• You can use a placebo to treat a child’s cold

    I was checking out JAMA Pediatrics, and saw that they’re on placebos, too. “Placebo Effect in the Treatment of Acute Cough in Infants and Toddlers“:

    Importance  Cough is one of the most common reasons why children visit a health care professional.

    Objectives  To compare the effect of a novel formulation of pasteurized agave nectar vs placebo and no treatment on nocturnal cough and the sleep difficulty associated with nonspecific acute cough in infants and toddlers.

    Design, Setting, and Participants  In this randomized clinical trial performed in 2 university-affiliated outpatient, general pediatric practices from January 28, 2013, through February 28, 2014, children 2 to 47 months old with nonspecific acute cough duration of 7 days or less were studied. Surveys were administered to parents on 2 consecutive days, the day of presentation (when no medication had been given the prior evening) and the next day (when agave nectar, placebo, or no treatment had been administered to their child before bedtime) according to a partially double-blind randomization scheme.

    Interventions  A single dose of agave nectar, placebo, or no treatment administered 30 minutes before bedtime.

    Main Outcomes and Measures  Cough frequency, cough severity, cough bothersomeness, congestion severity, rhinorrhea severity, and cough effect on child and parent sleep.

    Colds suck, especially when a small child has one. They’re not very good at “sucking it up”, and there’s so little you can do for them. Most of the over-the-counter medicines have been pulled from the shelves, because they didn’t work and had lots of side effects.

    People are always trying to look for help, even from complementary medicine. This was a randomized controlled trial of an agave nectar formulation versus placebo versus no therapy. Everyone had a baseline measurement the night before they got their randomized “therapy”. On the next night, kids in the trial got a single dose of their “therapy” before bedtime. The main outcomes were cough, congestion, runny nose, and sleep – for both the child and parent.

    The first thing to note is that in all groups, even in the no therapy group, there were improvements from baseline. Even “being studied” seemed to have an effect. The second thing to note is that kids were significantly better on the agave nectar than in the “no therapy” group. But there was no difference between kids in the agave nectar group and the placebo group. The placebo group also did significantly better than the “no therapy” group.

    This is why I tell parents who have kids with colds to “try anything” that I don’t think has a harm. I include cost in the “harm” category. If you want to tell your child you’re giving them a special drink of warm tea, that’s awesome. If you have a special moisturizer that “soothes” their chest, that’s great. If you want to put a little agave nectar in water and tell them it’s medicine, I’m ok with that, too.

    Of course, in this study, the placebo effect was likely working on the parents as well as the kids. Which of them received the bigger benefit isn’t clear. But the effect is there.

    When we tell you that no medicines work for colds, we’re not telling you to do nothing. We’re telling you that nothing works better than placebos. You absolutely should use placebos. They work! Here’s a study that proves it.

    @aaronecarroll

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