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The cold truth about cold medicines

Thanks to a report last fall by safety experts for the Food and Drug Administration, we now know that over-the-counter cough and cold medicines are not only ineffective, but also potentially dangerous for young children.

What’s less known is that most of these medications are also ineffective for adults.

That’s right — ineffective, as in “don’t work.”

Yet annually we spend billions of dollars purchasing over-the-counter cough and cold medicines in the United States — an estimated $3.5 billion last year on cough medicines alone.

Why do we so feverishly believe that these meds will relieve our runny noses, sneezing and coughing? (Standard, generic pain relievers are all we need for the other two symptoms of the common cold: headaches and sore throat.)

“You’re often looking at the placebo effect,” says Mike Forte, a pharmacist at the University of Minnesota’s Boynton Health Services.

And a lot of aggressive advertising, he adds.

What the evidence shows
The evidence against the effectiveness of cough and cold medicines can be found in a series of review articles published by the Cochrane Collaboration. This nonprofit international organization recruits teams of independent scientific reviewers who sort through all the clinical trials on a particular medical topic. After eliminating poorly designed studies, the reviewers painstakingly examine the rest and come up with a conclusion about what those good studies show.

Here’s what they concluded in a series of review articles about the key ingredients in cough and cold medicines:

This is the only ingredient that Cochrane reviewers found to be modestly effective. When compared to a placebo, decongestants did relieve short-term nasal congestion in adults. But the relief was very small: Patients reported a 6 percent decrease in their symptoms after a single dose and only a 4 percent decrease with repeated doses.

Other research has shown that taking decongestants can actually worsen your cold symptoms. After a few days, these drugs frequently cause “rebound congestion” — a non-cold-related stuffy and runny nose that can take days to get rid of.

Because antihistamines successfully relieve the nasal congestion associated with allergies, people mistakenly think they’ll do the same for a cold. But histamine — the nasal secretion that causes the annoying symptoms of allergies — is not a factor with the common cold. No wonder, then, that the Cochrane reviewers found no convincing evidence that antihistamines do anything for cold sufferers. Maybe, maybe, they offer some relief from a blocked and/or runny nose when used in combination with decongestants, said the reviewers, but the evidence is poor.

Cough preparations
Whether over-the-counter cough medicines contain antitussives (cough suppressants) or expectorants and mucolytics (mucus thinners), the Cochrane reviewers’ conclusion was the same: The effectiveness of these preparations is, at best, “weak.”

Alternative treatments
Alas, alternative treatments for the common cold don’t fare any better under the independent glare of the Cochrane reviewers. Chinese medicinal herbs, Echinacea, vitamin C, and even steam inhalation were all found to be ineffective or to have insufficient evidence to support their use. The reviewers did say, however, that mega-doses of vitamin C might be helpful in preventing colds in people exposed to brief periods of extreme cold or physical stress or both (say, marathon runners and skiers), but they cautioned about generalizing from that finding.

So what can you do as you sneeze and cough your way through another Minnesota winter? “Basically, I tell people to drink fluids, get plenty of sleep, and if you’re running a fever, take acetaminophen — ibuprofen, if you feel achy,” says Forte.

And tell yourself daily: “This, too, shall pass.”

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