Report Questions Efficacy of Cough Syrup

A recent report from the American College of Chest Physicians questions the effectiveness of cough syrups. Madeleine Brand talks with physician and Yale Medical School professor Dr. Sydney Spiesel.

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MADELEINE BRAND, host:

Chances are you or someone you know has a cough. 'Tis the season, after all. And your first impulse may be to open up your medicine cabinet and drink some cough syrup. Well, don't. According to a new report from the American College of Chest Physicians, cough syrup doesn't work and may actually be harmful. And to explain why, here is Dr. Sydney Spiesel. He's on the faculty at the Yale Medical School, and he writes on medicine for the online magazine Slate.

Hi, Dr. Spiesel.

Dr. SYDNEY SPIESEL reporting:

Hi. How are you?

BRAND: Fine, thank you. Well, before we get into this report, let's talk about what is actually in cough medicine and how it is supposed to work.

SPIESEL: Well, actually, cough medicines contain a lot of different ingredients. Probably the most important ones are the sugar and the flavoring agents. Pretty colors are in it; I think red always works best for a cough. They also contain some ingredients that are thought to be or have been--until recently, thought to be active ingredients. For instance, there are medicines called expectorants, things that make you spit, which are supposed to loosen mucus or increase mucus flow. And then other medicines are antihistamines, and one that we know a lot about is diphenhydramine, which is the active ingredient in Benadryl. There are decongestants that dry up your nose.

And then there are some medications which are intended to suppress cough. They're supposed to turn off the cough reflex. One is called dextromethorphan, DM. And that may or may not suppress cough. There's some evidence that at least it does so for a short time. And then finally there are things which just coat everything, that smooth everything up, the high-viscosity agents. My mother used to favor honey and butter.

BRAND: Oh.

SPIESEL: It's hard to analyze the effect of any one ingredient because, you know, a lot of cough is in our head, and placebo effects are very strong here.

BRAND: Well, what do you mean `in our head'?

SPIESEL: Well...

BRAND: There's actually physical coughing.

SPIESEL: ...there is physical coughing, although sometimes it turns out that for a lot of the studies that have been done, if you give patients sugar syrup, it seems to work just as about well as the things that are labeled `cough syrup' and sold as cough syrups. But it does work. You know, if you give them nothing, the cough gets worse or remains the same, although in some of the studies that have been done, just waiting a day or two also helps a lot.

BRAND: Well, why is it that there are so many cough medicines on the market, and why is it that people keep taking them if they don't work?

SPIESEL: Well, coughing is a tremendously common symptom, and it makes everybody crazy. And you always want to--I mean, doctors want to make patients feel better. Parents want to make their children feel better. So there really is a tremendous interest in suppressing the symptom if we can.

BRAND: Now this report also says that cough syrups may, in fact, be harmful. How is that?

SPIESEL: Well, if you actually read the report, it pretty much skirts this question, although it kind of hints that it might be harmful. When one of the authors of the report was interviewed, they raised the possibility that, for example, using a cough syrup might mask a disease which should be treated, like whooping cough. But of course that conflicts with the other part of the report that says that cough syrups don't work to suppress cough at all, so I can't put that together very much. I think another issue, however, which they do mention, is the possibility that some of the cough medicine ingredients could have adverse effects in children and especially if the dose gets very high. These are higher than the recommended doses.

BRAND: So what do you tell patients about what they should do when they want something to help their cough or their children's coughs, and what do you take yourself? Do you take the old honey-and-butter recipe from your mom?

(Soundbite of laughter)

SPIESEL: Well, first of all, I usually remind people of my first love, pediatrics, which is that if there's any illness for which there are a hundred treatments, it's probably true that none of them works. And, second of all, I'd point out to parents that when it comes to colds and cough, actually nothing works for me and nothing works for them, and so probably nothing will work for their kid either. Now personally I'm sort of hard about medications, and I actually probably never take any medications--any cough syrups myself. As I say, I do remember my mom giving me honey and butter and I liked getting it, but I also remember that she didn't take it for her own cold. She used to take whiskey and lemon juice.

BRAND: That sounds a little more palatable, I must say. Dr. Sidney Spiesel is a pediatrician in Connecticut, and he writes on medical news for the online magazine Slate. Thanks a lot.

SPIESEL: Thank you very much.

BRAND: More to come on DAY TO DAY from NPR News.

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