A Spoonful of Sugar: Honey More Effective Than Cough Medicine
September 15, 2010 Leave a comment
Although we continue to make remarkable advancements in the world of Western medicine, we still have not developed a successful treatment for the common cold. Perhaps one of the most notable and troubling symptoms of the common cold is cough. Cough accounts for close to 3% of outpatient visits in the United States. The cough is particularly disturbing at night, when it disrupts both patients’ and families’ sleep. Consumers spend billions of dollars a year on over-the-counter medications for cough – in spite of the lack of evidence that these medications are of any benefit.
Several studies have demonstrated the lack of effectiveness of diphenhydramine (Benadryl), and dextromethorphan (DM or DXM) in adult and children populations. One, published by the American Academy of Pediatrics in 2004, was a prospective randomized controlled study of 100 children ages 2 to 18 who were given dextromethorphan, diphenhydramine, or placebo for 2 days for a cough attributed to upper respiratory infection. The study demonstrated no difference in cough frequency, impact on child and parent sleep, “bothersome” nature of cough, or severity of cough. On the second night, all of these outcome measures improved for all treatment groups. Insomnia was reported more commonly in those who were given dextromethorphan, and drowsiness was reported more often in those who were given diphenhydramine. Refer to Paul et al., Effect of Dextromethorphan, Diphenhydramine, and Placebo on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents, for a detailed analysis of outcomes.
An interesting article published in 2007 in the Archives of Pediatrics and Adolescent Medicine, Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents, demonstrated in a single-night study of 100 children that all outcomes (cough frequency, cough severity, bothersome nature of cough, and child and parent sleep quality) improved with honey. In comparative analysis, honey was the most effective treatment for all outcome measures. Furthermore, honey but not DM was significantly superior to no treatment for nocturnal symptoms.
Adult studies have demonstrated similar results. An article published by Schroeder in BMJ in 2002, Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults, reviewed 15 randomized controlled trials that compared OTC cough medications to placebo in adults with acute cough due to upper respiratory tract infection. The conclusion was that 9 of 15 trials demonstrated active treatment was not better than placebo. The other six studies were of “questionable clinical relevance” due to small effect sizes, loss to follow-up, small sample sizes, and both reported and unreported conflicts of interest.
In light of these studies, the FDA is now considering placing restrictions on cough medicine because dextromethorphan abuse has increased dramatically in recent years, with a total increase of 73% from 4634 in 2004 to 8000 in 2008. Refer to an article published recently in American Medical News, Cough medicine abuse prompts FDA to consider restrictions, for more information about the FDA’s proposal. Of course, this is an aggressive initiative and will encounter heavy resistance from the pharmaceutical industry. Pharmaceuticals make a large profit from hundreds of colorful bottles in the medication aisle of the supermarket or local pharmacy which all promise to treat fever, myalgias, cough, congestion, sore throat, and several other symptoms. As the industry expands and develops newer bottles to fill the shelves, Americans are purchasing at an even greater rate. According to data from Mintel International, Americans spent $3.6 billion on over-the-counter cough, cold, and throat remedies in 2009, an increase of 1.7 percent from 2008.
An excellent article published in January 2010 in The New York Times, Tips to Treat a Cold or Flu, With Your Wallet in Mind, discusses some of the most effective treatments for the common cold, which include acetaminophen (Tylenol, ibuprofen (Motrin), nasal saline solution, humidifiers, hot showers, rest, tea, and chicken soup. Whether or not the FDA is able to pass restrictions on cough medications, it is important that we make patients and their families aware of the limited benefits of these remedies. As Mary Poppins would say, “A spoonful of sugar makes the medicine go down.” Perhaps, in the case of the common cold, we should simply modify these well-known lyrics to, “A spoonful of sugar is the best medicine.” Maybe Winnie the Pooh did know best after all.