Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults

The article by Schroeder and Fahey made me laugh out loud. Of course
cough medicines don't work - but as a GP I shall continue encouraging
patients to use them, and I hope NHS Direct will do the same.

Why? Well,
parents of children with viral infections causing a cough present to
doctors for a variety of reasons.

Firstly, they are concerned that their
child has a serious illness - usually meningitis or a chest infection.

Secondly, they are generally tried after being up all night and want help
- any help.

Thirdly, (and this is not an exhaustive list!) they feel
helpless in the face of their child's suffering and they want to be able
to do something for them. So, we give them things to do, whilst they wait
for the viral illness to get better on its own. We suggest calpol, we talk
importantly about encouraging fluid intake and keeping the child cool, we
even issue detailed instructions about how to inhale decongestants, and we
advise parents of children with a cough to talk to their pharmacist about
cough medicines. We then give them instructions about what to do if the
condition worsens or doesn't improve over a specified (usually arbitary)
time period.

The object of the exercise? To make them feel that they
understand what is wrong, can do something to help, and have a fallback
plan if things don't get better.

"Evidence based medicine" has much to offer but please don't let us
confuse pharmacological efficacy with the real world of managing human
emotions alongside physical illness.

Kath Checkland