Consumer summaries of Cochrane systematic reviews

Daily aspirin may not be worth the risk for everyone
According to a Cochrane review about people with high blood pressure, daily aspirin can prevent major complications for those who have had a stroke, heart attack or circulation problems in the legs. But for people who haven't, the risk of harm seems to be as great as the chance for benefit. Although some strokes are caused by bleeding in the brain, most serious heart disease, strokes and circulation problems in the legs are caused by blockages or clots in the blood vessels. These blockages and clots are called thromboses. There are drugs that can help prevent thromboses by 'thinning' the blood.

These drugs are sometimes called 'clot-busters', and the medical term is anti-thrombotic therapy. One of the potential drawbacks of these anti-thrombotic drugs is that they increase the chance of bleeding because they also make it more difficult for blood to clot when it needs to. This sometimes leads to bleeding that is hard to stop, and can occasionally cause a serious stroke.

Lip GYH, Felmeden DC. Antiplatelet agents and anticoagulants for hypertension. The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003186. pub2. DOI: 10.1002/ 14651858. CD003186. pub2.

Antibiotics not recommended to fight the common cold.
Antibiotics aren't effective against the common cold - and can even cause adverse effects. The common cold is an infection of the upper respiratory tract ( breathing system). It can cause a sore throat, blocked and/ or runny nose, and sometimes a cough or fever. Colds are usually caused by viruses, which do not respond to antibiotics. However, antibiotics cause adverse effects, especially diarrhea, and overuse can increase levels of antibiotic resistance in the community. The review found that trials do not show any benefit from taking antibiotics for the common cold, and adverse gastrointestinal effects are common.

Arroll B, Kenealy T. Antibiotics for the common cold and acute purulent rhinitis. The Cochrane Database of Systematic Reviews 1998, Issue 4. Art. No.: CD000247. DOI: 10.1002/ 14651858. CD000247.

Wearing a helmet is safer for cyclists
Wearing a helmet dramatically reduces the risk of head and facial injuries for bicyclists involved in a crash, even if it involves a motor vehicle. Head injuries are responsible for around three quarters of deaths among bicyclists involved in crashes. Facial injuries are also common. The review found that wearing a helmet reduced the risk of head or brain injury by approximately two thirds or more, regardless of whether the crash involved a motor vehicle. Injuries to the mid and upper face were also markedly reduced, although helmets did not prevent lower facial injuries.

Thompson DC, Rivara FP, Thompson R. Helmets for preventing head and facial injuries in bicyclists. The Cochrane Database of Systematic Reviews 1999, Issue 4. Art. No.: CD001855. DOI: 10.1002/ 14651858. CD001855.

Fluoride toothpaste cleans teeth better
Cochrane reviewers looked at trials with more than 40 000 children, and found that children aged 5-16 who use fluoride toothpaste every day have fewer fillings and lost teeth than children who use toothpaste without fluoride. Using it twice a day is even better. More than one in two children who have higher rates of tooth decay would have fewer fillings and lost teeth if they used flouride toothpaste, and even one in four children with good teeth will benefit. It is still not clear whether toothpaste increases the white stains that develop in some children under six who have been exposed to too much fluoride.

Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride toothpastes for preventing dental caries in children and adolescents. The Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002278. DOI: 10.1002/ 14651858. CD002278.

Less pain for breastfeeding women
Painful breasts are a common reason for women to give up breastfeeding. Engorgement can occur when excess milk is not removed from the breast during breastfeeding. The cells that excrete the milk become swollen, hot and painful. The review of trials found that the commercial drugs Danzen ( Serrapeptase) and Kimotab ( bromelain, trypsin) are effective but oxytocin, ultrasound and cold packs are not effective in improving the symptoms of engorgement. The review also found that there was no difference between using cabbage leaves or a cold gel pack.

Snowden HM, Renfrew MJ, Woolridge MW. Treatments for breast engorgement during lactation ( The Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD000046. DOI: 10.1002/ 14651858. CD000046)

Can alternative therapies help you quit smoking?
Acupuncture is commonly recommended, but it hasn't been successful in trials for quitting smoking. It is possible that regular acupuncture followed by a course of ear acupressure might work, although more research is needed. Ear acupressure involves taping a seed or similar object against an acupressure point in the ear and this is pressed against when you feel an urge to smoke. Trials of hypnosis have showed no increase in the likelihood of people quitting smoking. There are various forms of complementary therapies that might help with the withdrawal symptoms, but they haven't been studied in trials of people trying to quit smoking.

Abbot NC, Stead LF, White AR, Barnes J. Hypnotherapy for smoking cessation. The Cochrane Database of Systematic Reviews 1997, Issue 1. Art. No.: CD000009. DOI: 10.1002/ 14651858. CD000009. White AR, Rampes H, Ernst E. Acupuncture for smoking cessation ( The Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD001008. DOI: 10.1002/ 14651858. CD001008.

Soy formula not the answer for allergy prevention
Soy formulas for babies who are at high risk of developing allergies or food intolerance have not been shown to work Cochrane reviewers found five trials of soy formulas involving more than 1 000 babies at high risk of developing allergies or food intolerance. Soy formula was not effective in preventing the development of allergies, food intolerance, eczema, asthma or several other problems in children. The reviewers concluded that, while it is not out of the question that future research could find some benefit from soy formula, it does not seem likely that these formulas are effective. There were some reports of babies developing allergy to soy after being fed long term on soy formulas.

Osborn DA, Sinn J. Soy formula for prevention of allergy and food intolerance in infants. The Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003741. pub2. DOI: 10.1002/ 14651858. CD003741. pub2.