COUGH SYRUPS
Every year we spend up to $400 million on over-the-counter remedies such as cough medicines. But in 2014, a major review by the authoritative Cochrane organisation found there was no good evidence that over-the-counter cough medicine shortened the duration of coughs or sped up recovery.
'No new drug of proven effectiveness has been licensed for acute cough in over 30 years'
It analysed the results of 29 trials involving almost 5,000 patients with acute cough - defined as lasting less than eight weeks and usually due to an upper respiratory tract infection caused by a virus.
As Professor Alyn Morice, an expert in respiratory medicine at the University of Hull, explains: 'Despite the large expenditure on cough remedies, evidence for them is poor.
'No new drug of proven effectiveness has been licensed for acute cough in over 30 years.'
He says there is evidence medicines containing dextromethorphan can suppress coughs 'but the 60mg dose recommended by the manufacturers is probably too low'.
And he cautions against simply taking higher doses, in case your medicine contains other drugs that are risky at high concentrations.
Medicines containing the antihistamine diphenhydramine may reduce coughing triggered by allergies, without necessarily speeding recovery. But Professor Morice says those buying drugs for non-allergic coughs are probably wasting their money.
ARTHROSCOPY FOR CREAKY KNEES
The pain is coming from the underlying bone and the tissue lining the joints, rather than just the cartilage
Many people in the UK undergo arthroscopies - where surgeons examine inside the knee with a tiny camera and then trim off torn cartilage - to tackle knee pain.
'But evidence shows it generally doesn't work,' says Philip Conaghan, a professor of musculoskeletal medicine at Leeds University. He suggests this is because the pain is coming from the underlying bone and the tissue lining the joints, rather than just the cartilage. 'Arthroscopy isn't going to affect either of those things,' he says.
'But the problem is that there are many people with un-met pain needs. Telling them you can look inside their knee and clean it out a bit can sound like an attractive option.'
There is a specific problem it does help with, however. 'If you have a torn meniscus - the half-moon-shaped wedge of cartilage on each side of the knee - it can get stuck between the bones, giving you a locked knee. These people do very well with arthroscopy.'
PILLS FOR MODERATE DEPRESSION
'I don't think antidepressants do anything useful for mild to moderate depression'
Prescriptions for antidepressants are the fastest growing in the NHS, almost doubling over a decade to 57.1 million in 2014.
But the evidence that they make a significant impact on depression is thin, says psychiatrist Dr Joanna Moncrieff, a senior lecturer at University College London, and the author of several clinical papers questioning their widespread use.
'I don't think antidepressants do anything useful for mild to moderate depression and the difference between an antidepressant and a placebo is minuscule,' she adds.
'They do seem to have an emotional numbing effect which some people may like, but I'm not sure that is useful in depression.
'The core problem is that we have come to see depression as a medical illness when it is an emotional reaction to life's circumstances.'
She says there is 'little evidence' to show antidepressants help, adding: 'There has been an expectation from patients that something will be prescribed and it is often the easiest, or only thing doctors feel they can do.'
However, the Royal College of Psychiatrists claims 50 to 65 per cent of people with moderate to severe depression improve after three months on antidepressants (30 per cent will see the same improvements with a placebo).
Meanwhile, there is also evidence that cognitive behavioural therapy (CBT), the flagship government treatment, does not sustain benefits long term.
The problem is that the talking therapy, which encourages patients to alter their depressive thinking, does not address the root cause of problems, argues Oliver James, a chartered psychologist and author.
He believes the government should focus on psychodynamic therapy which helps people address the source of their cognitive issues.
FLOSSING YOUR TEETH
An emerging body of research suggests flossing makes no difference to oral or dental health, says Professor Damien Walmsley, scientific advisor to the British Dental Association.
A review last year in the Journal of Clinical Periodontology concluded: 'The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal and in reducing gingival (gum) inflammation.'
The majority of available studies fail to demonstrate that flossing is generally effective
Professor Walmsley admits that he continues to floss anyway as it makes him 'feel better' and it helps to dislodge bits of food, but says: 'If you are not flossing, don't worry too much about it as there may be no need.'
Flossing may still be part of recommendations from your dentist because, as Professor Walmsley says, it can take a long time for a body of opinion to take on new findings and modify recommendations.
'We still recommend floss because if used correctly, it's unlikely to cause harm,' he adds.
In contrast, the recommendation to brush your teeth twice a day is well supported by studies, he says, as it disrupts bacteria build-up and prevents sticky biofilms developing, which can lead to plaque and tooth decay.
CALCIUM PILLS FOR WEAK BONES
Many people take calcium supplements to boost bone density and prevent fractures in later life.
However, two major studies, published in the BMJ last year, concluded that there is no evidence they work.
'If you have a decent diet containing some yoghurt, milk and cheese you do not need additional calcium,' says Klaus Witte, a cardiologist at the Leeds Teaching Hospitals NHS Trust.
Many people take calcium supplements to boost bone density and prevent fractures in later life
'Almost all studies show that it's pointless.' However, he says some people may well need more vitamin D, which helps the body absorb calcium, and which is often included in calcium pills. 'But there's no evidence that people benefit from the calcium alone.
'In fact, there is a hint that taking big doses could lead to it being deposited in the arteries, which raises the risk of heart attacks and strokes.
'I see many older patients on calcium supplements with presumed osteoporosis and my concern is that it may in fact be accelerating their vascular disease.'
