Talk:Cough medicine

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Linctus[edit]

Hello, I started doing the Linctus page, but it was (rightly) redirected to here. I'd like to add 'Linctus' to this page in some way (ie to mention it's a cough suppressant, syrupy medicine, etc...) The history of the Linctus page should have my points. Also some references regarding whether it works or not, etc, might be good?

Linctus Photo[edit]

Took a photo of a linctus bottle (needs rotating, sorry don't have necessary software, maybe it could be used???)

Lintus bottle

Don't mention brands[edit]

I think this should be replaced:

Today one of the most popular brand names are Fisherman's Friend, Halls and Ricola.

It says "one of the most...", but three brands are mentioned. Also, I've never heard of one of these "most popular" brands. Just say "there are many brands and forms available", something like that.

DavidH 1 July 2005 03:59 (UTC)
  • I think listing brands are fine. Better wording would be "Some popular brands are..." though. The goal of Wikipedia is to be informative, even if that information is about giving people an idea of what to look for at the grocery store. --Aleron235 05:17, 23 January 2006 (UTC)


"Some cough mixtures contain both expectorants and suppressants in their active ingredients - again suggestive that they are primarily placebo in their effect."

Antitussives prevent coughing. Expectorants aid the removal of mucus --- they make coughing productive. One product does not cancel out the other. — Preceding unsigned comment added by 69.142.244.49 (talk) 05:22, 12 February 2013 (UTC)

How does containing both a suppressant and an expectorant suggest that the placebo effect is the intended action mechanism. Couldn't this be a two pronged mixture intended to handle both types of cough?

An expectorant promotes coughing, a suppressant prevents coughing. Their actions are in conflict with each other. CustardJack 11:30, 20 October 2005 (UTC)

An expectorant lowers the viscosity of the mucous/phlegm of the bronchi/trachea and causes more respiratory fluid, which has low viscosity, to be produced. This action allows for the break-up of any thick obstruction in the throat and allows for easier removal via productive cough. Without the expectorant, any coughing would most likely be unproductive and irrating to the respiratory tract. The antitussive also aids in the treatment by lowering the total amount of coughing and irritation that is caused by both the obstructive mucous caused by infection/inflammation and the expectorant. Productive cough is still achieved and the overall effectiveness of the combination therapy is better than no treatment when excessive irritation and pain are being caused by coughing.

Also, notice that in the paragraph above the one we are discussing it is clearly stated that the "cough reflex is very strong, and cannot be suppressed entirely". Thus, the person will still cough no matter what you do. Why not add an ingredient that will at the very least make those coughs more effective? It makes perfect sense.

"The last statement has no weight. whoever wrote it probably doesn't understand..." I removed this text from the main article. The article pages are no place for ad hominim attacks. Instead, I replaced it with something that I think captures both thoughts. I also edited the text in the above paragraph to make it render correctly. Someone may wish to include it in the main article at some later time. --Mdwyer 02:21, 25 November 2005 (UTC)

Question[edit]

Does anyone know anything about the history of cough syrup flavoring or where that article might be found?

Handling of Expectorant(s)[edit]

There is some inconsistency in how 'expectorant' and 'expectorants' are handled.

  • 'Expectorant' redirects here (to 'Cough medicine')
  • This article then uses the linked word 'expectorants', which would be kind of self-referential, except that...
  • 'Expectorants' redirects to 'Mucolytic agent', but then...
  • 'Mucolytic agent' informs us that "expectorants should not be confused with a mucolytic."

Among other things, it seems unreasonable that 'Expectorant' and 'Expectorants' would redirect to different places. Jim (talk) —Preceding comment was added at 02:56, 14 April 2008 (UTC)

Effective expectorants[edit]

A couple of years ago I researched expectorants online, and I recall reading that the only expectorant that had been proven to work was water (which fits with my own experience). This is the closest I could find, when I searched again: "Clinical studies have not shown these products (i.e. expectorants in ) to be effective.[1] ... Water is a natural expectorant and can be recommended for increased fluid intake in children and teenagers who are not on fluid restriction.[2]" - Choosing Pediatric OTC Medicines (US Pharmacist journal)

I suspect it's accurate to say that "Water is the best expectorant you can take and will help thin the mucus and loosen the cough."[1] & "For a wet cough, a glass of water is the best expectorant you can take."[2]. But these sources aren't ideal - does someone knows some more appropriate (e.g. academic) sources? --Singkong2005 03:00, 20 April 2006 (UTC)

btw the effect of water on mucus should also be relevant to articles such as sinusitis and nasal mucus (logically, and based on personal experience). However I can't find suitable sources. --Singkong2005 04:47, 20 April 2006 (UTC)

In the main article, there is an external link citation to mayoclinic.com after the claim that water is a good expectorant.. but the mayoclinic article does not talk about water being an expectorant.. it doesn't even mention the word "water" in it at all. --Wuziq 18:36, 1 October 2006 (UTC)

On dark chocolate: While pure theobromine may be effective and with fewer side-effects, the mentioned dosages of black chocolate are not. Ingesting the suggested amount(50g) could lead to very unpleasant stomach issues, as just experienced by myself with a much smaller amount. Really crappy advice people :) , but I forgive you. —Preceding unsigned comment added by 85.164.233.247 (talk) 19:56, 15 May 2009 (UTC)

"A new study by a Penn State College of Medicine research team found that honey may offer parents an effective and safe alternative than over the counter children's cough medicines."

Also from the article: " These findings are especially notable since an FDA advisory board recently recommended that over-the-counter cough and cold medicines not be given to children less than 6 years old because of their lack of effectiveness and potential for side effects."

Does anyone have a link to this information? I've read anywhere from age 2, to 4, to 6, and have been unable to confirm the FDA guideline. I feel the above info should be included. Thoughts? Gandydancer (talk) 13:48, 12 November 2009 (UTC)

  • I added some herbal antitussives. I removed sunflower.Gandydancer (talk) 14:11, 16 November 2009 (UTC)
  • Yes, I agree, it was a mistake to use caps for the plants. However, I would like to suggest that studies *have* been done. Dozens of them. Nothing however that meets today's standards. Do you think we could come up with a term to express that? "no scientific studies", perhaps? Gandydancer (talk) 18:03, 16 November 2009 (UTC)
Find me a pubmed reference of some studies rather than a book link ( a review preferably ). I am hesitant to start stating the obvious. All studies should be scientific. People do none scientific things than try to attach the wording of science to it. The over the counter stuff and the gold standard (codeine) has recently been shown to be bunk. Everyone compared there treatment to the gold standard with no evidence that the gold standard was better than placebo. I am sure the companies new what they were doing ( they have subsequently made billions on OTC snake oil ). It is usually not hard to match a placebo.Doc James (talk · contribs · email) 18:16, 16 November 2009 (UTC)
  • Hi Doc, yes I see what you mean and I tend to agree. I was thinking of some of the old texts, but could they really be called studies? At the time they felt the info was adequate, but by today's standards, certainly not. Which of course is not to say that *todays* studies are worth much either, but that's another story. I'll see if I can find anything worth much, but I doubt it. So, yes...just leave it as per your change. Gandydancer (talk) 18:55, 16 November 2009 (UTC)

cough drops of death[edit]

for two days ive been taking cough drops because of my caughing and i find it haard not to choke on them because of the huge reflex of breathing in realy fast after a cough... theyre deadly... Milldog 93 17:42, 16 March 2007 (UTC)

Why the hell are you keeping it in the back of your mouth where it will obstruct your windpipe when you inhale? -Grammaticus Repairo 22:03, 12 April 2007 (UTC)

Cough medicine a euphemism for cough medicine?[edit]

Current article says: "Cough medicine", for example "Grandpa's old cough medicine", is also a commonly used euphemism for whiskey and other strong alcoholic beverages, or even actual cough medicine such as NyQuil which in some formulations has a high alcohol content.

