COMMENTARY

'Doc, Would You Prescribe Chocolate Milk for My Concussion?'

Arthur L. Caplan, PhD

Disclosures

March 11, 2016

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Hi. I am Art Caplan from the Division of Medical Ethics at the New York University Langone Medical Center in New York City.

Can chocolate milk actually help athletes recover cognitive function faster after concussion? A press release from the University of Maryland says that it can. In fact, the press release says that a study by a researcher at the University of Maryland School of Public Health found that drinking Fifth Quarter Fresh® fortified chocolate milk, with nothing particularly special added to it, did help athletes maintain cognitive function or recover it more quickly throughout the football season. According to the manufacturer, this milk comes from special cows that produce an especially healthy kind of milk.

At least one school district in Western Maryland has said that it will buy that milk and make sure that their kids in that district get it. No doubt, other people around the country, excited by the discovery that drinking chocolate milk from special cows can counteract the impact of concussions, will be enthusiastic about it too.

But they shouldn't be. It turns out that when journalists began to probe the facts behind the claims, they found that no study had been published—or even submitted—to prove the points that were in the press release. The researcher has not even presented these findings at a public meeting.

It also turned out that Fifth Quarter Fresh milk is partly subsidized by a state program in Maryland and partly by the dairies that make it. Thus, the press release is talking about a product that the school and state industries are trying to promote—Maryland cows' milk. They are trying to promote the state's dairy industry, which sheds doubt on whether anyone can credit these claims.

I do not know how this press release managed to be distributed without a paper to back it up, but I believe that it has some lessons about what to do when patients come in and say, for example: "I heard that coffee is good for me"; "I heard that I should drink a lot of red wine"; "I heard that I should eat kale every day—and doing this will bring good health."

All kinds of claims are floating around on the Internet about everything from bee pollen to who knows what, saying that they will help you. What you need to talk about with patients is whether any actual research exists to back up these claims. In the case of the Maryland study, there were no verified data, only an opinion put forward by a particular person at the university. You need to ask whether the information has been confirmed. Determine whether there is a second study that says, "Yes, we can verify what the first study found about red wine or kale or bee pollen or honey or coffee; we have replicated the results."

I do not believe that people should be changing their lifestyles or spending money on magical food remedies or preventatives unless more than one paper published in some reputable journals back it up. I do not expect every doctor to know whether there's a study out there to back up every particular claim that is made, but if patients are going to bother to find this stuff on the Internet, they can bother to find out whether there is a journal or a scientific article—or what the foundation is for the claim. I believe that you can ask the patient to do that.

I would also strongly urge that every once in a while you take a peek on the Internet at whatever remedies might be coming up in your specialty, whether chocolate milk, sleeping on your side, or doing something else that might help headaches, or sore backs, or chronic fatigue, or whatever it is that your patients find. That will enable you to respond to them when they come in, as they inevitably will, and say, "I saw that this product or that product, or this food, or this substance is a magic elixir, and I want your view about whether I should use it."

The lesson of chocolate milk is: Let the buyer beware. You cannot always trust what makes it into news reports. You cannot always trust what makes it onto the Internet. Conflicts of interest can sometimes fuel premature announcements about the benefits of things. Before they change their lifestyles or empty their pocketbooks, you and your patients must fully understand that they need evidence to show that it is worth their while.

I am Art Caplan at the Division of Medical Ethics at the NYU Langone Medical Center in New York. Thanks for watching.

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