/ Health

Are you sure your much-loved medicines actually work?


When I go to my local chemist, I trust that what they sell me works: after all it’s the same place that I get my prescriptions and health advice from. But how can I be sure that these products stand up to their claims?

Well, according to our latest research, I can’t. We found that some of our best-loved brands – such as Benylin chesty and tickly cough syrups – just don’t have the evidence base to prove they work, and other products have much cheaper alternatives. So what’s going on?

Medicine claims

To give some background, before medicines are approved for use, they go through clinical trials and are licensed. But before granting a licence, the regulator asks for evidence of acceptable quality, safe use and efficacy for the conditions the product claims to treat.

Yet, in the case of cough syrup, a review by the Cochrane Collaboration (the gold standard) concluded:

‘This lack of evidence of effectiveness also has implications for the regulatory bodies and brings into question how these products can continue to be promoted using language that implies that their effectiveness is not in doubt.’

So we asked the manufacturers to show us their evidence that their products actually work, and in some cases, they declined to do so. The trade body, the Proprietary Association of Great Britain, said it’s because they didn’t want to give competitors ‘commercially sensitive’ data.

Although manufacturers have invested in research and new product development it’s rare for over-the-counter medicines to have patent protection once launched. What’s more is the European Medicines Agency encourages data sharing for pharmaceutical drugs and routinely publishes the clinical data submitted by companies.

Spot the difference

Our research also picked up on products that have cheaper alternatives. For example, Combogesic and Nuromol can be fairly expensive painkillers combining Ibuprofen and Paracetamol in one tablet. But, at 25p and 29p per tablet respectively, you could combine two generic ibuprofen and paracetamol tablets from up to 2.8p per tablet for an equivalent dose.

Another product to look closely at is Otrivine nasal spray. You can buy an Otrivine spray for allergy relief, another for sinusitis and a third for nasal decongestion. But the small print on the back of the packet would tell you that all three are exactly the same!

Otrivine’s manufacturer told us that these products marketed for different conditions to help you select ‘the product most suited to your needs’. Although the regulator says it’s in line with the product’s licensing, we think it’s misleading and you could waste money buying all three.

And if you’re in the market for the Otex and Earex Advance ear drops that our expert panel looked at, the wider evidence shows that they work. However, it’s likely that cheaper alternatives including saline, water, and olive or almond oil would work just as well.

Informed decisions

We think these firms should be more transparent and share their data so we can see if medicines and other health products are really worth our money.

So have you questioned the claims of any over-the-counter medicines? Should manufacturers be more upfront about their product claims?


Hello Which? My wife, who is 72, has had a problem with ‘dry eyes’ for some time. The only medication that seems to offer any benefit is the Optrex dry eye spray, which is very expensive for such a small amount. Unfortunately she does not get the same benefit from eye drops, which are much cheaper. Are there any suitable alternative sprays that would contain the same active ingredients and therefore provide the same benefit, yet might be less expensive?

Hi Leonard – Your wife’s GP may be able to help and she will qualify for free prescriptions. Dry eyes might be caused by prescribed drug, so it would be good to let the doctor know.

I’m pleased to see the report in Sept Which? describing useless or near-ineffective over-the-counter “medicines”, supplements and the like, as well as proprietary vs. generic drugs. Keep these reports coming. Maybe publish a booklet to reach a wider public.

I can understand the pharmaceutical companies not being willing to reveal all their clinical trials results to Which? or the public. Why should they make public information that could be commercially sensitive and that could be misused or misrepresented. We have a Medicines and Healthcare Regulatory Authority to look after the public’s interests. Why are they allowing products to be marketed without proof of efficacy? If they are, it is they who should be being held to account. Perhaps Which? could ask them about the products they criticise.

The All Trials campaign http://www.alltrials.net provides examples of how the drugs industry has concealed information that might harm the reputation of some of the products.