How can "cough medicine" be a euphemism for "actual cough medicine such as NyQuil"?

I think the author needs to sort this out. Perhaps two sentences are required. e.g. "Cough medicine is also a commonly used euphemism for whiskey and other strong alcoholic beverages. Note that some cough medicines such as NyQuil can have high alcohol content."

Ordinary Person 06:52, 17 May 2007 (UTC)

== Recreational usage ==--137.238.121.88 (talk) 02:19, 1 April 2008 (UTC)

can something be put in about recreational usage, ie its effects, detriments Etc.

If you have such information, then go ahead and add it (while still respecting Wikipedia's "no original research" policy). -Grammaticus Repairo 06:31, 13 June 2007 (UTC)

[http://www.erowid.org/chemicals/dxm/dxm_health2.shtml The Bad News Isn't In A Look at the Evidence for Specific Mechanisms of Dissociative-Induced Brain Damage and Cognitive Impairment]

Sorry if the coding isn't exactly right--my browser is weird :\

-Qolonoscopy

Too much on tainted stuff[edit]

for an article on cough medicine in general, too much focuses on the 2006 china incident. --137.238.121.88 (talk) 02:19, 1 April 2008 (UTC)

Linctus Codeine[edit]

I took my mother to a hospital where she was subscribed "Linctus Codeine" for some cough she has been having for some time. I have been to most farmasis and was said that this drug has been banned for almost 2 years now. Is this true? Please help. —Preceding unsigned comment added by Karrunan (talkcontribs) 05:28, 13 August 2008 (UTC)

Legal and related matters[edit]

This entry seems to concentrate primarily on pharmacology (i.e., ingredients, their effects, etc.) but I'm wondering if there should be at least a brief section summarizing some of the legal issues pertaining to the subject: for example, some states have laws limiting the sale of cough medicines containing certain ingredients; individual retail stores have initiated their own policies, and so on. (I realize it might be possible to look up each and every ingredient mentioned in the article, but something 'central' might be more convenient.)

Of course, if this particular article should be limited to pharmacological matters, a 'legal issues' section wouldn't be appropriate.

  --JWMcCalvin (talk) 03:05, 13 November 2008 (UTC)

your mom smokes crack —Preceding unsigned comment added by 70.178.11.53 (talk) 20:14, 25 May 2009 (UTC)

Remove overlong narcotic section[edit]

The editorial section on opioid analgesics needs to be edited and reduced to fit into scope of the article as a whole. I think it should stick to products used in current practice with maybe a paragraph or two on history of prior products. Laudanum is the stuff of Victorian Age poets Byron and Shelley. There are hundreds if not thousands of opioid analogs and derivatives that have zero practical value in modern medicine anywhere in the world. Perhaps with some citations and some fact checking, this part of the article could be moved to a page about the history of opioid products. As it stands its wordy, inaccurate, incomplete, and has way too much detail unessential to discussion of "cough medicine." All opioids have some cough suppressant properties; there are only a handful in use in modern medicine. Also, not all of them are opioids or derivatives. One that pops into mind is benzonatate. Its a good idea for people to have a reference to see the range of cough preparations, buts lets not send them to the chemists seeking Laudanum. 68.4.46.85 (talk) 02:45, 14 July 2009 (UTC)John

Contradiction with Toxic Cough Syrup Article[edit]

This article asserts contamination with diethylene glycol, while Toxic cough syrup and others state ethylene glycol.

Iain marcuson (talk) 01:46, 5 August 2009 (UTC)

POV[edit]

It states that codeine is the strongest cough suppressant and is the gold standard that all other meds are compared too. The only problem is recent studies have found it no better than placebo. That makes it an easy gold standard to meet."journals.lww.com".  Doc James (talk · contribs · email) 04:06, 16 November 2009 (UTC)

I've gone ahead and removed the POV template because I don't see an issue with neutrality. ButOnMethItIs (talk) 12:35, 7 January 2010 (UTC)
Yes think i fixed most of them. Doc James (talk · contribs · email) 12:39, 7 January 2010 (UTC)

Alternative medicine[edit]

Much of this section seems off-topic and thus appear biased or incite unneeded comments. Most of the studies mentioned are about symptoms of colds or influenza which are much (much) broader and only indirectly related to the page topic 'Cough medicine'. Perhaps simply linking to the relevant cold or influenza pages would be more appropriate, unless the studies specifically relate to cough medicine. — Preceding unsigned comment added by 124.149.62.204 (talk) 08:13, 13 June 2012 (UTC)

The article states: "Evidence however does not support many other herbalist's claims of plants as effective antitussives." There is no ref provided. While I am not suggesting that the herbalist's claims are true, I am not aware of any studies (other than echinasea)that have been done. If we can't provide studies, I feel the wording needs to be changed to reflect the lack of studies rather than to suggest that they have been done and have found the herbalist's claims to be not factual. Gandydancer (talk) 15:50, 18 November 2009 (UTC)

  • Opps, I am so sorry! Somehow in my editing I have encluded ref#8 in my changes to the zink info. I will try to untangle what I have done, but if anyone else sees my mistake, please fix it. Thanks! Gandydancer (talk) 16:52, 18 November 2009 (UTC)
Here is evidence for Chinese herbals.Doc James (talk · contribs · email) 21:01, 18 November 2009 (UTC)
  • I changed the alternative section today and referenced it very well. However it has been completely deleted with this re-write:

Many alternative treatments are used to treat the common cold. None, however, are supported by solid scientific evidence.[8]

A 2009 review found that the evidence supporting the effectiveness of zinc is mixed with respect to cough[9] and a 2000 Cochrane review found the evidence of benefit or harm in the common cold inconclusive.[10] A 2004 review however found a possible decrease in the severity and incidence of the common cold in certain sub populations.[11]

Echinacea in trials for prevention of the common cold has been found to be ineffective well for treatment an effect is seen in some trials with certain type of echinacea and no effect is seen in others.[12] Another review from 2007 claimed benefit from echinacea for the common cold[13] however further analysis found problems with the interpretations of this review.[14]

While a number of plants and Chinese herbs have been purported to ease cold symptoms, including ginger, garlic, hyssop, mullein, and others, scientific studies have either not been done or have been found inconclusive.[15]

Here are the problems that need to be addressed:

Echinacea has solid evidence and I provided several good references. The ScienceDaily study is the Lancet study. Actually your ref #14 is the Lancet study and it found problems with the earlier New England Journal study. Also, I had four good refs for zink. And in fact, the one that you provide supports its effectiveness as well! So clearly it would seem that you are not correct when you state, "None, howerer, are supported by solid scientific evidence". It seems to me that you are just pushing your POV here rather than accept the solid evidence that I have provided.

I am unable to follow several of your links--they don't match the information, don't work, etc.

