E-DRUG: Need for cough mixtures (contd.)
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As far as using a placebo for the primary care management of coughs,
I support the idea for the following reasons:
1. Cough mixtures such as Simple Linctus and others containing
soothing ingredients are, in essence, not really placebos as they
have a soothing effect on dry mucous membranes. At best, they can be
of mild benefit. At worst, they may be ineffecitve. At least they do
no harm.
2. The power of the placebo is well documented. If we are at a stage
in healthcare when society expects therapy, then it would be wise to
work with these expectations whilst we simultaneously try to alter
the expectations through educational efforts. Once again there is
only benefit to be obtained (at this point in time) as the placebo
would be inexpensive, might offer relief, would do no harm, and would
be very inexpensive. Better this than the alternative i.e. meeting
their expectations with a pharmacological agent that might suppress a
productive cough, an antibiotic that would be of no value, an
antihistamine that would dry secretions etc.
3. The possibilty exists that the cough may not be simply associated
with a self- limiting respiratory infection but may be a symptom of a
more serious condition such as asthma, tuberculosis, cardiac disease,
etc. In the primary care situation it is also possible that the
skills and tools may not be available to investigate the cough
thoroughly when it first presents. Surely we would hope that a
persistent cough would re-present for further investigation.
In my opinion, by giving nothing at all to the patient for the cough
at the first visit, sends a message that the cough is not a problem
and should be endured or 'lived with'. I would imagine that if the
cough were to persist, the patient would be unlikely to return as
he/she would now believe that nothing can be done about it, so what's
the point of seeking further care.
If, on the other hand, a placebo was given alongwith counselling, the
patient would be a partner in the management of his/her cough. Being
now involved with his/her own care, if the cough did persist, he/she
would be inclined to re-present which would provide the primary care
worker with a valuable patient history and the opportunity to arrange
for this patient to be investigated further.
I think we would do well to acknowledge the psycho-social aspects of
medicine as well as the purely scientific side.
Geraldine Bartlett, MPharm
Executive Director
The TPS Drug Information Centre
50 Stiemens Street
Braamfontein 2017
South Africa
Email: bartlett@icon.co.za
Telephones: ( + ) 27 11 3394811 (work)
( + ) 27 11 706 3243 ( home)
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