The results of ALL clinical trials must be made public. Here is one short video by Ben Goldacre: https://www.youtube.com/watch?v=3PU5ilpz31g

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Withholding of information is nothing new. Remember thalidomide. Anyone who thinks it is OK to withhold information because it is commercially sensitive might benefit from finding out why this might not be a good idea.

Thanks for the comment wavechange. We have a regulator whose job is to evaluate the evidence provided by the drug companies; if we have good reason to believe they are not doing that correctly then they need to be dealt with, and made to do that job. Most of us are not experts who can assess claims or evaluate evidence. Maybe we could discuss the role of the regulator?

Consultants with expertise don’t have access to commercial information, Malcolm. How can we make an input without access to the information?

I strongly recommend reading ‘Bad Pharma: How Medicine is Broken, and How We Can Fix It’ by Ben Goldacre. You could argue with the author’s style of presentation, but the message is important.

We often comment about regulators not doing a very good job, for example relating to nuisance calls and energy, but at least we have access to information to make informed comment.

The article in Sept Which? covered products that “repackaged” normal drugs at higher prices, which as others have said, by reading the ingredients or maybe asking the pharmacist, you could save money.

The other products were those, such as cough medicines, where their effectiveness is queried. The Medicines and Healthcare products Regulatory Agency says “Prior to placing a medicinal product on the market, all manufacturers are required to submit evidence of acceptable quality, safe use and efficacy in the proposed indications”. So back to my point: if “experts” say “there’s no good evidence cough medicines work” then the Regulator’s pronouncement is being directly challenged. Who is right? It is the regulator who should be asked to explain their decision; they are the public’s guardian and should be transparent. If they are not up to the job they should be replaced. Alternatively the verdict of the other “experts” might be questioned by asking them to disclose the basis of their decision. There seems to be information in the public domain that allows these views to be reached.

I was also particularly interested to see that the Which? report says that “there isn’t enough evidence that oral phenyleprine is more effective as a decongestant than as a placebo”.

My personal experience is that I find the cheap 12.2mg phenyleprine hydrochoride tablets sold by the likes of Sainsbury’s and Morrisons to be very effective – at least if the test subject is me.

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Duncan US jails are not the only places that trials take place. My late son was the victim of a clinical trial which he agreed to that killed him before a bone marrow transplant could be administered for his leukaemia. The consultant admitted this contributed to his untimely death but as my son agreed to it there were no grounds for redress.

My only consolation is that at least he played a part in helping to significantly reduce the number of child deaths from leukaemia.

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Thanks Duncan, the ultimate sacrifice is always a big price to pay. Coincidentally it would have been his birthday today.

PS: I think your heart is pretty sizeable too 🙂

I’m very sorry, Beryl. It was bad enough to lose a very good friend to leukaemia, but worse for his brother who had acted as donor for the bone marrow transplant. Some us have been very fortunate in life.

Thank you Wavechange I will never know whether a bone marrow transplant would have saved him. It is now 13 years since his passing but birthdays always rekindle fond memories.

You have been extremely active today on Convo 🙂

Years ago I used a decongestant containing pseudoephedrine and there is no doubt that it was effective. Having investigated the possible problems associated with using this drug I will put up with congestion in future.

The MHRA has a guide on the advertising of medicines: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/376398/Blue_Guide.pdf
Section 5.6 gives specific advice on claims.

Dodgy claims seem to be an international problem. Here, for example, is a video about some of the questionable claims made for fish oils in Australia: https://www.youtube.com/watch?v=pxh1B7GBC9Q

Very funny but worrying video – about 9 minutes.

It was your post above that drew my attention to this. Thanks for that and I will have a look at some of the other ‘Checkout’ videos.

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She won it some time ago, Duncan, and the litigiousness also concerns Asbestos causing mesothelioma (apparently talc is often found near naturally occurring asbestos), so nothing new there, then. The case continues.


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Calm down, Duncan. If you read what I post you will see there are two issues being discussed. The talc one is old news, now, and the asbestos one is because a lot of talc is contaminated with asbestos. As I said.

