It goes down like medicine

Fatigue is a common and disabling symptom that affects many people with multiple sclerosis (MS). I have been suggesting that patients try drinking a daily cup of high-flavonoid hot chocolate, off the back of this interesting trial.

Some doctors balk at the idea. Why?

This was a well-designed, albeit small, feasibility study which showed a small but significant effect of a very low-risk (even enjoyable) intervention on a common and disabling real-world symptom. 

Compare this to the drug amantadine, which is listed in textbooks as a treatment for MS fatigue but in the real world is rarely effective or tolerated. In fact a recent well-designed trial reported that amantadine was overall more harmful than placebo and no more effective.

Real-world effects matter. Patient-reported outcomes matter. We need to reflect this in clinical trials.


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