It’s that time of year again — time, according to @SoVeryBritish, for clasping your mug with both hands, apologising for the state of your face, saying ‘I’m fine’ a lot, and filling every pocket on your person with manky old tissues. I used to dread this part of the year as a GP as it meant two very inevitable things. One: that I would invariably get The Bug about two weeks before everyone else, and all I had to do was sit, wait, and carry on working while, slowly but surely, patients came in and asked what it was. Two: about ten times a day, I would have to confirm people’s suspicions that theirs really was a cold and there was nothing that could be done about it — as, if there was, I would have done something about my own.
Or was there? Perhaps I was remiss in my training. For, spending even a brief time on that viral incubator called the London Underground, I am confronted with a different interpretation. Everywhere there are adverts proclaiming remedies for the usual ailments of winter — tiredness, malaise, frontal sinus pressure, excessive mucus, dry coughs, loose coughs, loose stools and stomach upsets.
This all defies the conclusion reached by the MRC Common Cold Unit, set up in 1946, which found that, as there were hundreds of different viruses causing the common cold, it couldn’t be vaccinated against, and that despite the significant morbidity (and loss of productivity) it wreaked on the population, the only solution was very simple: time and rest.
Occasionally, the adverts are withdrawn. Earlier this month Boots was forced to drop its advertising campaign for its Cold and Flu Defence Nasal Spray, a seaweed/sea kelp-based nasal spray that it claimed was ‘clinically proven’ to protect against influenza. The Advertising Standards Authority ruled that its evidence was insufficiently robust.
Here is my guide to the various medicines available, from the relatively useful to the potentially pointless.
eg, Sudafed, Otrivine, Vicks Sinex
These can be helpful, but only in the short term, for up to about five days. Any longer than that and you can develop a dependence. Even worse, long-term use can create a change in your nose called Rhinitis Medicamentosa, which means you need the spray to relieve a constantly drippy nose. The advertising for some of these sprays even markets them as a valid treatment for nasal allergies in the summer, which I think is inappropriate — while they relieve congestion, they don’t treat the cause of the allergy.
Don’t use these sprays long term.
eg, Buttercup Bronchostop, Tixylix, Robitussin, Day and Night Nurse
Don’t believe the hype. There is little evidence to suggest these work, according to the British Thoracic Society, which found that, while patients subjectively report feeling better, this may well be a placebo effect. And the doses you receive to treat your symptoms are often lower than the therapeutic dose required to have some sort of effectiveness against the virus itself.
Giving the kids less sugar (many of these are crammed with them) can only be a good thing.
eg, Sterimar, NeilMed
A salt water-based spray. Anyone who has seen me for sinus-related issues knows I am a fan of what is referred to in the profession as ‘nasal douching’. It clears mucus from the nasal passages by making it thinner and less viscous, helping you to breathe more easily, and clears your sinuses, too, by relieving pressure. By reducing the build-up of mucus it also lowers your chance of a nasal superinfection.
The rinses can be very helpful in alleviating a common cold-related medical condition called Eustachian tube dysfunction. This is where tinnitus and poor hearing are caused by mucus accumulated behind the eardrum and in the tube that drains into the nose. Definitely worth a shot.
(Heston Blumental even distributed a saltwater rinse to passengers on British Airways flights to make his food taste better. This is because smell, which suffers significantly at altitude, is heavily linked to taste.)
Alcohol hand gels
These tend to breed the neurotic user. But, considering that viruses are often airborne, they aren’t going to be effective in many cases — short of spraying the entire carriage on the way to work. In fact, best to do it twice in case you missed some. Oh damn, touched a door knob, you need another squirt…
It is better to save your skin, which often gets irritated when too much is used and tends to crack and fissure. Wash your hands when necessary, but don’t be scared of normal social discourse. Gripping that handrail isn’t going to kill you. Not gripping that handrail might.
Nasal ‘defence’ sprays
eg, Prevalin, Vicks First Defence, Coldzyme, Boots Cold and Flu
These, once squirted into the nose, claim to offer a barrier between the nasal surface and the various pathogens and allergens that could cause a cold. Some possess enzymes that work similarly by blocking the entry of the virus into the body. The problem is you fight the respiratory viruses along the whole respiratory tract. If you were to try to spray these down to the bronchi, you’d probably be doing some damage.
There are a range of brands on the market, all claiming to do a similar thing. Some even spray into the mouth. But I don’t buy the idea that they can be effective against infections in other areas of the respiratory tract.
This is sold in various places in Europe. This doesn’t, however, mean it is good. It is a mix of 70 per cent polymethylsiloxane (a common, relatively inert substance used in the manufacture of silly putty and breast implants) and 30 per cent purified water. Its makers purport to offer a ‘complete detoxification of the body’. This seems unsubstantiated. It is, in fact, impossible to detoxify your body.
The manufacturer also makes a number of surprising claims of effectiveness against significant medical conditions. These seem unfounded. The gel can, apparently, help to remove heavy metal salts and radionuclides from the body. It is a shame Alexander Litvinenko didn’t have any in his pocket.
eg, Feroglobin, Floradix
These are based on the premise that your excessive yawning and feet-dragging is clearly a result of not having enough iron. This is a common reason for the 18- to 40-year-olds coming in to surgeries and asking for blood tests for tiredness. Most often, this is rooted in climate, levels of exercise and nutrition, recent viruses, work/life balance, sleep quality and lifestyle. Sometimes, heavy periods or an underlying medical problem can be a factor, causing anaemia.
However, just taking iron for tiredness can be inappropriate where, perhaps, good nutrition or more sleep might be a better solution. Iron supplementation can cause problems, and so it might be worth having a chat with your GP if your tiredness carries on even after you have adjusted your lifestyle.
eg, Viridian, Vitabiotics, HealthAid
The jury is still out on multivitamin supplementation and mortality. There is a suggestion that munching multivits when you should go see a doctor actually shortens your life, because you think the vitamins have you covered and you aren’t so careful when it comes to less healthy behaviour.
The effects of vitamins are also not fully understood. High-quality research has suggested they don’t really do that much, although other studies have differed. High-dose vitamin C for colds? Not convinced. B12 for energy? Perhaps, but why not eat more healthily? Most people are replete with B12 as it is found in plenty of foods.
Vitamin supplements are no substitute for tackling the root cause of feeling tired or unwell. All these vitamins are commonly found in good, wholesome, non-processed foods.
Light boxes and alarm clocks
Light therapy is used to treat sleep disorders, as our circadian rhythm is influenced by when natural light falls on the back of the eye and when we first eat.
Light therapy can be helpful when morning somnolence and sluggishness is an issue, and also when the afternoon slump kicks in around 4pm. Annoys everyone in the office, as it emits a nuclear white glow when you switch it on, and if people are nearby they might have to put on sunglasses. It is also used for seasonal affective disorder.
Remember when we stockpiled about £424m of a drug derived from star anise that was not proven to work against a virus that never even happened (swine flu)?
Two major studies have been published since. One, published in the Lancet in January, did conclude Tamiflu was effective. The other, by the Cochrane Collaboration, found that it was not. As a GP I did not offer Tamiflu to patients as its benefits are unclear.