However, the full facts are here:

Talcum powder is made from talc, a mineral made up mainly of the elements magnesium, silicon, and oxygen. As a powder, it absorbs moisture well and helps cut down on friction, making it useful for keeping skin dry and helping to prevent rashes. It is widely used in cosmetic products such as baby powder and adult body and facial powders, as well as in a number of other consumer products.

In its natural form, some talc contains asbestos, a substance known to cause cancers in and around the lungs when inhaled (see Asbestos). All talcum products used in homes in the United States have been asbestos-free since the 1970s.

Most concerns about a possible link between talcum powder and cancer have been focused on:

1. Whether people who have long-term exposure to natural talc fibers at work, such as talc miners, are at higher risk of lung cancer from breathing them in.
2. Whether women who apply talcum powder regularly in the genital area have an increased risk of ovarian cancer.

Does talcum powder cause cancer?

When talking about whether or not talcum powder is linked to cancer, it is important to distinguish between talc that contains asbestos and talc that is asbestos-free. Talc that has asbestos is generally accepted as being able to cause cancer if it is inhaled. This type of talc is not used in modern consumer products. The evidence about asbestos-free talc, which is still widely used, is less clear.

Researchers use 2 main types of studies to try to figure out if a substance or exposure causes cancer.

Lab studies: In studies done in the lab, animals are exposed to a substance (often in very large doses) to see if it causes tumors or other health problems. Researchers might also expose normal cells in a lab dish to the substance to see if it causes the types of changes that are seen in cancer cells. It’s not always clear if the results from these types of studies will apply to humans, but lab studies are a good way to find out if a substance might possibly cause cancer.

Studies in people: Another type of study looks at cancer rates in different groups of people. Such a study might compare the cancer rate in a group exposed to a substance to the rate in a group not exposed to it, or compare it to what the expected cancer rate would be in the general population. But sometimes it can be hard to know what the results of these studies mean, because many other factors might affect the results.

In most cases neither type of study provides enough evidence on its own, so researchers usually look at both lab-based and human and studies when trying to figure out if something causes cancer.

Studies in the lab

Studies that exposed lab animals (rats, mice, and hamsters) to asbestos-free talc in various ways have had mixed results, with some showing tumour formation and others not finding any.

Studies in people

Ovarian cancer

It has been suggested that talcum powder might cause cancer in the ovaries if the powder particles (applied to the genital area or on sanitary napkins, diaphragms, or condoms) were to travel through the vagina, uterus, and fallopian tubes to the ovary.

Many studies in women have looked at the possible link between talcum powder and cancer of the ovary. Findings have been mixed, with some studies reporting a slightly increased risk and some reporting no increase. Many case-control studies have found a small increase in risk. But these types of studies can be biased because they often rely on a person’s memory of talc use many years earlier. One prospective cohort study, which would not have the same type of potential bias, has not found an increased risk. A second found a modest increase in risk of one type of ovarian cancer.

For any individual woman, if there is an increased risk, the overall increase is likely to very be small. Still, talc is widely used in many products, so it is important to determine if the increased risk is real. Research in this area continues.

Lung cancer

Some studies of talc miners and millers have suggested an increased risk of lung cancer and other respiratory diseases, while others have found no increase in lung cancer risk. These studies have been complicated by the fact that talc in its natural form can contain varying amounts of asbestos and other minerals, unlike the purified talc in consumer products. When working underground, miners can also be exposed to other substances that might affect lung cancer risk, such as radon.

No increased risk of lung cancer has been reported with the use of cosmetic talcum powder.

Other cancers

Talc use has not been strongly linked to other cancers, although not all possible links with other cancers have been studied extensively.

One study suggested genital talcum powder use may slightly increase the risk of endometrial (uterine) cancer in women who are past menopause. But other studies have not found such a link. Further studies are needed to explore this topic.

Some limited research has also looked at a possible link between inhaled talc exposure at work and other cancers, such as stomach cancer. But there is no strong evidence of such links at this time.