I am going to revert your post. Please discuss before you change it again so that you can point out to me where my information is incorrect.Gandydancer (talk) 04:45, 19 November 2009 (UTC)

Primary research and science daily are not good enough sources. Please see WP:MEDRS. I am happy to discuss things however. Ref 9 and 10 do say the evidence is mixed and inconclusive respectively. 11 says possible benefit in certain sub populations but this looks like data mining IMO.
For evidence to be submittable it has to be a review. Publication bias is such as huge issue in alternative medicine.
BTW this page is about cough not the common cold.Doc James (talk · contribs · email) 05:05, 19 November 2009 (UTC)
  • Yes, I'm aware of which article this is. I assume you are aware of the Lancet study?

"Because of the size and scope of the UConn meta-analysis, which included only randomized, placebo-controlled, peer-reviewed studies, the researchers were able to observe effects the smaller, individual studies, including the New England Journal of Medicine study which was included in the UConn review, were not able to determine alone. The UConn researchers also were able to examine Echinacea’s effects with and without the presence of additional supplements and whether exposure to viruses occurred naturally or study subjects were inoculated with a cold virus."

Refs 9 and 10 are about OTC's and zinc. The zinc is not even available. I provided 4 Pub Med refs for zinc. Did you read them? Gandydancer (talk) 06:06, 19 November 2009 (UTC)

You mean the 2007 Lancet study regarding Echinacia which I referenced and the response to this study in 2008?
Primary research is not usually admissible as a reliable resource especially when reviews are available as I state above.Doc James (talk · contribs · email) 06:26, 19 November 2009 (UTC)
The Cochrane collaboration however is one of the world leaders in evidence based medicine. So even though their review is one year older it still holds more weight than the lancet paper especially since the lancet paper has published concerns regarding it.Doc James (talk · contribs · email) 07:01, 19 November 2009 (UTC)
  • Hi Doc, No I am unable to look at the Lancet followup to the U of CT article. After a long web search I did eventually figure out that it was disputed and the authors then answered with their own thoughts on the dispute. As you know, that is quite common.

We have agreed that PubMed is a good source and I need to know why you have deleted all of my references for zinc. I am glad that we agree that good references are important, because I have been looking at several other articles and I found many of the references to be worthless.

I hope that we can work together on this and come up with something that is not POV on either side, but merely gives the latest information so that people can make up their own minds.Gandydancer (talk) 20:57, 19 November 2009 (UTC)

  • Here is the conclusion from the Cochrane folks on echinasea:

http://www3.cochrane.org/press/wiley/2006.01.25.echinacea_and_common_cold.pdf Gandydancer (talk) 21:10, 19 November 2009 (UTC)

I have complete e copies of all the journals and the Cochrane reviews if you need a copy. Rather than going with someones interpretation of the Cochrane review we currently use the review itself [3]
Pubmed just provide journal abstracts of both primary research and reviews. Primary research is not routinely used. Doc James (talk · contribs · email) 21:16, 19 November 2009 (UTC)
  • Was the reply to the Lancet critcism in the form of a letter? I would like to see it. Thanks. You said, "Pubmed just provide journal abstracts of both primary research and reviews. Primary research is not routinely used". I have no idea what you mean when you say primary research is not routinely used--please explalin. Gandydancer (talk) 01:02, 20 November 2009 (UTC)
From [4] "A primary source in medicine is one where the authors directly participated in the research or documented their personal experiences. They examined the patients, injected the rats or filled the test tubes, or at least supervised those who did. Many, but not all, papers published in medical journals are primary sources. A secondary source in medicine summarizes one or more primary or secondary sources, usually to provide an overview of the current understanding of a medical topic. Literature reviews, systematic review articles and specialist textbooks are examples of secondary sources, as are position statements and literature reviews by major health organizations. A good secondary source from a reputable publisher will be written by an expert in the field and be editorially or peer reviewed. Do not confuse a scientific review (the thing) with peer review (the activity)." Doc James (talk · contribs · email) 14:12, 20 November 2009 (UTC)
  • Yes, I understand that. My question is that I don't understand your motive for explaining to me that "Pubmed just provide journal abstracts of both primary research and reviews. Primary research is not routinely used". Are you suggesting that PubMed refs are not acceptable in reply to my question about why you refuse to accept my PubMed refs for zinc? Gandydancer (talk) 16:58, 20 November 2009 (UTC)
They were not reviews.Doc James (talk · contribs · email) 20:34, 20 November 2009 (UTC)
  • I have added some info from existing refs to avoid weasel words and the words "mixed" and "inconclusive", etc. Providing Wikipedia readers with the actual figures will allow them to make up their own minds on whether or not these words apply. Again, I have added no new references, but am using the ones already supplied. Gandydancer (talk) 16:17, 22 November 2009 (UTC)
  • Hi Doc, you have replaced my edit with the note "you have replaced a review with primary research". As I noted, I replaced your edit because there was NO reference. Please revert your edit. Thanks. Gandydancer (talk) 23:06, 24 November 2009 (UTC)
You mean this one? Dealleaume L, Tweed B, Neher JO (October 2009). "Do OTC remedies relieve cough in acute upper respiratory infections?". J Fam Pract 58 (10): 559a–c. PMID 19874728.  Here you can clearly see your edit [5] Doc James (talk · contribs · email) 23:39, 24 November 2009 (UTC)

"Effectiveness" section[edit]

There are a number of things wrong with this section. I'm looking at the "effectiveness" section, which is basically a criticism section. Some of the contents seem to manipulate words in order to prove a point. For example, the first line says: "Health care professionals have a long history of acceptance of cough and cold medicines." The citation was from a "Cough and Cold Review Group" in Wellington, New Zealand. The sentence fails to point out that cough and cold (and flu) medicines have been administered for decades *because of clinical studies showing that they ameliorate the symptoms*. Yes, there are new studies and meta-analyses that are questioning this, but it's not like doctors were duped into administering the stuff. In other words, the "acceptance" of cough and cold medicine isn't random or flippant. So it would be good to be more clear in what we're saying or just delete the sentence. I chose to delete. If someone disagrees, by all means, reinstate it and revise accordingly.

The section then cites a meta-analysis that states that cough medicines may be no more effective than placebo in treating acute cough. This is important and may have great significance, but the fact that it was a meta-analysis and not a clinical study is only glossed over. This is, however, an important detail. It means that this has opened up a question, rather than showing anything conclusively (as would well-replicated double-blind randomized placebo studies). Also I don't know if this applies to productive coughs from cold and flu or to non-productive coughs. Symptoms of the former -- productive coughs -- are, to a degree, effectively treated my going after the mucus through expectorants, which get rid of mucus, and decongestants, that use the vasoconstriction to prevent the mucus from being formed in the first place. (The efficacy of small dose decongestants has recently come under scrutiny but this is a topic that still being debated. The case is far from closed, and I suspect that the final determination will fall somewhere in the middle.) The latter -- non-productive coughs -- are harder to attack because they may be caused by many different things, including bacteria (see next paragraph), viruses or diseases (e.g. cancer). One can try cough suppressants but this likely won't stop the underlying cause. The point is that there are different types of coughs that can, at the present moment, be treated with medicines that have differing degrees of efficacy. Thus, the type of cough that this meta-analysis focuses on is very important.

