandmother was big on tea and honey and on homemade chicken soup. Hers was a stewy version, thick with rice and studded with mushrooms, and seasoned with a liberal amount of saffron. I don’t think either did much to hasten the cold along but they certainly made the cold more tolerable.

      1. goodnightirene says:

        We like our honey straight up, but it’s also good in a hot toddy, which we also gave the kids (with literally a half a thimble of whiskey).

        I favor the kind of chicken soup that is more like the Campbell’s type, but way better. But your Grandma’s sounds awesome and delicious! The old man absolutely HAS to have Mrs. Grass’ out-of-the-box- with-40,000-grams-of-salt- per-serving when he takes to his sick bed.

  3. Kel says:

    I know children go through periods of having frequent colds. I have a 7 year old girl and she has been pretty healthy but there were few winters that it seemed like back to back colds – last year being one of the worst. She missed an entire week of school (and strangely, when I called her in sick I got alot of push back from the school – but I as her mother and caretaker I used my best judgement to keep a miserable first grader home). I basically just medicate her aches and pains and discomfort from fever with ibuprofen and she likes sweet warm herbal tea to soothe a cough and sore throat – we also use a humidifier and lots of warm baths.

    I am curious if these cold-causing viruses mutate enough to be significantly different from region to region, because we did move about 1000 miles from our old home last winter. I was sick with colds, including a few bad ones lasting over a month, from January until May. As soon as I thought I was getting better I would get another one. I was much sicker than everyone around me who probably had the same viruses. Is this because my immune system was naive to the new environment?

    1. Allen says:

      I lived in Massachusetts for 17 years and then moved to Utah 20 years ago. I haven’t had a cold for over 20 years, and it doesn’t appear like my change of location has caused me to get more colds. I’m 78 years old.

  4. Allen says:

    I’ve been running for over 40 years, including marathons in my mid-40s. I realized one day that I no longer got colds. During my years of running, I’ve noticed that the only times I get a cold is when I overtrain and increase the stress of running beyond my body’s ability to handle the stress, or when I get insufficient sleep at night. Before I started running, I would get several colds each year.

    I have good health and take no prescriptions. I try and eat a balanced diet but take Juice Plus to compensate my my dislike of many vegetables. I’m 78 years old.

    Why don’t get colds anymore? I don’t know, but I don’t. I’m continuing my life-style, under the philosophy that if it works don’t mess with it.

  5. Mika says:

    How about a similar article from the adult’s (you know, the usual readers of SBM) point of view, or are we supposed to think that studies that show little or no benefit in children can be taken to say the same for adults as well? What about potential side effects, if they are strong enough to be a contraindication in children does that mean adults shouldn’t use the same therapy as well?

    1. Vicki says:

      Steve Novella wrote one, a few years back: http://www.sciencebasedmedicine.org/treating-the-common-cold/

      (I found this by entering “codeine” in the site search bar.)

  6. DJDenning says:

    Here’s the spiel I gave about 8000 times in my years as a retail pharmacist:

    “For a sore throat, gargle with half a teaspoonful of salt in a cup of warm water and take Tylenol or Motrin for pain. For a cough, you can take Robitussin or DM, though coughing is your body’s natural mechanism to clear your chest, so I recommend taking something at bedtime so you can sleep, and just let yourself cough in the daytime. Try some tea with lemon and honey. Tylenol and Motrin also work for a fever and be careful not to take too much of those. Otrivin nose drops for stuffy nose. See your doctor if your cold doesn’t seem to be clearing up after several days, or you experience high fever, bad cough, pain in your sinuses and your upper teeth.” Blah blah. I never liked the combination products because they don’t make any sense. Robitussin DM? A supposed cough suppressant + an expectorant? WTF?? I encourage people to buy single-ingredient products, though many people are damn nostalgic about their Neo-Citran or NyQuil.

    I used to talk healthy young people out of taking antibiotics for colds, though a couple of doctors told me I was playing a dangerous game.

    Currently, I am in the 2nd day of a raging cold. I use Otrivin for the stuffy nose, and for my throat that is raw as a steak, some ibuprofen 300 mg q6h or so and the salt gargles. And currently I am enjoying a throat-soothing glass of Guinness, which I will repeat prn.

    1. goodnightirene says:

      I’ve always been a fan of the good ol’ salt water gargle for sore throats–and I had frequent strep throat as a child until I had my tonsils out at sixteen, so I know about sore throats. The gargle, followed by a hot toddy (whiskey, fresh squeezed lemon, honey, hot water), is still my treatment of choice.

      Sadly, I haven’t had a cold for many years (even though I quit running) and it took me a few years to figure out I could just go ahead and have a hot toddy anyway!

