Cough and Cold Products

Coming into the cough and cold season, the Science-Based Medicine blog has posted an article concerning OTC substances for such. This blogger recommends that all parents read the article in its entirely. Below are the conclusions:

Despite a long history of reasonably safe use, there’s no evidence that traditional cough and cold products have any effectiveness in children. Mild side effects are not uncommon, and fatal side effects are exceptionally rare, but possible. Given that colds are generally mild and resolve on their own, and that no product has ever been demonstrated to have a meaningful effect on the duration of a cold, over-the-counter products, “natural” or not, are unnecessary for children. Rest, adequate fluid intake, and acetaminophen or ibuprofen for the feverish child, may be all that is required.

Homeopathic and other “natural” remedies have emerged as the only marketed alternative — not because they are effective, but because of regulatory double standards and loopholes allow the sale of these products without demonstrated efficacy (or even any medicinal ingredients at all). With the medicinal products pulled off the shelf, they’re the only game in town now. And while homeopathy is admittedly safer than restricted products, given there’s no medicinal ingredients, and they’re not effective, all you can expect are placebo effects. Are parents aware the substitute remedies are just sugar and water?

Pharmacists have some challenges to manage. They may be concerned that the “traditional” products they’ve recommended for years are gone, and embrace the new remedies, without pausing to look for the evidence. Others may rely on marketing, anectodal reports of efficacy, or just read the parent’s desire to have a product – any product, as justification for selling them. And in some cases, they may just recommend these products because it’s profitable to do so. As a pharmacist, I admit that it’s more time consuming and less profitable to reassure an anxious parent that the cough and cold product they’re seeking isn’t necessary. But it’s far more ethically acceptable to me than to sell a homeopathic nostrum or unproven “natural” remedy that has no demonstrated evidence of efficacy, just so parents have the illusion they’re doing something to ease their children’s symptoms.