The section then continues with this sentence: "In 2006, the American College of Chest Physicians published a guideline that had the dual message that many over-the-counter cough medicines are not effective, and that those that are effective in treating the symptom do not treat the underlying cause; the underlying disorder emphasized by the guideline was pertussis (whooping cough) in the elderly." There is much wrong with these sentences. First of all, the source is a dead link form www.chestnet.org. Second, the author begins by making the pronouncement that "many over-the-counter cough medicines are not effective" -- this isn't really true. The most popular cough medicines treat *productive* coughs associated with cold and flu. These work quite well on this type of cough -- especially those that attack the mucus that makes productive coughs so nasty (I touched on this in my paragraph). Anyone who's taken an expectorant has probably felt its effects as mucus is released from the nose and chest. The efficacy of expectorants has been studied clinically and documented anecdotally. So to say that these over-the-counter meds are ineffective is, at best, misleading, and, at worst, simply false. And, most importantly, these popular cough medicines are not meant for whooping cough. They have little to do with whooping cough, which is caused by a bacterium and can last for weeks or months. A doctor wouldn't prescribe most over-the-counter cough medicines for whooping cough because of this underlying problem. Expectorants and decongestants would do nothing to help, and cough suppressants *might* provide temporary relief (or might not) but would by no means stop the cough because the bacteria would still be present. The author does actually write that the available cough medicines don't "treat the underlying cause" -- obviously. They aren't meant to. They are, for the most part, indicated for an entirely different kind of cough. Thus, the inclusion of this revelation that over-the-counter cough meds don't treat whooping cough is silly. These meds don't treat arthritis or acne or anemia either. Should we mention that too?

The paragraph on cocoa compounds that act as cough suppressants was good except for the part where it said the compound was "free from [adverse] side effects in the blind tests." What the author meant to write (or, at least, I hope s/he meant to write this) is that the compound was free of the adverse effects that accompany use of the alternative cough suppressant in the study, which was the opiate codeine. Theobromine, which is the cocoa compound in question does certainly have side effects such as sleeplessness, tremors, restlessness, anxiety, diuresis and numerous other light but very-much-present effects on the heart & vascular system. (By the way, I practically copied and pasted that info from the wiki article. So let's change here sentence here at least for consistency's sake!) What theobromine doesn't have is the many of the adverse effects of codeine. Codeine can have obvious and serious side effects, mostly after prolonged use (which, like all opiates, can cause addiction) or use in amounts too large (which, like all opiates, can cause respiration to severely depress or even stop entirely).

I simply deleted the sentence: "The efficacy of cough syrups for children has long been questioned by medical professionals." This un-sourced sentence blatantly violates numerous Wiki guidelines all in one sentence. Questioned by who exactly? For a long time you say? I'll need a source on that please... The sentence may be accurate but is unacceptable in its present condition.

Sorry for the Biblical length post. It's just frustrating to read a section that's chock full of misleading and, even (in at least one case) inaccurate statements. The problem is that it all sounds authoritative but is actually riddled with these issues. This is a dangerous combo for a medical-related article.

Cheers, ask123 (talk) 06:10, 4 August 2010 (UTC)

Please provide evidence for all your assertions. WP:MEDRS outlines what qualifies as a reliable source.Doc James (talk · contribs · email) 06:43, 4 August 2010 (UTC)
Hi Doc -- which point exactly are you referring to? Also, I don't have a problem with the sources here. My problem is with the use of language, omitted information and, in some cases, with the *lack* of sourcing. ask123 (talk) 06:57, 4 August 2010 (UTC)
By the way, as I'm sure you noticed, I was bold and just made some changes to the areas I discuss above. If you or anyone else has issues with any of these changes, please make changes of your own or discuss these topics with me (and others) here. I'm not one of those guys who thinks his changes are the end-all and be-all an article. Any input is appreciated. I will gladly discuss. Cheers ask123 (talk) 07:03, 4 August 2010 (UTC)
Well first of all there seems to be some confusion here. You write "The section then cites a meta-analysis that states that cough medicines may be no more effective than placebo in treating acute cough. This is important and may have great significance, but the fact that it was a meta-analysis and not a clinical study is only glossed over. This is, however, an important detail. It means that this has opened up a question, rather than showing anything conclusively (as would well-replicated double-blind randomized placebo studies)." Meta analysis are some of the best evidence sources. We do not use primary studies but prefer to use review articles. Your comments seem to imply that cough medicine is effective unless I am misinterpreting what you write. If this is the case can you provide review articles to support this.Doc James (talk · contribs · email) 07:07, 4 August 2010 (UTC)
Review articles can be fine and don't have to be meta-analyses. Also, meta analyses can be very good and even, in some cases, offer insights into the data that weren't previously discernible. However, I think it's a great stretch to say that meta-analyses are "some of the best evidence sources." The methodology has many noteworthy deficiencies. To begin with, meta-studies are a far cry from the "gold standard." They don't have the advantages of clinical studies that address a specific, well articulated mechanisms. As mere statistical analyses, they inherently don't have the advantages of direct studies (controls, randomization, double-blinding, administering placebos, etc.). The data in a meta-study may come from studies that have these traits, but the meta-analysis itself cannot, by nature, control the issues that these traits address. Direct studies, on the other hand, permit these traits and therefore allows the studies to home-in on a particular question while also addressing the factors that may skew data, make data misleading or cause researchers to draw false conclusions. It's all about the ultimate interpretation and ensuring that it isn't tainted or "off." Meta-analyses don't have as many checks and controls for this. Ultimately, if the conclusions of a meta-analysis are accurate, then they should able to be corroborated in multiple direct studies that are performed in controlled, double-blind randomized fashions (and with placebos -- assuming that that wouldn't make the studies unethical). Until that has been done, a meta-analysis remains a mere statistical study and carries with it all of the weaknesses attendant to such a method.
Also, the data examined in meta-analyses can come from diverse studies that address related but often not identical questions. The studies can also examine different causal factors. Trying to draw conclusions from studies addressing different questions or different factors (even if the differences are slight) can be tricky and lead to specious results. There is also the issue of study size. Some studies may be small; others large. Some studies may be lousy and poorly constructed. A meta-analysis may have all of these weaknesses and still be published. And there are problems with statistical analysis in general. Correlations and trends can be, by design, diametrically misleading. As one example of this, there is the Simpson Effect that can make a trend from combined data direct one way while the trends for each of the data groups alone direct in the reverse. Also, the statistician must make subjective decisions -- such as what studies to include, what not to include or how to measure and interpret the data. There also may be studies that are relevant but unknown to the statistician. These studies wouldn't be included in the data pool. The point is that statistical meta-studies can easily produce "off" results or even, in some cases, be intentionally manipulated. They are not the "best evidence sources" in my opinion. I think a lot of researchers would agree with this. ask123 (talk) 20:25, 4 August 2010 (UTC)
BTW medicine used to be based on tradition. Evidence based medicine is relatively recent. The need to show medications work before they can be sold is also relatively recent.Doc James (talk · contribs · email) 07:08, 4 August 2010 (UTC)
Indeed. The practices of medicine and of medical research have modernized over the centuries, particularly over the past 150 years. There are also now organizations dedicated to consumer protection. We're better off for it... I'm not quite sure as to what you're driving at here? I'm suggesting that the results of a meta-analysis can be misleading. It depends on certain particular details of the meta-study. Also, this article doesn't specify what "cough medicine" was studied. There are different types of coughs and different types of cough medicines. What are we looking at here? Without specifying that, the lay-readers who glance at this article (and most all readers of Wikipedia are lay-readers) will surely leave with great misunderstandings. ask123 (talk) 20:34, 4 August 2010 (UTC)
To be honest, I came upon this article randomly. It's not my desire to labor over it excessively. I just want the authors to pls keep in mind that most people looking at this stuff can't read between the lines. That's one reason why more specificity and articulation is a good thing. For instance, specifying what cough medicine one is talking about would be helpful. The section I read mentioned "cough medicine" as if all the different types were lumped together. Obviously, they're not all the same and can't be grouped like that. These studies must focus on one compound/family of drugs or another. So the conclusions they draw may be relevant to one medicine but not to others. And they lay reader won't know that unless you specify it. That's part of my concern. Cheers, ask123 (talk) 23:29, 4 August 2010 (UTC)
And any evidence that any of them work?Doc James (talk · contribs · email) 03:34, 5 August 2010 (UTC)