What expert agencies say

Several national and international agencies study substances in the environment to determine if they can cause cancer. (A substance that causes cancer or helps cancer grow is called a carcinogen.) The American Cancer Society looks to these organizations to evaluate the risks based on evidence from laboratory, animal, and human research studies.

The International Agency for Research on Cancer (IARC) is part of the World Health Organization (WHO). Its major goal is to identify causes of cancer.

IARC classifies talc that contains asbestos as “carcinogenic to humans.”
Based on the lack of data from human studies and on limited data in lab animal studies, IARC classifies inhaled talc not containing asbestos as “not classifiable as to carcinogenicity in humans.”
Based on limited evidence from human studies of a link to ovarian cancer, IARC classifies the perineal (genital) use of talc-based body powder as “possibly carcinogenic to humans.”

The US National Toxicology Program (NTP) is formed from parts of several different government agencies, including the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Food and Drug Administration (FDA). The NTP has not fully reviewed talc (with or without asbestos) as a possible carcinogen.

You also have to view these sensationalist stories you post with some scepticism and examine their origin. These are emanating from the US, which has one of the most aggressive litigation businesses in the world.

I have just binned most of a small tin of talc that was last used in the mid-70s when my leg was encased in a full-length plaster for six weeks. I remember being careful not to inhale the dust.

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Sorry Duncan; I can’t understand your post.

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The more important question is why are any medical terms whatsoever asterisked out? And just who made that decision?

@user-66219 @carneades Hi both. Good points on medical terms – I will check on why the decision was made and see if they can be unfiltered.

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Duncan, my apologies – I meant to place that one in moderation (it should now be displaying as such) as I wanted to contact you separately (likely by email) regarding the word filter. As you’ll have seen, I think you make a good point with regards to medical terms – I’m going to check tomorrow to see if we can get those words unfiltered and will be in contact. Also would just like to say that posts are never automatically removed (unless they’re picked up by certain filters – URLs, for example).

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Morning Duncan. We’ll pick this up separately so this convo can get back to medicines. Looks like we will be able to relax the filter for medical terms, which is good news. I’ll be in contact.

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“Mr. Lanier said Johnson & Johnson had spent 40 years covering up evidence of asbestos in some of its talcum-based products and should mark those products with warning labels or focus on powders made with cornstarch.”

It will be interesting to watch the award as the numerous appeals kick in. AIUI this is not about the substances per se but about J and J’s failure to warn customers that there might be asbestos in the products. And that of course, is common to all talc.

I have no desire to make any excuses for Johnson & Johnson, Duncan, but I take exception to your denial of freedom of speech when you say “NO excuses please for J & J”.

I am glad the Missouri Court agreed with you, and I hope your advocacy also prevails when the case reaches the next level as it surely will.

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Duncan – I thought I made it clear that I have no desire to make any excuses for Johnson & Johnson. But someone else might have something to say in mitigation and you tried to stop that by saying “NO excuses please for J & J“.

I wouldn’t be too quick to compare yourself to Pontius Pilate.

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I wouldn’t hold up Pontius Pilate’s judgment as a paragon of virtue either, Duncan. He was not inherently an honourable man but a tyrannical ruler who committed many atrocities. His judgment in the case of Jesus was not intrinsically merciful but an ulterior one to save his own skin. He went along with the demands of a multitude of Jews and had Jesus crucified where he could have spared him that fate, except he would probably have been lynched or stoned to death. He washed his hands afterwards in a contrived act of exculpation in order to blame the Jews for the sacrifice of Jesus. I am not a religious person and it’s a very long time since I read the scriptures but that bit sticks in my memory.

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Duncan, interesting. I expect additional rip offs by the attorneys 🙂

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Thanks Duncan. The issue seems to be that some companies have used glucosamine chloride rather than glucosamine sulphate, Duncan: https://4classaction.com/2018/04/13/have-you-purchased-glucosamine-sulfate-supplements/

Labelling products incorrectly is a good reason for taking action against irresponsible companies but I very much doubt which form of glucosamine is used will make a difference. Many users find no benefit at all, either on its own or as glucosamine + chondroitin. The law firm that that put together the case for a class action (see link above) has clearly not understood that potassium sulphate is not intended to be an active ingredient.

