The top five cold remedies that do not work

A cure for the cold, from
One of my daughters caught a cold last week, and now she's given it to me. We’re giving ourselves the best treatment known to science: rest. But to judge from the products offered at our pharmacies, you’d think there were dozens of options to treat a cold. In local pharmacies and in the medicines aisle at my local grocery store, I’ve found row after row of colorful packages, claiming to relieve cold symptoms, shorten the duration of the common cold,” and more. 

Some of these medications actually do treat symptoms, but none of them cure a cold. But mixed among them—sometimes side-by-side with real medicines—I found several products that don’t work at all. 

How can a drug manufacturer get away with this? Simple: the products that don’t work are either supplements or homeopathic products. The manufacturers of both these types of “medicines” have successfully lobbied Congress to pass laws that exempt them from FDA regulation. Supposedly they aren’t allowed to make direct claims to cure or treat disease, but unless you read the wording on their packages very carefully, you’d never notice. (Note to older adults: bring your reading glasses to the pharmacy section!) 

Most important for consumers: if a treatment says it’s homeopathic, then its ingredients do not have to be shown effective. “Homeopathic” simply means that the ingredients are listed on the Homeopathic Pharmacopoeia, a list maintained by homeopaths themselves. And if it contains supplements or vitamins, they too are exempted from regulation by the FDA, under a law known as DSHEA

So next time you go searching for something to take for your cold, or for your child’s cold, here are the top 5 cold remedies you should not buy:

1. Zicam is a zinc-based remedy. Zinc is tricky, because there is some evidence to suggest that taking zinc right at the onset of a cold might shorten its duration a little bit, from 7 days to 6. But as Dr. Terence Davidson from UC San Diego explained, if you look at the more rigorous studies, the effect vanishes. Zinc turns out to have some worrisome side effects, too. Zicam's nasal spray and gel versions were linked to a serious loss of the sense of smell (anosmia), which led the FDA to issue a warning letter in 2009. Zicam responded by withdrawing the product for a time, but their website now says “A clinical link between the Zicam® products and anosmia was not established.“ Strictly speaking, this is correct, but there have been published reports suggesting a link, such as this one from 2009.*

Zicam’s website makes the misleading claim that “All of our Zicam® products are regulated by the FDA.” This is a common ploy of homeopathic drugmakers, claiming the FDA regulates them because the FDA could step in (as they've already done with Zicam) if consumers are being harmed. Unlike real drugs, though, Zicam has not been evaluated by the FDA for effectiveness or safety.

2. Airborne. You can find this in the cold remedy section many pharmacies (I did), but Airborne doesn’t cure anything. It’s a cleverly marketed vitamin supplement with no scientific support for any health benefits. How do they get away with it? Actually, Airborne paid $23 million back in 2008 to settle a class-action lawsuit over its advertising. They had been calling Airborne a “miracle cold buster.” According to the Center for Science in the Public Interest’s David Schardt, 
“Airborne is basically an overpriced, run-of-the-mill vitamin pill that’s been cleverly, but deceptively, marketed.”
After the lawsuit, Airborne modified their packaging, which now claims only that it “helps support your immune system.” This is one of those vague claims that supplement makers love, because it doesn't really mean anything. Airborne's products also now include a disclaimer that
 “These products are not intended to diagnose, treat, cure, or prevent any disease.”  
So what the heck are they doing in the “cold medicines” section of the store?

3. Coldcalm is a homeopathic preparation sold by Boiron, one of the world’s largest manufacturers of homeopathic remedies (including Oscillococcinum, an almost laughably ineffective flu remedy). It claims on the package to relieve cold symptoms. What’s in it? A dog’s breakfast of homeopathic ingredients, including belladonna, about which NIH says
Belladonna is UNSAFE when taken by mouth. It contains chemicals that can be toxic.” 
Another ingredient is pulsatilla, which “is highly toxic, and produces cardiogenic toxins and oxytoxins which slow the heart in humans.” Neither belladonna nor pulsatilla relieves cold symptoms.