Cocoa[edit]

So why was the paragraph on cocoa deleted? Is this http://www.fasebj.org/cgi/content/abstract/04-1990fjev1 no longer valid? Piechjo (talk) 13:28, 21 September 2010 (UTC)

We need a review article of data in humans. This one is about guinea pigs. Doc James (talk · contribs · email) 20:58, 21 September 2010 (UTC)
Figure 4 in the article shows how theobromine was much more effective than codeine or placebo in 10 healthy volunteers. Did you see it? --IO Device (talk) 08:22, 13 May 2014 (UTC)
We need review articles. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:15, 13 May 2014 (UTC)

Dubious Editing[edit]

The Examples section contains what appears to be questionable editing. It phrased codeine in such a way as to suggest it does not suppress any coughs, which is not what the citation says and then said DM/DXM did not suppress coughs in adults, which is not what the citation says either, it says it "provides some relief". Since the DXM claim was almost the complete opposite of what the citation said, perhaps someone has a vested interest or bias in writing this information rather than making a simple editing error, it's worth keeping your eye on, 87.113.222.60 (talk) 14:12, 27 December 2010 (UTC)

Even if they did make an editing error, perhaps it was of the Freudian Slip variety, in that they read the article through the tinted glasses of their bias and then wrote "DM doesn't work" instead of DM "provides some relief" in upper respiratory infections. Someone should watch this article to make sure it doesn't become unbalanced. You've already had your chance to bash their effectiveness in the effectiveness section (though I haven't checked the citations there to see if they actually contain what is written in Wikipedia) you can't attribute your view point to citations in which it does not exist.
And remember, personal credentials shouldn't be used to strengthen one's own position if a debate ensues, not only are such things easy to fake on the internet, others in their field of similar or greater standing may disagree with them, as a professional they will be able to provide accurate citations to support their stance. 87.113.222.60 (talk) 14:35, 27 December 2010 (UTC)
Maybe try looking at the Cochrane reviews cited? Doc James (talk · contribs · email) 16:11, 27 December 2010 (UTC)


Effectiveness[edit]

I think the discussion of effectiveness is best while discussing each individual med.--Doc James (talk · contribs · email) 03:45, 26 June 2011 (UTC)

Unless we're making a statement about cough medicine in general, we HAVE to be specific about which meds we're talking about. As to where we should discuss efficacy, I don't know. If we can't do a better job of listing and discussing each med, it may make sense to have a dedicated efficacy section. ButOnMethItIs (talk) 04:36, 26 June 2011 (UTC)

antitussive[edit]

I'm surprised that antitussive redirects to cough medicine and yet is barely mentioned. What are antitussive medicines, how do they work, a list of antitussive medicines is... would seem appropriate. 67.167.106.3 (talk) 12:46, 3 January 2012 (UTC)

yet another wikipedia pov article under the thrall of a dominant editor[edit]

Recent studies show that antitussives are not 100% effective and not significantly effective in young children. However, This entire article gives the POV that all antitussives are unless. What crap!

1, do you thing a giant international pharmaceutal business could be sustained on fraud? If so you obviously have never heard of efficient markets theory.

2, do you think doctors who prescribe antitussives are all idiots convinced by marketing blitz?

3, do you think no person ever has gained aid in using an antitussive --- and if so why do they continue to use them? People are not idiots, in the main, I used DXM tonight an my coughing stopped. I guess I'm just an idiot too.

4, If you want clinical evidence I suggest you do a google scholar search on "antitussive". You will find many articles regarding positive antitussive effects. Do you want me to cite them all? http://scholar.google.com/scholar?hl=en&q=antitussive&btnG=&as_sdt=1%2C31&as_sdtp= — Preceding unsigned comment added by 69.142.244.49 (talk) 04:50, 12 February 2013 (UTC)

Please provide high quality secondary source per WP:MEDRS. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:56, 6 October 2013 (UTC)

Mechanics Not Explained.[edit]

I could not find anywhere how these cough medicines actually work, particularly the antitussives. — Preceding unsigned comment added by Preroll (talkcontribs) 13:36, 12 February 2013 (UTC)

It is not clear if they do work. Doc James (talk · contribs · email) (if I write on your page reply on mine) 07:09, 6 October 2013 (UTC)

confusing bias[edit]

I tried to add hyrdocodone to the list of antitussive because I have taken it. It was removed because of a poor reference. I tried rewording something that lacked a reference, and then a reference was added. That's fine, but the text added was for codeine. The reference is for codeine and morphine. Why isn't morphine included on this list? This article seems to be deliberately poorly written in order to discourage the use of cough medicine. IWannaPeterPumpkinEaterPeterParker (talk) 09:50, 23 November 2013 (UTC)

The current opinion of the majority of the medical literature is that "cough medicine" are not better than placebo [6]. As this appears to be the case it is not surprising that the majority of the literature discourages their use. Many countries have specifically come out with statements against their use in kids.[7][8] Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:19, 23 November 2013 (UTC)
You have supplied plenty of references to support your claims and you remove any that do not support your claim. Most of your references are specific for children. Can we get another opinion here? IWannaPeterPumpkinEaterPeterParker (talk) 10:26, 23 November 2013 (UTC)
Sure feel free to as at WT:MED. I added another review from 2012 published in lung. There are not really any high quality recent review articles that disagree. The requirement for evidence were a lot less 20 years ago. People said a lot of stuff which was simply "expert opinion" that turned out to be wrong. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:30, 23 November 2013 (UTC)
That board seems to not get a lot of use. I'll try an RFC first to get some fresh eyes. IWannaPeterPumpkinEaterPeterParker (talk) 10:37, 23 November 2013 (UTC)

RfC[edit]

Trying to determine whether or not this article is biased in a way that implies cough medicines are ineffective and deliberately does not include sources and references that imply that they are. It is also missing many typical medicines such as hydrocodone and morphine. There have been attempts in the past to fix the article (scroll up on talk page) but they have always been met with resistance. IWannaPeterPumpkinEaterPeterParker (talk) 10:37, 23 November 2013 (UTC)

Just added hydrocodone supported by a review from 2012. If you can find review articles from the last 3 years in high quality journals that disagree with this article happy to discuss. By the way it was know that OTC cough meds did not work in kids back in 2002 [9] Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:40, 23 November 2013 (UTC)
By the way Cochrane is typically deemed to produce some of the highest quality evidence in the world. Here are their most recent conclusions "There is no good evidence for or against the effectiveness of OTC medicines in acute cough." This is for both kids and adults. [10] Stuff without evidence is typically not recommended. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:43, 23 November 2013 (UTC)
That study actually is just saying that there are no conclusions you can safely draw from that study. Nothing it says is meant to disagree with any earlier studies, so that study cannot be used as a grounds for removing earlier studies. You should really include the whole quote, "There is no good evidence for or against the effectiveness of OTC medicines in acute cough. The results of this review have to be interpreted with caution due to differences in study characteristics and quality. Studies often showed conflicting results with uncertainty regarding clinical relevance. Higher quality evidence is needed to determine the effectiveness of self care treatments for acute cough." IWannaPeterPumpkinEaterPeterParker (talk) 10:53, 23 November 2013 (UTC)

So in medicine one assumes no effect until an effect is shown. One states that no effect of benefit has been found until one has been.

