Saturday March 4, 2006
If there’s one thing that irritates a scientist, it’s not knowing. This week, the Prescription Pricing Authority decided to authorise magnetic bandages for ulcer treatment on the NHS: and I have no idea why. They won’t tell me what the presented evidence was, because that’s not their policy. Shhh. It’s a secret.
And you thought science and medicine was about openness and evidence? So I trogged over to the Magnopulse site: when I could get through, that is, for hours all I got was: “This site is unavailable because it is too busy,” so business is good.
Sniffing around for data I found, to my immense delight, that they also have a special magnet for women to wear: “Wearing mn8 also boosts your body naturally, giving you softer skin, shiny hair and stronger nails.” It sounds a bit like the Winalot TV ads to me, but that pales into insignificance next to the Magnetic Pet Coaster that goes in your dog bowl.
Did the dog bowl magnet feature in the evidence they offered to the PPA? We will never know for sure, but the claims are equally grand. “They will love the taste.” Why?
Because “Magnetic treated water is more natural. Using a pet coaster ensures that your pet receives maximum benefit from their drinking water”.
I want one. Why do my dog and my girlfriend always get special treatment? “Given the choice,” they go on, “your pet will always choose to drink magnetic water, they can tell the difference.”
Now, stats can be complicated, I realise: but “always” is a very easy thing to do the maths on, in one afternoon, with one dog and two bowls. If Derek Price of Magnopulse Ltd (one million sales so far) wants to get in touch, I’d very much like to help him verify that claim.
Does the hyperbole end there? I found the magnetic bandage in question. It’s hard to miss, there’s a big picture of the 4Ulcercare box plastered with the words: “NHS trials proved conclusively that Ulcercare helps the body heal chronic leg ulcers. Naturally.”
“Proved conclusively,” again, is a rather grand claim, and I’m hoping for evidence. But all I can find is a small pilot study with 26 patients, and a customer survey. Can that be conclusive proof?
Magnet therapy has been heavily investigated elsewhere, of course, and the evidence is not good. It’s easy to tell, if you’re in a “blinded” trial, whether you got the real magnet or the placebo one – whether you want to know or not – because magnets stick to your fridge, or your keys when you get them out of your pocket. Trials that haven’t accounted for this are worrying, while trials which hide the magnets cautiously show that they’re no better than placebo.
And that’s the key, of course. Because magnet therapy might draw a blank, but placebos are very effective, and popular. There was an ingenious trial just two weeks ago in the BMJ, comparing a placebo sugar pill against a placebo ceremony, themed on acupuncture, and it found, again, that there are different grades of placebo. Because, of course, placebo is not about a sugar pill, it’s about the cultural meaning of the treatment, the interaction, the setting, and the ritual.
This is something that has been vanquished from modern medicine, where we champion informed consent and patient autonomy over efficacy. I’m completely embedded in that idea. For all I know we only do it to fulfil our own professional fantasies of rationality. Maybe we should just get over ourselves and start confabulating to patients about evidence and theory like alternative therapists do.
In fact, maybe that’s what’s happening here. The PPA, to be fair – and they were allowed to tell me this – only assess on things like cost-effectiveness, and safety. But I honestly suspect that this might be the first time in history that something has been embraced by the NHS, with no compelling evidence of efficacy, knowing at the time that its effects may only be placebo. This could be the beginning of a very weird cultural shift: just so you know.
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