      1. DJDenning says:

        Have you heard of the whiskey cure? You put a hat on the bedpost, and drink until you see two hats, then go to sleep (aka pass out). When you wake up, your cold is gone.

  7. Jessica says:

    Great information. I have a three year old boy, and one thing I’ve definitely learned is that I’m often more uncomfortable at the thought of his discomfort, than is his actual state of comfort.

    A few months ago, both he and I were sick with sore throats. That was definitely hard, there was very little I could do but give him foods/liquids that were easy on the throat and reserve the Tylenol for sleep disturbances, if any. Of all the things I tried, it was an act of distraction that worked the best: I fixed him “tea”, along with myself (something lemon/honey-ish) and cozied on the couch with him. He never actually drank the tea, but he so loved the idea of it that he temporarily forgot his discomfort.

    1. DJDenning says:

      A friend tells this story during cold and flu season: he had a little brother about 20 years his junior who developed a bad cold when they were visiting family out in the country. The little boy’s distress ramped up over the day, and by the evening, he had a high fever and was sobbing and dyspneic. They found the number for an old country doctor, who came to the house, examined the child, and prescribed half an ounce of whiskey in a glass of the boy’s favourite juice.

      As my friend tells it, if you give half an ounce of whiskey to a four year old, his body goes, “Whoa!” He slept solidly, and by the morning had no fever and just a slight snuffly nose.

      The family figures the doctor made a diagnosis of a not very physically ill child who was suffering from acute psychological distress because he was four and had a bad cold. Not that I recommend booze for wee kids, but it works as well as anything in the cough and cold section.

  8. Frederick says:

    I just came out of a week and a half of Cold, with 5 day of bad coughing, mucus and all. I used Buckley day pills and Nyquil pill for the night. I wanted that couching to stop, i had hard time sleeping because of it. I always tough it worked. Well At least liquid Nyquil feel good on soar throat and knock you out, so you can sleep. Anyway that’s a great read. I always thought they worked, although during a couple of nights during last week, when i was coughing bad, i began to doubt that, at least for 2 night i didn’t feel any reduction in coughing. In the day buckley seemed to work, againg that might ave been placebo just my perception.
    One thing that help my throat and coughing was Fisherman friend original extra strong. it worked for the time it stay in you mouth. And of course tylenol and motrin for headache. other that that i’m flushing all those drug out of my cold remedy.

    Thank for that, another win for science! :-)

    1. Frederick says:

      I’m surprise with honey result, That is good to hear i LOVE honey! On a toast with butter :-) huum or on a pancake hehe. Well that’s one article we won’t see CAM believers coming up saying “you are big pharma chill! you want people to buy POISON… oh wait… what honey?.. »

      So basically there is nothing to do but to wait, of course for Kid you can always give them something to cheer them up and comfort them that you are helping them.

      1. Sawyer says:

        Mark Crislip has mentioned this oddity several times in his podcasts. I’ve been wary to trust him though, because he is clearly a shill for Big Apiary. I think we can all see that John Snyder has also been corrupted by the bzzzzzness of medicine.

        1. Frederick says:

          Yeah they are the worst.. they have agents buzzing everywhere. be really careful when you talk against them… i’m pretty sure they use nanotech to mutate bees with cybernetic microphone…
          they might be behind you RIGHT NOW! :-)

  9. Chris says:

    You forgot intranasal interferon ;). Not that anyone outside of a research lab is doing that.

  10. Birdy says:

    Interesting to see honey has some effect.

    There’s a company local to me – Honibe – that’s been getting some press lately about their solid honey products being explored to use for drug delivery. Their new factory has a lab for looking at medical uses of their products. Thought it was interesting to see in the news.

    The solid honey lozenges/drops are really lovely when you have a sore throat. My kids love them too and giving them what amounts to candy when they are sick makes it a little less unbearable for them.

  11. DJDenning says:

    I had a Guinness on Friday night, and two last night, and today my cold is considerably better! This is definitely hypothesis-generating and calls for a randomized controlled trial, with maybe a non-stout beer for the placebo group.

    1. Andrey Pavlov says:

      @DJDenning@

      Sign me up! I’ll be happy to be randomized to either arm.

      1. weing says:

        Samuel Smith’s Imperial Russian for me.

  12. MadisonMD says:

    DJDenning:
    About colds, I don’t know. However, I learned in med school that Guinness advertisements once claimed it to be good for influenza.

  13. Adam Haun says:

    What about bed rest? A lot of people (including my wife) still go to work when they’re sick. Is there any evidence that this prolongs a cold?