The whole point of a systematic review is to provide an overall summary of the evidence. Thus this conclusion over rides all RCTs and this is consensus here on Wikipedia per WP:MEDRS Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:29, 23 November 2013 (UTC)

One has been shown, in the countless references you have removed. The study you cite says it can prove or disprove nothing, but there _are_ other studies. IWannaPeterPumpkinEaterPeterParker (talk) 22:53, 23 November 2013 (UTC)
Additionally you can't provide a reference that says it can't prove something and say "there is no evidence for this". To do that, you would have to check every study on it. You can't prove a negative. IWannaPeterPumpkinEaterPeterParker (talk) 22:58, 23 November 2013 (UTC)
Why does this sound depressingly familiar?--FergusM1970Let's play Freckles 22:58, 23 November 2013 (UTC)
One what has been shown? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:58, 23 November 2013 (UTC)
From the context one can reasonably infer that he means one benefit has been shown.--FergusM1970Let's play Freckles 23:01, 23 November 2013 (UTC)
Yes. IWannaPeterPumpkinEaterPeterParker (talk) 23:03, 23 November 2013 (UTC)
Additionally, can you quote the section of WP:MEDRS you are referring to? It's not clear from context. IWannaPeterPumpkinEaterPeterParker (talk) 23:03, 23 November 2013 (UTC)
You mean "Individual primary sources should not be cited or juxtaposed so as to "debunk" or contradict the conclusions of reliable secondary sources" Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:16, 23 November 2013 (UTC)
This has nothing to do with it. The Cochrane report said it can draw no conclusions and can be used to debunk nothing. IWannaPeterPumpkinEaterPeterParker (talk) 23:24, 23 November 2013 (UTC)
We report the conclusions of the Cochrane review Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:30, 24 November 2013 (UTC)
It doesn't make any conclusions. That's kind of the point.--FergusM1970Let's play Freckles 01:26, 24 November 2013 (UTC)

Yes it does, "CONCLUSIONS: There is no good evidence for or against the effectiveness of OTC medicines in acute cough" Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:32, 24 November 2013 (UTC)

Which translates as "This study tells us nothing useful."--FergusM1970Let's play Freckles 01:33, 24 November 2013 (UTC)

It tells us a great deal that is useful. What it means is that these medications should not be recommended until proper trials are done that show this stuff to be useful. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:42, 24 November 2013 (UTC)

I agree with Jmh649, not only because that's what the sources say, but because that's what my doctor also said. SandyGeorgia (Talk) 03:47, 24 November 2013 (UTC)
Good to hear that you have an excellent doctor :-) Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:03, 24 November 2013 (UTC)
Georgia, what your doctor says is original research. It is also not what the sources say. Specifically there are other sources that Doc James keeps removing that say that the medications ARE effective. You cannot use a study that has "no conclusions" to remove other studies that have conclusions. IWannaPeterPumpkinEaterPeterParker (talk) 08:13, 24 November 2013 (UTC)
It's not "no conclusion" reread what Doc wrote. Doc's edits are the correct application of our content rules to the best quality sources. Zad68 13:29, 24 November 2013 (UTC)
What Doc wrote is an incorrect summary. IWannaPeterPumpkinEaterPeterParker (talk) 15:34, 24 November 2013 (UTC)
No, the doctor is correct. That's the way medical research is understood. What that conclusion means is that there is no good evidence that OTC cough meds work. There is also no good evidence that they don't work (you can't generally prove a negative) because we don't know if they work because that hasn't been proven conclusively yet. Until then, we don't recommend them. Doing so would be quackery and/or health fraud. There is no doubt poor quality research which says they work, but the weight of good evidence is that they don't. When evidence that they work becomes conclusive, reviews of multiple studies will make that conclusion, and only THEN can Wikipedia report it. We always follow the sources, and are thus always behind the curve. That's the way it's supposed to be here. Cochrane reviews are top notch. -- Brangifer (talk) 03:34, 1 December 2013 (UTC)

*Comment: There are a lot of cross-purposes in this discussion (which I read before reading the article, which in turn is too brief and superficial for proper coherence.) I reckon we should construct a list of considerations that deserve distinct attention before we argue what should go in and in what form. One statement (whether in the article or in the Talk) will say something about "cough", another will deny it on the justification of a study on "acute cough" which failed to find effect. etc etc. Acute cough is not in such argument distinguished usefully from cough in acute diseases, or cough of acute intensity in the absence of infection (eg resulting from irritation or injury, possibly of an intensity sufficient to be a serious problem in its own right.) It does not distinguish between cough as a sign or symptom, or as a pathological condition. It does not distinguish between cough control for the patient's comfort, the patient's associates' comfort etc. And it says precious little about the nature of the benefits of medicines, failing to distinguish between superficial effects and placebos. For example, honey is dismissed as a placebo, whereas it can be very effective as a mild expectorant in a dry cough that can be of a dangerous intensity. (There are better expectorants and lozenges, but in default of anything better, it is a hell of a lot better than a materially functionless placebo!) In short, as things stand the article is of little use to the user and the talk is likely to circle and circle indefinitely unless we can mark out the points we want to make and avoid. Elsewhere on the page we had some good stuff translated from the Swedish, but we need to go further than that. JonRichfield (talk) 07:12, 25 November 2013 (UTC)

*Comment: Since writing the immediately foregoing, I have had a quick look at Cough. It addresses a lot of my points. Either this article should be merged with Cough, or it should systematically address the concepts discussed there. JonRichfield (talk) 09:57, 25 November 2013 (UTC)

  • Comment: Cochrane reviews are immensely reliable. Its combined interpretation of many studies trumps any one study -- certainly any one study that was part of the Cochrane, and likely any generally available at the time. A later study (or new review including later studies) may be able to vacate the Cochrane's "no good evidence for or against" conclusion-at-this-time, but such would need to explicitly address the current Cochrane and explain how it is overcome.
I recommend that, even in the lead, the context of the "There is no good evidence for or against" statement be more explicit, conceptually something like: "A 2010 Cochrane review (a "study of studies" etc etc) found that, at present, there is no blah blah...". EEng (talk) 05:07, 5 December 2013 (UTC)
When no one disagrees we simply state the facts. How silly would Wikipedia look if every sentence began with "A study published in the BMJ by X Y and Z from York found A" A review of studies in JAMA in 2009 by V and Z found B. We do not typically write like this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:13, 13 December 2013 (UTC)
I'm not suggesting every sentence on WP begin that way. I thought it was appropriate in this case but maybe I misunderstand something. So what text are you suggesting? EEng (talk) 09:11, 13 December 2013 (UTC)

(invited by the bot) I really didn't go in depth enough to have an opinion on any excluded material. And most of the article looks OK. But there were two things that really jumped out at me when I read it. One is the "effectiveness" section. There's one sentence in the (#2) which a "gold standard" in terms of content and sourcing: "A 2012 Cochrane review concluded that "There is no good evidence for or against the effectiveness of OTC medicines in acute cough". But the rest of the section seems put together in a way to be negative in ways that are really reaching from a Wikipedia standpoint. Sentence #1 and #3 made broad negative statements in the voice of Wikipedia with sourcing that is nowhere strong enough to justify doing so. Sentence #1 does in a way that sort of "slips under the radar".....using the word "questionable" could be justified on the grounds that it means "in question" while it's common meaning / connotation actually is "bad" or "not so". Then remainder of the section is sentence after sentence / saying say it doesn't work for something, but the "somethings" are typically more serious diseases not related to it's common uses.