Being homeopathic, these ingredients are highly dilute, but I think I’ll pass on Coldcalm.

4. UmckaUmcka is another homeopathic preparation that claims to “shorten the duration of common cold” and “reduce severity of cold symptoms.” Sounds pretty good—if only it were true. Umcka’s active ingredient is a plant extract called pelargonium sidoides, an African geranium. Interestingly, there have been a few experiments on this extract, some of which showed a small positive effect. However, a review of these studies reported that their quality was “very low," that all of them were conducted by Umcka itself, and that all of them were conducted in the same region of Russia. And remember: homeopathic preparations are so dilute that they contain little, and sometimes none, of the active ingredient.

5. Antibiotics. Okay, these are real medicine, and you can’t buy them over the counter at your pharmacy. But Americans take them in huge quantities to treat the common cold. The problem is, antibiotics don’t work for colds.

When my daughter told her friends she had a cold, they wanted to know why she didn’t go to the doctor. Of course, doctors can’t do anything about a cold, and going to a doctor’s office just puts other patients at risk. My daughter knows this. But her friends were astonished to hear that we never take her to the doctor for a cold. It turns out that most of them had been to doctors many times for colds, often coming away with a prescription for antibiotics. 

Antibiotics treat bacterial infections, not viruses. Taking antibiotics unnecessarily can be bad for you: besides wiping out your gut flora, it increases the risk that bacteria will develop drug resistance. Perhaps if we changed the name to "antibacterials," doctors would stop prescribing them for viruses.

I found Zicam, Airborne, Umcka, and Coldcalm for sale at Walgreens and Walmart. CVS and RiteAid don’t carry Umcka (good for them!) but do sell the others.

When you get a cold, you develop immunity to it and you won’t catch it again.We keep getting colds because they're caused by more than 100 different viruses, most of them nasty little buggers that continually circulate in our population. Each time you catch a cold, you’re getting a brand new one. The only consolation is that once you’re over it, you won’t get that one again.

So if you get a cold this winter, save your money. Stay home, rest and drink plenty of fluids. And I have it on good authority that there is one treatment for the common cold that’s inexpensive, widely available, and really, really works: chicken soup.

*In response to my inquiry, Zicam's manufacturer, Matrixx Initiatives, sent me some additional information. They pointed out that subsequent studies have not supported a link between Zicam and anosmia (loss of the sense of smell), and also that they permanently discontinued Zicam intranasal gel products ("Cold Remedy Nasal Gel and Cold Remedy Gel Swabs) in 2009, "despite the absence of any credible scientific data pointing to a potential link." They also argue that "the efficacy of zinc-based formulations is primarily a function of bioavailable dose" and that "Zicam products are formulated to ensure availability of the zinc." Arguing in favor of Zicam's benefits, they pointed to several studies that I'd already read, and I remain unconvinced and, as I pointed out above, Matrixx does not have to prove efficacy to the FDA because they are selling Zicam as a homeopathic preparation, which allows them to avoid FDA regulation.

“Shocking Report” on flu vaccines is neither shocking nor correct

Flu season is coming, and once again it’s time to get your flu shot (or snort, if you prefer FluMist). It’s not perfect, but the vaccine is your best protection against the influenza virus.

So I was surprised to stumble upon an article titled “Johns Hopkins Scientist Reveals Shocking Report on Flu Vaccines,” which popped up on an anti-vaccine website two weeks ago. Johns Hopkins University is my own institution, and I hadn’t heard any shocking new findings. I soon discovered that this article contained only a tiny seed of truth, surrounded by a mountain of anti-vaccine misinformation. Most of it focused on a report published in early 2013 by Peter Doshi, a former postdoctoral fellow at Hopkins.

