A 21 year old with cold symptoms, including a cough (little money) called to ask if they should buy a cough syrup with dextromethorphan? Here is the data. What would you do?
A friend called and said I should mention the issue of honey in children less than 1 year of age. The World Health Organization and other national groups recommend not giving honey under 1 year of age. The concern is that honey may contain spores of botulism. Infant botulism is actually the most common form of that condition but it is rare. There are fewer than 100 cases per year in the US, and the exposure to honey was not universal. In one analysis, of nearly a 100 cases, honey was given to about 20% (about 1/2 of those from one state), but so was syrup, fruits, other items and those, even, were given more often. Also, some countries commonly use honey in feeding without increased reports. So, we really don’t know the full contribution of honey to the condition. HOWEVER, there are many alternatives to honey so not giving is an easy way for parents to avoid the potential risk. It is best to follow recommendations to not give honey in infants. I appreciate the opportunity to address this aspect.
Another reader asked; “Why don’t you just say, honey is best and should be used exclusively? It is at least as good with little risk!” Another said, “Honey and whiskey may be more expensive than OTC agents, so you can’t be sure it is cheaper!”
These are good comments. Addressing the first comment; first, when there is not good evidence, no evidence, or conflicting evidence, it may be justified to not recommend anything. It is easy to say, don’t use OTC, but that is too simple. For one thing, the studies may not be very good, which, in my view, is the case with these studies. One could pick one of the studies out that supports their bias and recommend, but that would not be right. Colds go away on their own and if a person has a favorite, it helps them and they are willing to pay for it, there really is not good enough evidence to say they are wrong. But, most importantly, there is not good enough evidence to support any single remedy for all.
I love the comment about cost. A little bit of honey and a little bit of cheap bourbon may be less cost than OTC, and my friend who reported that his grandmother liked bourbon assured me that he bought the cheapest he could for her and she never complained! So, again, pick what you like to help your cough, but you don’t necessarily need OTC agents. That is the message, I think.
A friend called and said I should mention the issue of honey in children less than 1 year of age. The World Health Organization and other national groups recommend not giving honey under 1 year of age. The concern is that honey may contain spores of botulism. Infant botulism is actually the most common form of that condition but it is rare. There are fewer than 100 cases per year in the US, and the exposure to honey was not universal. In one analysis, of nearly a 100 cases, honey was given to about 20% (about 1/2 of those from one state), but so was syrup, fruits, other items and those, even, were given more often. Also, some countries commonly use honey in feeding without increased reports. So, we really don’t know the full contribution of honey to the condition. HOWEVER, there are many alternatives to honey so not giving is an easy way for parents to avoid the potential risk. It is best to follow recommendations to not give honey in infants. I appreciate the opportunity to address this aspect.
Another reader asked; “Why don’t you just say, honey is best and should be used exclusively? It is at least as good with little risk!” Another said, “Honey and whiskey may be more expensive than OTC agents, so you can’t be sure it is cheaper!”
These are good comments. Addressing the first comment; first, when there is not good evidence, no evidence, or conflicting evidence, it may be justified to not recommend anything. It is easy to say, don’t use OTC, but that is too simple. For one thing, the studies may not be very good, which, in my view, is the case with these studies. One could pick one of the studies out that supports their bias and recommend, but that would not be right. Colds go away on their own and if a person has a favorite, it helps them and they are willing to pay for it, there really is not good enough evidence to say they are wrong. But, most importantly, there is not good enough evidence to support any single remedy for all.
I love the comment about cost. A little bit of honey and a little bit of cheap bourbon may be less cost than OTC, and my friend who reported that his grandmother liked bourbon assured me that he bought the cheapest he could for her and she never complained! So, again, pick what you like to help your cough, but you don’t necessarily need OTC agents. That is the message, I think.