The other thing that jumped out at me is that there is very little coverage of the main subject by it's common meaning. The common meaning of "Cough medicine" is the common stuff that they sell at the store.....billions of dollars worth per year is made of that stuff by a huge industry, but there seems to be very little coverages of that. The article seems to be more about methods /chemicals used to treat cough and discussions about the use, effectiveness and consequences of those. That's all fine, but where's the coverage of "cough medicine" by it's common meaning? Sincerely, North8000 (talk) 02:21, 13 December 2013 (UTC)

So the way medicine works is that the profession is negative towards something until evidence supports a positive position. So if there is no evidence the professional literature is negative.
This article is discussing the medical ingredients of cough medicines. That is what DM and codeine are. They are the active ingredients of many medications. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:13, 13 December 2013 (UTC)
I'm with North: this article ought to describe far more than two medications out of the dozens listed at Category:Antitussives—most of which are Rx only and therefore not covered by that Cochrane review at all—and it ought to mention the most popular over-the-counter combination drugs, like NyQuil. We need to WP:Build the web here and not just rely on a collapsed navbox to get people to more detailed information. If you read this, you're going to think that there are really just two that are worth more than half a sentence.
Also, why is Zinc acetate listed under "alternative medicine"? WhatamIdoing (talk) 06:48, 13 December 2013 (UTC)
I don't agree, there is no need to list every single cough medication available. The article lists commons ones, if you desperately need to list them create List of cough medicine and we can link to there. CFCF (talk) 11:09, 13 December 2013 (UTC)
I don't care if they are just colored sugar water snake oil, I don't see coverage of those gazillions of bottles of stuff I see on the shelves at the stores, which is the common meaning of the term. And such is promoting normal Wikipedia coverage of a topic (a few paragraphs of summary in prose) so I think that the putative "exhaustive list" method of doing this is a straw man possibility. Sincerely, North8000 (talk) 11:54, 13 December 2013 (UTC)
That is what "OTC cough medicine" refers to. When medical research looks at stuff it looks at the active ingredients. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:54, 18 December 2013 (UTC)

[Invited by the bot] This article has WP:UNDUE and WP:SOAPBOX issues in its discussion of the (in)effectiveness of the medicines. I'd start by removing liberal sprinkling of "attempt" in the lead. Coughs are routinely treated with cough medicine. Whether this is effective or not is a separate question and not one we're going to resolve on Wikipedia. ~KvnG 01:36, 18 December 2013 (UTC)

They are often used in people with a cough. The majority of the evidence supports that most do not actually treat cough though. Do you have any refs that state that they are routinely used? Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:54, 18 December 2013 (UTC)
Cough medicines are available in stores. People buy them. Most people use medicine for its advertised purpose. I don't think a citation is necessary.
I think you're confusing treatment and cure. The medical definition I find for treatment is, "Management and care of a patient or the combating of disease or disorder." You can always treat. Whether or not the treatment produces a cure is a separate issue. "Attempt to treat" and similar language in the lead is awkward and unclear. Removing this language would be a step away from the WP:SOAPBOX. ~KvnG 05:23, 18 December 2013 (UTC)
If you look at the literature, there is no evidence of benefit in children and possible harm. That is not a "treatment". And this is why a number of governments have come out with statements against their use in children under 6. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:52, 18 December 2013 (UTC)
I think that Kvng is right. "Attempt to treat" is when you prescribe antipsychotics but the patient refuses to swallow the pills. "Treat" is when you do something, even if it's ineffective. You have treated high blood pressure if you prescribe pills that the patient took, even if those pills didn't work.
And this article is wildly incomplete. Do you really think that 34 (mostly short) sentences can cover this whole topic? I see nothing on abuse of cough medicine. What about the economic effects of making cough meds available OTC? How about mentioning that there are between $2 billion and $4 billion in sales each year, just in the US? Why not mention a few notable brands of OTC cough meds, so that people will actually find the information that they're looking for?
Why not write more of this in plain English, so that non-professionals will understand that "These may include..." a long list of jargon means "Some of these have Tylenol in them, and many have stuff that isn't actually a cough med"? This isn't a medical advice page. Its first duty is to describe the product itself, not to assess its efficacy. If your personal goal is to discourage use of unproven meds, then you need to keep in mind that there's no point in telling people that dextromethorphan may be worthless if they're going to leave the page saying "Well, that dextrowhatever may not work, but I'm taking NyQuil, and they didn't say anything against that." WhatamIdoing (talk) 23:00, 18 December 2013 (UTC)
Agree with WhatamIdoing, and that what they are saying is important with respect to this article. The subject is "cough medicine". Not "a medical/scientific analysis of the active ingredients of methods of treating cough and their efficacy" although the latter could certainly be included as a portion of the article. North8000 (talk) 23:19, 18 December 2013 (UTC)

Thanks Jmh649 for reworking the lead. The fact that 2/3rds of the lead is about the ineffectiveness of cough medicine I guess accurately reflects the WP:UNDUE emphasis of this aspect in the body of the article. I think WhatamIdoing has presented some good ideas for improving coverage of the other aspects of this topic. We can improve the lead as we improve the article. ~KvnG 23:58, 18 December 2013 (UTC)

Agree with expanding discussion of the economics aspects of cough medicines. Could also use some discussion of legal aspects. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:01, 19 December 2013 (UTC)

Counterfeiting[edit]

The cases of poisoning caused by counterfeit cough medications do not belong in this article. They are nothing to do with actual cough syrup, and their inclusion looks a lot like scaremongering against a product you have a personal dislike for.--FergusM1970Let's play Freckles 23:00, 23 November 2013 (UTC)

The article mentioned cough medications. Seems okay as it is not making a medical statement. More a social and cultural one. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:01, 23 November 2013 (UTC)
Read my comment, please. It has nothing to do with actual cough medicine whether the source mentions them or not. This article is about cough medicine. Discussing fake bottles tells us nothing about cough medicine. It's just giving a misleading impression that cough medicine is potentially dangerous. Scaremongering, in other words.--FergusM1970Let's play Freckles 23:05, 23 November 2013 (UTC)
I don't think the inclusion is encyclopedic nor is it held to the same standards as everything else in the article. IWannaPeterPumpkinEaterPeterParker (talk) 23:03, 23 November 2013 (UTC)
The inclusion seems highly relevant to me as are many social aspects of different pharmaceuticals. We should not single out this one, and the text is not scare-mongering at all. It only takes up a fraction of the article. CFCF (talk) 00:40, 24 November 2013 (UTC)
It is not about cough medicine. It is about counterfeiting. It is not relevant. This article is discussing cough medicines, not intellectual property theft in China.--FergusM1970Let's play Freckles 01:03, 24 November 2013 (UTC)

"Society and culture" is a nonsensical heading for this. Why is it even in the article? What does it tell us about cough medicine? The answer, clearly, is absolutely nothing. It fails WP:REL and only seems to be here to discredit cough medicine, although why anyone would want to do that passes my understanding.--FergusM1970Let's play Freckles 01:16, 24 November 2013 (UTC)