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Duncan – sorry to hear that news but thanks for sharing.

I took Omeprazole for a while in 2008 (to combat painful heartburn) but have almost never used them since. In may case, I was convinced that the root causes were stress related and, whether or not that was true, I was able to make some significant home to work life balance improvements and my problems went away.

I’ve always known that PPIs such as Lanzoprazole were to be avoided if at all possible, so I’m unsure why this is news as such. However, it’s worth bearing in mind that many medicines are potentially extremely dangerous for some, and are prescribed as the lesser of two evils.

But in the UK, anyway, Lanzoprazole – to name but one – has carried these warnings for as long as I can remember:

Bone fractures warning: People who take several doses of this drug per day for one year or longer may have an increased risk of bone fractures. These breaks may be more likely to happen in your hip, wrist, or spine. Talk to your doctor about your risk of bone fractures. You should take this drug exactly as prescribed by your doctor. Your doctor should prescribe the lowest dose possible for your treatment for the shortest amount of time.
Severe diarrhea warning: This drug may increase your risk of severe diarrhea. This may be caused by an infection in your intestine due to Clostridium difficile (C. diff). Call your doctor right away if you have watery diarrhea, stomach pain, and a fever that won’t go away.
Kidney damage warning: This drug may cause kidney damage. Call your doctor if you have flank pain (pain in your side and back) or changes in urination during treatment.
CLE and SLE warning: Lansoprazole can cause cutaneous lupus erythematosus (CLE) and systemic lupus erythematosus (SLE). CLE and SLE are autoimmune diseases. Symptoms of CLE can range from a rash on the skin and nose, to a raised, scaly, red or purple rash on certain parts of the body. Symptoms of SLE can include fever, tiredness, weight loss, blood clots, heartburn, stomach pain, and joint pain. If you have any of these symptoms, call your doctor.
Fundic gland polyps warning: Long-term use (especially over one year) of lansoprazole can cause fundic gland polyps. These polyps are growths on the lining of your stomach that can become cancerous. To help prevent these polyps, you should use this drug for as short a time as possible.”

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I have never read anyone, ever saying you are ” “too technical ” for the general public”, Duncan. Someone, somewhere may have said it once, but I’ve never seen it.

On the rest of your comment I agree. There has been an in-built tendency in the medical profession to believe they know best and the patient should simply accept what’s given to them. It’s a paternalistic attitude that I’d hoped had gone, but it seems not. Although GPs and surgeons are time pressured, they should always explain what medications are for and explain the potential side-effects.

One problem, however, is that very few patients really comprehend risk and probability. There is, after all, risk in everything; eating too many chips in a day can be fatal, as can drinking copious amounts of water. The probability, however, of either event is extremely low and we’ve seen the results when criminals such as the struck-off Wakefield export their brand of snake-oil mythology to the US where the gullible swallow his hokum about vaccination, resulting in deaths and serious damage from measles to many children who could have been protected.

The basic rule is that no medication is totally safe. The issue is whether the alternative is or could be worse.

All medicines are accompanied by comprehensive information about their use and potential side effects, telling you to contact your doctor if you experience them. Worth reading (you might need strong spectacles)
in case they affect you in the ways described. They are usually, in my experience, a balance between very likely doing you good and the very slight possibility of doing you harm. Chemotherapy is perhaps an extreme case. The option is not to take medicine and tolerate the consequences.

Your January 2022 article about painkillers under combination cold and flu products showed the difference in prices between shops. However, no reference is made to the form in which the tablets are sold. Some people find it much easier to take capsules instead of large tablets. We need to know if the cheaper shops sell capsules as opposed to tablets.

Packets will be marked with the type of pill. I know that you can buy cheap ibuprofen as tablets, capsules and caplets.