Thursday, 17 April 2014

Cough and Cold? Getting a better nights sleep with Vick's Vapo Rub?


It is great to see the eye’s of science peer down on a consumer product as old and ubiquitous as Vicks Vapo Rub. A recent randomized trial in the journal Pediatrics looked at the effect of vapor rub, petrolatum (petroleum jelly), or no treatment for children with nocturnal cough symptoms. As the parent of small children who currently have colds, I want to know the answer. Which works best?

Surveys (6 questions on a 7 point Likert scale) were administered to parents on 2 consecutive days. The first was done on the day of presentation to a pediatric clinic before medication was given. Children were randomised to get one of the above treatments. Then the next survey was completed the following day by the parent self report who hopefully had a better night’s sleep

I already know what you are thinking? How did they blind Vapo Rub? Believe it or not, the study design cleverly asked parents to place Vapo Rub below their nose before opening the study packet which contained the randomised medication. (I wonder how many actually performed this requested step!? ) In addition, they asked the children not to disclose to their parents whether the treatment had an odor. Despite these efforts, the parents were able to accurately identify the actual treatment arm 90% of the time.

The results? 138 children completed the trial. Vicks Vapo Rub consistently scored the best and no treatment was the worst.

Unfortunately it is hard to really get a sense of how much the Vapo Rub actually works given the nature of the complex Likert scale utilized as the outcome measure.

Obviously there could have been some bias introduced due to lack of blinding. Do smelly placebos work better? Once again, this was a self completed survey by the parent.

In addition, this study was industry funded! It was supported by an unrestricted grant from Procter & Gamble and the lead author has been a paid consultant for company. Is nothing else sacred in this world?

This study is far from definitive. I would be disappointed but not overly surprised if I saw direct to consumer advertisements for Vapor Rub stating it is “clinically proven” to decrease nocturnal cough and cold symptoms in children.

What will I do with my kids? I’m busting out the Vapo Rub! Yes the science isn’t perfect but if the parents said they all slept better than what am I to do. If my evidenced based sceptical head is sleeping on a pillow made of placebo, then so be it.

Covering:

Paul IM, Beiler JS, King TS et al. Vapor Rub, Petrolatum, and No Treatment for Children With Nocturnal Cough and Cold Symptoms. Pediatrics 2010;126;1092-1099.

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