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Beating the Swing Flu?

A PSA from Herräng Dance CampWith the Northern Hemisphere arrival of summer it’s swing camp season and that means one thing – completely out of sync with the rest of the population it’s swing flu season. And with the swing flu season comes all sorts of remedies to ward off the lergy from Herräng’s anti-cold juice to bottles of military-grade Nyquil. But does any of this actually work?

I’m a science and evidence based policy junkie (which explains my love for the work of Ben Goldacre and also the Youtube Channel Healthcare Triage, who actually have an episode on cold remedies), so I’ve been aware of the Cochrane Collaboration for some time. This non-profit organisation scours the literature and does systematic reviews of all sorts of different medical treatments (including plenty of CAM ones too). Fortunately Cochrane has reviewed the evidence on multiple remedies for the prevention and treatment of colds, flu and flu-like illness. I thought I’d summarise their publications to just get a very brief snapshot of what the evidence actually says.

Firstly let me get this out of the way: This is not medical advice! Making health decisions based on what you saw on some blog on the internet is an incredibly stupid idea. Before you decide to take any medication, supplement or start any sort of regimen you should – talk – to – your – doctor! Ask them about the evidence, or even take along some of the reports from Cochrane.

The one thing that stands out from looking through all these reports is how flimsy the evidence base is in many of these studies. They read like a veritable index of poor trial design, suffering from inadequate blinding, small sample sizes and a host of other issues – and that’s before we even get to issues of publication bias. So even where a small effect was found in the systematic review there’s a reasonable chance it’s no more effective than placebo. In fact the only thing that appears to work well is good hygiene – so wash those hands!

Note also that these are all reports regarding healthy adults. Others examine the evidence base for those with particular conditions or in children.

Once again, in case I wasn’t clear before This is not medical advice! Talk to your doctor about what’s right for you.

Remedy Prevention Treatment
Acetaminophen/Paracetamol Although widely included in over the counter cold/flu medication the research evidence for its effectiveness is poor quality. It may help reduce some nasal symptoms of common cold but does not appear effective on other symptoms.
Antibiotics Antibiotics have no benefit for common cold and can cause significant side effects.
Atrovent Nasal Spray (ipratropium bromide) This product may relieve some cold symptoms, but the existing evidence has some limitations.
Chinese Herbs There is very weak evidence that these may have similar effects to antiviral drugs at treating and preventing influenza
Drink Plenty of Fluids There is no evidence for or against the common recommendation to increase fluid intake during acute respiratory infections.
Echinacea There is no good evidence for use of Echinacea in treating colds, but it is possible there may be a small benefit.
Flu Vaccine The evidence demonstrates a modest impact on reducing symptoms and working days lost in the general population due to flu (NNT 40-70). No evidence of association between vaccination and serious adverse reactions was found.
Garlic There is some evidence to suggest that regular daily garlic can have a protective effect against the common cold, however the evidence is insufficient and of poor quality. Also we’re dancers – why would you want to smell like Garlic?
Handwashing Spread of respiratory viruses can be reduced by simple handwashing.

Learn how to do it properly!

Nasal Saline Use of nasal saline may relieve some symptoms of URTIs but the quality of the research is low.
NSAIDs (Aspirin, Ibuprofen etc.) Although the research evidence is somewhat limited, it appears that these types of drugs are somewhat effective at relieving discomfort, but do not appear to help with other cold symptoms.
Oscillococcinum (a homeopathic preparation) No evidence for effectiveness in influenza or flu-like illnesses No evidence for effectiveness in influenza or flu-like illnesses
Probiotics There is some evidence that probiotics are effective at preventing and minimising the impact of Upper-Respiratory-Tract-Infections, but the quality of the research is poor.
Steam Inhalation Studies on this treatment have had inconsistent results and the research quality is poor.
Steroid Nasal Spray There is no research evidence to support their use to relieve common cold symptoms, however there have only been a small number of studies.
Tamiflu and Relenza There is evidence of a small protective effect from prophylactic use of these drugs on influenza only, but side effects are a concern. There is evidence of a small reduction in duration of influenza and flu-like illnesses, but side effects are a concern.
Typical Cold and Flu preparations (containing antihistamines, decongestants and analgesics) These medications appear to be generally beneficial in treating the symptoms of common cold, but many people report side effects.
Typical Cough Medications There is no good evidence for or against the use of cough preparations in treating cough and the quality of the research in this area is poor.
Umckaloabo This may be effective at relieving some symptoms of the common cold but the quality of the evidence is low to very low.
Vitamin C Regular supplementation does not reduce the incidence of common cold, but it does have a small effect on reducing the length of common cold. Regular supplementation has been shown to reduce incidence in people exposed to high physical stress (e.g. skiers and marathon runners), but it is unclear whether this would extend to swing dancers. The evidence on therapeutic use of Vitamin C is limited and doesn’t suggest any benefit, but it may be worthwhile to consider on an individual basis.
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