David Reid, an emeritus professor of rheumatology and clinical adviser to the National Osteoporosis Society, says that the average daily dietary intake of 700mg of calcium is enough for most people. 'The latest evidence is that calcium supplements may slow loss of bone after the menopause but only to marginal effect,' he adds. However, he says those with established osteoporosis may still need calcium supplementation along with vitamin D and their bone-strengthening medication.
ACUPUNCTURE FOR BACK PAIN
Acupuncture is no longer recommended as a treatment for low back pain on the NHS following a review of evidence that found it's no better than a placebo.
Acupuncture is no longer recommended as a treatment for low back pain on the NHS
However, George Lewith, a professor of health research at Southampton University, says he is 'completely at a loss' as to how this conclusion was reached, especially as the same data is interpreted in a different way in other countries.
But Professor Conaghan points out that cost effectiveness comes into decisions by NICE (National Institute for Health and Care Excellence), too. 'It looks at efficacy first, and cost effectiveness second. Neither of these points made acupuncture look particularly attractive.'
FISH OIL FOR YOUR HEART
Omacor is an omega 3 fish oil supplement that GPs often prescribe to patients with heart disease, angina, or who have had a heart attack says Sundip Patel, a consultant cardiologist at the London Bridge Hospital.
'At one point it was thought to be beneficial to heart health,' he says. The capsules, which cost around £21 for a month's supply, were thought to help by reducing the levels of triglycerides or blood fats.
Dr Patel says: 'Evidence has since shown there is no benefit from taking it, but patients still ask for it.'
'There is no evidence that omega 3 fatty compounds help to prevent coronary heart disease'
A study in 2012 in the Journal of American Medical Association analysed the outcome of 68,000 people taking fish oils (1.5g a day) or a placebo for two years. Those taking oils did not have statistically fewer heart attacks or less heart disease than those not taking them.
NICE recommends that doctors tell people: 'There is no evidence that omega 3 fatty compounds help to prevent coronary heart disease.'
ANTIBIOTICS FOR EARACHE
One in four children suffers an ear infection (otitis media) by the age of ten. Research carried out at Southampton University shows ear infections are the most common reason for children being prescribed antibiotics by their GPs.
In fact two in three ear infections are caused by viral infections, which antibiotics are powerless to treat, says Professor Tony Nerula, president of the ear, nose and throat specialists' body ENT UK. Only about one in three is caused by bacteria.
A viral infection usually clears up on its own within 48 hours, and patients are advised simply to take paracetamol or ibuprofen.
'The problem is GPs have no way of knowing if a virus or bacterium is the cause,' says Professor Nerula. 'So most issue a deferred prescription for antibiotics dated for a couple of days' time. The parent is told to collect the prescription if the infection does not clear up by then.'
Two in three ear infections are caused by viral infections, which antibiotics are powerless to treat
ASPIRIN FOR A FAULTY HEARTBEAT
Around one million people have atrial fibrillation, an irregular and often abnormally fast heartbeat. It can raise the risk of blood clots forming in the heart's chambers, causing a stroke.
Even though research shows aspirin is not beneficial in atrial fibrillation patients, some are still given it, says cardiologist Klaus Witte. 'Aspirin does have a marginal blood-thinning effect but this is probably ineffective in preventing the type of clot that causes a stroke in atrial fibrillation.'
These patients should instead be prescribed an anticoagulant - medicines to prevent clots - such as warfarin, or one of three newer drugs, apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto). Yet the results of a small survey last year by the Atrial Fibrillation Association suggested 200,000 patients are still being given aspirin.
HIGH-FIBRE DIET FOR IBS
'For many patients it made the symptoms worse. There was never any evidence that it would work'
For many years increasing the amount of bran in the diet was the main advice given to those with irritable bowel syndrome. Yet there was no evidence it worked.
'In fact for many patients it made the symptoms worse. There was never any evidence that it would work - it just became a widespread belief,' says Professor Chris Hawkey, a gastroenterologist at Nottingham University who is also chairman of CORE, the charity for those with diseases of the gut, liver and pancreas.
PARACETAMOL FOR BACK PAIN/ARTHRITIS
Millions rely on paracetamol for everyday pains
Millions rely on paracetamol for everyday aches and pains. But when it comes to certain conditions we may be wasting our time.
Last year, a review of 13 clinical trials, published in the British Medical Journal, found it ineffective for back pain and, when it comes to osteoarthritis of the hip and knee, the improvement was so small that it was 'not clinically important'.
Instead the experts, from the University of Sydney, warned the drug could cause liver problems.
A more recent comprehensive study, published in The Lancet in March, found paracetamol had 'no role' in treating the joint pain of osteoarthritis. 'It's disappointing, but patients have been telling us for years that they are not impressed with paracetamol,' says Prof Philip Conaghan.
Non-steroidal anti-inflammatories seem to be more effective, he says, but many people cannot take these long term and they can have significant side-effects.
He says that what does seem to help with both problems is strengthening muscles, but this takes time.
STATINS FOR THE ELDERLY
STATINS are the most commonly prescribed drugs in the UK - many millions of people take them to help cut their levels of LDL or 'bad' cholesterol, which is thought to clog arteries and increase the risk of heart attacks and stroke.
There is evidence statins can reduce the risk of heart attacks and stroke, especially among those who have had a major event such as a previous heart attack.
'Yet sometimes these drugs are given to people in their 80s or older who have not had a previous major event and there is very little if any research to suggest that it is of benefit to them,' says Professor Simon Maxwell, consultant pharmacologist at the University of Edinburgh.
'Most research has been done on far younger people who have had a major event.' Statins are linked to side-effects such as muscle pain.
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