  14. windriven says:

    “Is there any evidence that this prolongs a cold?”

    Only for her coworkers.

  15. windriven says:

    @Mark Crislip

    I heard on NPR today that Alaska Airlines had to cancel some flights because so many of its pilots and flight crew were down with influenza. How many ways are you a dumbass if you don’t get the flu vaccine? Can you imagine how many people a virus shedding stewardess could infect in a day?

    As an aside, I got mine at my internist’s office this year. The 12 year old or so girl who gave me the shot went through a checklist of questions for me including, “have you ever had Jillian Bear syndrome?” I am not making that up.

    1. mousethatroared says:

      I suspect, Jillian Bear is a much cuter syndrome to have.

      Did they mention if the virus that the airline personel had was well matched to the flu vaccine?

      We had quite few kids very sick with a non-flu virus at my kids school. High fevers, very bad cough, etc. Although maybe that’s local.

      I haven’t heard reports yet on how well matched the vaccine was this year…but I haven’t made much effort to check it out.

      1. windriven says:

        It took me a few moments to translate the Jillian Bear thing – then I burst out laughing which, unfortunately, embarrassed and nonplussed the nurse (aide?). I explained that it was named after a couple of froggy doctors but I’m not sure it took.

        “Did they mention if the virus that the airline personel had was well matched to the flu vaccine?”

        They did not, mouse. What struck me about the report was that many healthcare institutions are pretty aggressive about getting staff to vaccinate. But there are many other careers that place people in close contact with lots of others: flight attendants, waitstaff, etc. I don’t know why vaccination isn’t part of the terms of employment for those with close contact with the public.

        1. mousethatroared says:

          Maybe the airline just figure that the 3 or 6 flight attendants are a drop in the bucket compared to the rest of the 150+ people on the flight + the previous people on the plane.

          1. brewandferment says:

            maybe airline personnel mix it up with so many people from such a variety of localities (both crew overnight locations and passenger points of origin) that effectively vaccinating for influenza varieties gets to be a logistic nightmare? (although how it could be worse than canceling flights or rerouting crews, hard to imagine)

  16. mousethatroared says:

    …Although I have a family member who is a pilot and a complete clean freak who would be perfectly happy to require the passengers to have flu shots before flying.

  17. windriven says:

    Maybe. I say: jab ‘em all ;-)

  18. luke1985m says:

    If this article is not to be taken as medical advice, then what is it purpose for? Your telling people that drugs dont work yet you insist to not listen to what you wrote. If you are talking to anybody you are making inpact on their minds, if they are to believe you and the outcome will be the same as a standard doctors advice, which says:
    “Eat this drugs, they will help you”. You say “this drugs wont help you”, and for a person who has the ability to think – the logical implication is that it is pointless to take them. This results in a contradiction.
    Unless somebody is really stupid he will see that you are denying yourself. And how anybody will trust a person who denies himself?

    1. windriven says:

      “If this article is not to be taken as medical advice, then what is it purpose for?”

      SBM is a site dedicated to the practice of medicine based on a solid scientific foundation. It is not a place to get personal medical advice on the cheap. Tune in Mehmet Oz if that is what you are looking for.

      “Your telling people that drugs dont work yet you insist to not listen to what you wrote.”

      Huh? This post was about the ineffectiveness of OTC cold remedies. They are ineffective. Don’t take them. If you have a physician telling you to take one of these for routine treatment of a common cold you might want to consider changing physicians.

      “Unless somebody is really stupid he will see that you are denying yourself. And how anybody will trust a person who denies himself?”

      I have absolutely no idea what this is supposed to mean. If you could rephrase perhaps someone can figure it out.

    2. WilliamLawrenceUtridge says:

      Luke, this touches on the point that while individuals are often wrong, collectively science tends to get it right. In other words – when your doctor says “here, take this cough suppressant and mucus thinner”, they are not reflecting the best and most recent science. In part, this is because medicine changes quickly, and covers a huge breadth of material. Keeping fully up to date, in real-time, for all diseases a doctor might see (let alone all that exist), is basically a futile endeavor. Fortunately, for conditions like the cold, you don’t really need to because it’s a mild, self-limiting condition anyway.

      The article isn’t giving medical advice, it is providing consumer-level updates on the most recent information regarding the treatment and symptomatic management of colds.