First, as has already pointed out, Doshi is not a virologist or an epidemiologist, but rather an anthropologist who studies comparative effectiveness research. He never conducted influenza research at Hopkins. (He’s now an Assistant Professor at the University of Maryland’s School of Pharmacy.) Second, Doshi’s 2013 article was an opinion piece (a “feature”), not an original research article, and it did not report any new findings. Third, it is highly misleading to suggest (as the anti-vax article’s title does) that Doshi somehow represents Johns Hopkins University. At Johns Hopkins Hospital, the flu vaccine is required of all personnel who have contact with patients, as a good-practices effort to minimize the risk that a patient will catch the flu from a caregiver.

But what did Doshi’s article say? Even though it isn’t new, why are the anti-vaccine sites recycling it? His central argument is this:
“The vaccine might be less beneficial and less safe than has been claimed, and the threat of influenza appears overstated.”
Let’s look at this statement. It’s almost obviously true: one only has to find a few overstated claims about the risks of flu, which isn't hard to do. But it’s also completely consistent to state that the vaccine is enormously beneficial and that the threat of influenza is very serious. See how that works? 

Doshi uses this slight-of-hand to suggest that the vaccine may not be beneficial at all. He never says this outright—instead, he just questions, again and again, whether the precise percentages reported in published studies are accurate. For example, he makes a big deal of a CDC announcement in 2013 that the vaccine’s effectiveness was only 62%. He casts doubt with phrases like 
“the 62% reduction statistic almost certainly does not hold true for all subpopulations”
which is almost certainly true, but is meaningless from the point of view of public health. Of course the vaccine doesn’t have the same effectiveness in everyone. The point is that it works most of the time. 

Doshi cites another study that showed a clear benefit for the flu vaccine, only to cast doubt on it with this argument: 
“No evidence exists, however, to show that this reduction in risk of symptomatic influenza for a specific population—here, among healthy adults—extrapolates into any reduced risk of serious complications from influenza such as hospitalizations or death in another population.”
Again, Doshi’s argument doesn’t prove that the original study was wrong, only that it doesn’t apply to everyone. But Doshi’s motivation, as evidenced by the relentlessly negative slant of his entire article, seems to be to convince people that the flu vaccine is bad.

Not surprisingly, the anti-vaccine movement has embraced Doshi (for example, here and here). And unfortunately, he seems to have accepted their acclaim: in 2009, he spoke at an anti-vaccine conference hosted by NVIC, a notorious (and misleadingly named) anti-vaccination group.

Perhaps even more disturbing is that Doshi signed a petition arguing that the HIV virus is not the cause of AIDS, joining the ranks of HIV denialists. He signed this statement while still a graduate student, so I contacted him to ask if he still doubted the link between HIV and AIDS. I also asked him if he supports flu vaccination, if he agrees with the anti-vaccine movement's use of his statements, and if he believes the flu is a serious public health threat.

On the question of signing the HIV/AIDS petition, Doshi responded that "Seeing how my name was published and people have misconstrued this as some kind of endorsement, I have written the list owner and asked for my name to be removed." (He declined to state directly - and I gave him the chance - that he agrees that the HIV virus causes AIDS.)

As for the flu itself, Doshi says "I don’t agree with CDC’s portrayal of influenza as a major public health threat." So he and I have a serious disagreement there. I asked if he agrees with the anti-vaccinationist who are using his writings to claim that the flu vaccine is ineffective, and he replied that while "ineffective" is "too sweeping," he has found "no compelling evidence of hospitalization and mortality reduction in [the] elderly."

Doshi’s argument against the flu vaccine boils down to this: the vaccine is much less than 100% effective. This is undeniably true, and the research community makes no secret of it. In fact, many of us have repeatedly called for more research into better vaccines, in the effort to create a vaccine that is not only more effective, but that (like most other vaccines) only needs to be taken once for lifetime immunity. We’re just not there yet. Meanwhile, though, the annual flu vaccine is usually effective: a recent study showed, for example, that it reduced children’s risk of ending up in a pediatric intensive care unit by 74%.

So get your flu shot (or snort) now, before flu season hits, because it takes a couple of weeks for your body to develop immunity. By getting immunized, you’ll not only increase your chances of getting through the winter flu-free, but (because you won’t spread the flu to others) you might also save someone whose immune system would be overwhelmed by influenza.