Arecent study in Archives of Otolaryngology-Head and Neck Surgery on the potential side effects of nasal zinc therapies is the newest staging ground in the debate over how otolaryngologists can advise patients on the benefits of homeopathic treatments in the context of the common cold.
Explore this issue:October 2010
The study reported that the use of over-the-counter, homeopathic nasal zinc gel and spray “can and does cause anosmia” (Arch Otolaryngol Head Neck Surg. 2010:136(7);673-676). The results are the latest data in the back-and-forth on the efficacy of intranasal zinc gluconate, which drew attention last year when the U.S. Food and Drug Administration (FDA) warned customers that three Zicam intranasal zinc treatments were associated with anosmia. Still, the FDA continues to label the therapy as “generally regarded as safe (GRAS)” on its consumer website.
“These things can come to market and don’t need to go through the same rigors and trials other treatments need to go through,” said Karen Fong, MD, co-director of California Sinus Centers (CSC) Advanced Sinus Surgery and Rhinology Fellowship in Walnut Creek, Calif. “Just because it’s over the counter doesn’t mean it doesn’t have any issues.”
Honesty Is Key
According to the study authors, increased FDA scrutiny and oversight of homeopathic medicines, “especially ones with limited proven therapeutic benefit,” are needed to monitor the safety of such treatments. In an interview, however, lead author Terence M. Davidson, MD, FACS, added that such a proposal would likely draw criticism from the producers of such treatments and the pharmacies that profit by selling them. He also questioned the amount of money and time spent scrutinizing treatments that may not prove medically beneficial in most patients, but that have no side effects and may be beneficial to certain patients.
Either way, Dr. Davidson and other otolaryngologists interviewed for this story agreed that candor is the best way to handle questions about the topic of alternative treatments.
“The single most important thing a physician can do is be honest,” said Dr. Davidson, professor of otolaryngology-head and neck surgery and associate dean for Continuing Medical Education at the University of California, San Diego School of Medicine. “When a patient asks about a homeopathic treatment, sometimes you have to say ‘I don’t know.’”
The usefulness of alternative treatments in treating the common cold adds a layer of uncertainty because of the condition’s self-limiting nature. The patient’s symptoms may dissipate in a matter of days as the illness runs its course, leaving both the physician and the patient unsure of whether any of the alternative treatments used, such as zinc therapies, nasal irrigation and oversized doses of vitamin C, had a measurable impact on recovery time.