  19. Kiiri says:

    I had the dreaded cold the week before Yule. Then dear hubby and 2 year old son got it right after the holiday. I will say there is nothing in this world that tears your heart than your snotty, crying, eyes watering, 2-year old waking up every hour just because he is miserable and can’t breathe and suck his binkie at the same time. I do admit scouring the shelves for something (anything) to help deal with the misery. Finally found some honey cough syrup (which was basically just honey) which has helped, along with motrin for the fever, and children’s generic zyrtec (as recommended by pediatrician). A little over a week in he is getting much better but still it is terrible. And the temptation to buy something just to be trying to make your child better is almost overwhelming. Cuddling in mommy’s big chair worked best though. Worked pretty good for mommy who got a pretty nice nap after two nights of sleep deprivation worse than when he was an infant. He was content to snuggle and watch baby TV while mommy snoozed.

    1. nancy brownlee says:

      Oh, honey, so sorry. Saline drops (warmed a little, to lukewarm) can help clear the sore little nose. Homemade slurpies- ice and fruit juice in the blender- help with fluid intake and lack of appetite.

  20. NorrisL says:

    The common saying for the common cold: If I treat your cold with antibiotics you will recover in a week. If I do not treat you at all, you will recover in 7 days.

  21. ken says:

    You got it wrong sorry. Have a look at the meta analysis of Zinc and you will see that it is proven to work both in the lab and in practice. Your reference to a 98′ study is a bit of joke actually.

    1. WilliamLawrenceUtridge says:

      Really?
      PMID 15693216, “There is no clear evidence that treatment with zinc or echinacea have any role in these infections.” From 2005.

      PMID 10801968, “We conclude that despite numerous randomized trials, the evidence for effectiveness of zinc lozenges in reducing the duration of common colds is still lacking.” From 2000.

      PMID 9361579, “Despite numerous randomized trials, the evidence for effectiveness of zinc salts lozenges in reducing the duration of common colds is still lacking.” From 1997.

      One meta-analysis from 2003, PMID 15496046, suggests efficacy, if given within 24 hours of symptom onset.

      Seems like, at best, there’s weak evidence based on three clinical trials only if adminstered within 24 hours. Zinc hardly appears to be a slam-dunk. Single, well-controlled, high-quality clinical trials can be far more illustrative than meta-analyses based on multiple flawed or low-quality clinical trials. And is it worth fever, coughing, stomach pain, fatigue?

      Curious all the studies are so old.

      1. ken says:

        You are still quoting old studies!
        Why not link to a 2012 meta analysis?
        http://www.ncbi.nlm.nih.gov/pubmed/22566526
        My point is that it works. It may not be an overwhelmingly great cure, but it does work. Furthermore, it stands to reason that it would be an extremely effective cure for people who are actually zinc deficient.
        I can’t understand why it is not being shouted from the roof tops! If you are getting frequent colds, check your zinc levels or take some zinc (with some caution with regards to side effects).

        1. Chris says:

          Um, because it was underwhelming: “We included 17 trials involving a total of 2121 participants”

          Wow. That is really not very convincing. Sorry.

          Here is an idea: make sure to get annual flu shots, wash your hands, sneeze into your elbow and don’t rub your eyes.

          1. WilliamLawrenceUtridge says:

            You’re missing the underwhelming part:

            The results of our meta-analysis showed that oral zinc formulations may shorten the duration of symptoms of the common cold. However, large high-quality trials are needed before definitive recommendations for clinical practice can be made. Adverse effects were common and should be the point of future study, because a good safety and tolerance profile is essential when treating this generally mild illness

            Results are tentative, risks are obvious. If this were a drug sold by Pfizer, ken would probably demand the FDA pull it. Maybe even shouting it from the rooftops.

            Heh, anyone see the first author? “M. Science”. Best name ever.

        2. MadisonMD says:

          Actually, the abstract is a bit misleading to claim 17 trials and 2121 participants. Only 8 trials and n=934 met criteria and pooled in the meta-analysis. The final result is that the meta-analysis showed a mean difference in symptom duration of -1.65 days (CI -2.5 to -0.81). There was no zinc testing in the studies (so not sure why Ken proposes this).

          Cochrane review also evaluated this here, with similar results using zinc lozenge high dose–at least 75mg per day– and notes that it causes bad taste and nausea as side effect. So, yeah, zinc looks like it will shorten a cold symptom by a day if you take a bunch of lozenges and have the side effects above.

          One caveat: some trials had no treatment control. So, some or all of this could be placebo effect.

        3. MadisonMD says:

          Lets reiterate what John Snyder wrote in his post:

          While there was a very modest improvement in symptom score in one study of adults, the benefit was seen only when zinc was taken in large doses 5-6 times per day. At these doses, GI side effects were significant and patients complained of a bad taste in their mouth.

          So I wonder what part of this Ken finds to be wrong? It seems to be quite similar to my review of his and Cochrane’s metaanalysis.

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