January 2, 2010

USA: Money Tips for When the Sniffles Start

. NEW YORK, NY / The New York Times / Health / January 2, 2010 Patient Money Money Tips for When the Sniffles Start By Leslie Alderman THERE is still no cure for the common cold, but that hasn’t stopped consumers from spending billions of dollars every year on vitamins, medicines and doctor visits. (I admit I do, too, from time to time.) “There’s a bit of magical thinking at work here,” said Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University. “In the 21st century, the idea is that we ought to be able to do something about colds and flus.” MULTIMEDIA So people will pop pills even when there is little or no proof they work. Americans spent about $3.6 billion on over-the-counter cold, cough and throat remedies in 2009, according to projections from Mintel International, a market research firm, about 1.7 percent more than in 2008. In addition, cold and flu sufferers will spend millions of dollars on prescription antibiotics that have no effect on viral infections. If you’re suffering but also trying to be a smart spender, read on for advice. Some of the best treatments, it turns out, will not cost you much at all. But before I tell you what not to do, let me remind you of what you should do to build up your immunity so you can avoid getting sick in the first place. For starters, get vaccinated for both H1N1 and the seasonal flu. You can get the H1N1 shot at retail clinics in chains like Safeway and CVS for $10 to $20; the seasonal vaccine is in shorter supply, so call your doctor’s office and ask if any is available. Also, make sure you get enough rest, stay well hydrated and exercise moderately, all of which can help strengthen your system, said Dr. Schaffner, who is also an infectious disease specialist. Finally, wash your hands frequently and thoroughly. Now on to a discussion of what you may want to avoid or use in moderation to treat your symptoms. DOCTOR VISITS Most healthy people do not need to see a doctor for a cold or flu. But if you have a fever for more than three days, a cough that produces sputum, chest pain or difficulty breathing, call your doctor. These may be signs that an infection is developing complications, and your simple cold could turn into something more serious like pneumonia. If you’re not sure whether you need to see a doctor, call and ask to speak to an advice nurse or physician assistant, Dr. Lisa Bernstein, an associate professor in the Department of Medicine at Emory University, suggested. “A nurse can listen to your symptoms and figure out what care you need.” If you have an underlying condition like lung or heart disease, you are older than 65 or you are pregnant, call your doctor immediately if you have any of these flu symptoms — fever, headache, body aches or a cough. Your doctor may want to prescribe an antiviral medication like Tamiflu or Relenza, which can reduce the duration and severity of flu. ANTIBIOTICS You probably don’t need them. “Antibiotics have exactly no effect on the common cold,” Dr. Schaffner said. “That’s because viruses, which cause colds and flus, are uninfluenced by antibiotics.” Antibiotics attack only bacteria, and bacteria are rarely involved with respiratory infections. Not only will the antibiotic be a waste of money, but it may also cause unpleasant side effects like diarrhea, a rash and possibly a yeast infection in women. Even more problematic, overuse of antibiotics leads to drug-resistant superbugs, which are difficult to cure. Contrary to popular belief, when your nasal discharge is green, it is not a sign that you have a bacterial infection that requires antibiotics. The color of your nasal secretions says nothing about the cause of your malady, Dr. Schaffner said. If your cold or flu leads to a secondary bacterial infection, a course of antibiotics may then be necessary. Signs that you have such an infection include tenderness around your sinuses, reappearance of symptoms after your cold seemed to be abating and chest pain, said Dr. Shmuel Shoham, an infectious disease specialist at the Washington Hospital Center in the District of Columbia. COUGH MEDICINES A 2008 review looked at 25 medical studies of over-the-counter cough medications and concluded that there was “no good evidence for or against the effectiveness of O.T.C. medicines in acute cough.” Dr. Shoham partly agreed. “While cough medicines may not work in the majority of the population, they may work in some people,” he said. For that reason, Dr. Shoham does not discourage patients from trying cough medicines if their cough is annoying them or keeping them up at night. VITAMIN C, ECHINACEA AND ZINC Some studies show a slight benefit from these supplements. But the research is a bit thin, and doctors remain skeptical. “The beneficial effect on the common cold is minor at best for these supplements,” Dr. Shoham said. So, he added, they “are probably not worth your money.” Taking large doses of vitamin C daily, year round, may reduce the duration of a cold, but it will not keep you from getting one. One well-respected study of echinacea, published in The New England Journal of Medicine, found that the supplement had no effect on the rhinovirus, one of the viruses that cause the common cold. Avoid nasal applications that contain zinc, which may affect your sense of smell. AIRBORNE Many consumers swear by this remedy, which is a cocktail of 17 vitamins, minerals and herbs — including vitamin C, echinacea and zinc. When the product was introduced, the label claimed that Airborne could fight the common cold. The Federal Trade Commission sued its maker on the grounds of false advertising, and in August 2008, the commission announced that the company had agreed to pay up to $30 million to settle charges that it did not have adequate evidence to support its advertising claims. The company that makes Airborne changed the wording on the label to read, “helps support your immune system.” Researchers are not persuaded that Airborne does even that. “The company has not done a proper study to prove the benefits it claims,” David Schardt, a senior nutritionist at the Center for Science in the Public Interest, said. “They certainly could afford the research — the company has made millions of dollars on this remedy.” Dr. Schaffner agreed. “There simply is no good evidence that Airborne boosts your immune system,” he said. Airborne’s maker said it had no comment. MULTISYMPTOM MEDICINES Cold medicines with multiple active ingredients like acetaminophen, a decongestant and an antihistamine have not been well studied. The reviews that have been done show they are no better than placebos in shortening the duration of colds, said Dr. Michael Brady, an infectious disease specialist and chairman of the Department of Pediatrics at Nationwide Children’s Hospital in Columbus, Ohio. These medicines may help with some of your symptoms, but be sure to read the labels carefully. There is a risk when taking these medicines that you may end up taking more active ingredients than you really need. This is particularly important in young children. The American Academy of Pediatrics strongly recommends that over-the-counter cough and cold medications not be given to infants and children younger than 2 because of the risk of life-threatening side effects. HOMEOPATHIC REMEDIES A review published in The American Journal of Medicine in 2007 looked at the effectiveness of several alternative therapies, including the popular homeopathic pill Oscillococcinum for treating flu. The researchers concluded that there was simply not enough evidence to say whether any of the therapies studied actually worked. So, what does work? While few, if any, medicines can shorten the duration of a cold, some can help reduce the onerous symptoms of upper respiratory infections. Nasal sprays shrink swollen blood vessels and relieve stuffy noses, though the relief is temporary and you should not use spray for more than three days. Acetaminophen and ibuprofen can reduce fevers and body aches. Rinsing your nasal passages with a saline solution or breathing steam can help loosen mucous and increase nasal secretions, which can help to prevent a secondary sinus infection. Humidifiers and hot showers also help. Drinking warm liquids like tea has been shown to reduce a variety of cold and flu symptoms. And don’t forget chicken soup. The age-old remedy, as you’ve no doubt heard, actually does help to reduce the symptoms of the common cold. [rc] Copyright 2010 The New York Times Company