If you read the text thoroughly Society and culture is a subsection to Drugs, medications and devices. CFCF (talk) 09:39, 24 November 2013 (UTC)
Yes, it lists "Legal status (off-label use or unlicensed preparations if notable and sourced), Recreational use, Economics". None of these are even close to what was included in the article. The heading is being interpreted differently. IWannaPeterPumpkinEaterPeterParker (talk) 15:30, 24 November 2013 (UTC)

Interesting[edit]

Fergus has removed this ref here and replaced it with a fact tag [11] [12]

The ref says "Overall, there was absence of credible evidence" and "No practice recommendations could be drawn from this review" thus not sure if this is an improvement [13] Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:34, 23 November 2013 (UTC)

The link was dead. That's why I removed it. The one you just provided works, thus resolving the issue.--FergusM1970Let's play Freckles 01:02, 24 November 2013 (UTC)
Great. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:11, 24 November 2013 (UTC)
Fergus, please see WP:DEADREF ("Do not delete a citation merely because the URL is not working today."). When you find a dead link, you should not remove the citation; you should tag it with {{dead link}}. That saves time for us, and doesn't leave our text looking uncited to our readers. SandyGeorgia (Talk) 02:18, 24 November 2013 (UTC)

Source for cough & children[edit]

This source might be useful for covering cough & children, PMID 22962927 , found at http://www.aafp.org/afp/2012/0715/p153.html . Zad68 05:30, 24 November 2013 (UTC)

Additional source:

This is from the Medical Products Agency - Sweden, translated by me (with great care not to influence the guidelines)[14]:

Hos vuxna är den akut påkomna hostan i samband med en infektion svår att påverka men lindras nog bäst med varm dryck. Olika läkemedels effekt på hosta är dåligt studerad och resultaten svårtolkade. Läkemedel mot hosta är därför inte rabattberättigade. Om torr rethosta föreligger, kan man pröva centralt hostdämpande farmaka, t ex noskapin, och är hostan mycket besvärande nattetid kan man med vederbörlig försiktighet skriva ut läkemedel innehållande etylmorfin, såsom Cocillana-Etyfin. Antibiotika påverkar inte förloppet.

In adults acute cough in conjunction with an infection is diffucult to influence, but is most likely helped best with warm beverages. The effect of different medication on cough is poorly studied, and the results difficult to interpret. Therefor pharmaceuticals against cough are not entitled to reduced rate[in Sweden]. If dry irritating cough is found it is possible to to try a centrally cough-reducing medicine, for example noskapin, och if the cough is very inconveniencing during the night one can with proper caution prescribe pharmaceuticals containing ethylmorphine such as Cocillana-Etyfin. Antibiotics do not effect the course of events.

Hos barn är det viktigt att först skapa sig en bild av den underliggande infektionen. Det gäller att behandla en eventuell obstruktivitet i första hand. Får man obstruktiviteten under kontroll avtar ofta också hostan. Att ge slemlösande medel är verkningslöst. Hostan kan ofta förklaras av att det tar tid för flimmerhåren att återbildas efter infektionen och den går över efter 1–2 månader utan behandling. Ett barn i 4–7-årsåldern kan efter en period av recidiverande nedre luftvägsinfektioner ha utvecklat postinfektiös hyperreaktivitet och hostreflexen har blivit mer lättutlöst. Sannolikt finns ett kroniskt inflammatoriskt tillstånd i slemhinnan. Vid långvarig hyperreaktivitet kan man pröva inhalationssteroid i lågdos 1–2 gånger/dag. Antibiotika påverkar inte förloppet.

In children it is important to form an image of the underlying infection. It is due to treat a possible obstructivity in first hand. If you get the obstructivity under controll the cough will often subside. To give exporants is without effect. The cough can often be explained by the time it takes to regain the cilia after an infection and it will pass after 1-2 months without treatment. A child 4-7 years of age can after a period of recidivating lower airway-infection have developed a postinfectious hyperactivity and the cough-reflex has become easier to provoke. Most likelt there is a chronic inflammatory condition in the mucous membrane. During prolonged hyperreactivity one can try an inhalation-steroid in low dosage 1-2 times a day. Antibiotics do not effect the course of events.

CFCF (talk) 11:10, 24 November 2013 (UTC)

P.S. This advice is directed towards medical professionals. CFCF (talk) 11:39, 24 November 2013 (UTC)

No consensus[edit]

These edits are specifically against the comments above [15]. This user has added them 4 times now and has been reported to 3RR [16] I have a few concerns with them:

  1. They basically remove the best available literature from the lead of the article such that it is no longer a summary of the article.
  2. They move a whole bunch of know evidence about the effects from a section on "effectiveness" to a section at the end called "contraindications". These are not contraindications.

I would thus propose reverting back to the last stable version of the article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:38, 24 November 2013 (UTC)

Agree with revert to previous version/lack of consensus for proposed changes, the proposed new version removes all discussion of effectiveness from the lead and therefore creates a WP:LEAD problem, and some of the other moves don't make sense. It's possible good stuff was added too, but the individual changes should be discussed, keep the ones there's consensus for and don't do the others. Zad68 03:57, 25 November 2013 (UTC)
I also agree with a revert, the article is worse without them and consensus points to keeping it in. CFCF (talk) 06:08, 25 November 2013 (UTC)

Based on this agreement I have reverted the article back to status quo ante, those interested in seeing some of those edits should propose them for discussion individually. Zad68 14:17, 25 November 2013 (UTC)

old friends think alike! lol [17] Mr Johnson The Second (talk) 20:06, 30 November 2013 (UTC)
"Great minds", you mean! Face-wink.svg... by the way, what's the main account this one is the sockpuppet for? Zad68 03:57, 1 December 2013 (UTC)

Organization[edit]

Not sure why this change was made. Thus reverted [18] Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:12, 11 January 2014 (UTC)

The pharmaceutical and alt med subheading are discussing effectiveness of each of these. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:52, 11 January 2014 (UTC)
No thing in [19] discusses the order of these or really anything on this article, it's only about specific drugs. It doesn't make sense to have effectiveness below examples of cough medicines which is a necessary section. Mr Johnson The Second (talk) 06:00, 12 January 2014 (UTC)

Except that the section you keep moving is not examples. But a discussion of the evidence for specific examples. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:51, 12 January 2014 (UTC)

Please add an examples section then. It does not make sense to discuss effectiveness of examples before defining them. Mr Johnson The Second (talk) 16:26, 12 January 2014 (UTC)
What do you think about this section called examples that comes right before effectiveness [20]? Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:23, 12 January 2014 (UTC)
Too small, it does not list any details. It is strange for the effectiveness to explain more than the examples section. Examples should explain what Dextromorphan is for instance. Mr Johnson The Second (talk) 17:31, 12 January 2014 (UTC)
The chemical structure of dextromorphan can be dealt with on that page. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:42, 12 January 2014 (UTC)
That was just an example. If this article is an appropriate place for discussing whether dextromorphan works or not, then it is an appropriate place to tell what it is. It doesn't make sense to have one and not the other, no one will know what is being discussed, and it seems biased. Mr Johnson The Second (talk) 20:52, 12 January 2014 (UTC)
The current layout that first explains what they are and then covers how well they work (or don't) is better. The proposed change mixes these two topics and then leaves an extra Effectiveness section after. The current layout is more clear. Zad68 16:13, 13 January 2014 (UTC)


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