Magnetic Sex Appea… Shhhh

March 4th, 2006 by Ben Goldacre in alternative medicine, bad science, magnets, placebo | 91 Comments »

Ben Goldacre
Saturday March 4, 2006
The Guardian

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.

Please send your bad science to bad.science@guardian.co.uk


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91 Responses



  1. Big Les said,

    March 4, 2006 at 1:15 am

    Cultural shift? Bollocks, more like.

    Efficacy is all in medicine, and if some part of that is placebo, then that needs to be stated. If people are still too blinkered to cease believing in the placebo (or start their own cult of the placebo, and I’m not talking Brian Molko) then fair enough. But at least those of us with more than three teeth and/or brain cells will be able to make informed decisions.

  2. Bryan said,

    March 4, 2006 at 6:07 am

    Here’s my reason why I don’t want medical professionals to pick up the trappings of alternative medicine. As someone who knows something about the placebo effect and how it relates to medicine, and as someone who values knowing how the medicine I take works, I have a tendency to distrust things which come in those trappings, particularly if there isn’t a reasonable argument for how they work. As such, I’m likely to be doubtful of any medicine presented in that manner.

    If believing in the efficacy of a placebo makes it work, then what’s the effect of actively believing they medicine you’ve been given won’t work? And how much less likely are you to stick to a plan of treatment if you don’t believe it works?

    Never mind the legal implications of lying to your clients.

    Possibly the biggest problem, though, is the financial one. Real medicine has a higher production and research cost than fake medicine. Real medical equipment is similarly more expensive. It takes longer and costs more to train a legitimate medical professional. And, because many cultures consider medical treatment to be of importance to everyone, costs have to be controlled.

    Perhaps the best system is the current one, where individuals can decide which they want: the legitimate medicine, the theater, or both.

  3. ludo said,

    March 4, 2006 at 11:01 am

    This is another thing that bothers me about alternative/complementary therapies.

    If they are claimed to work, why are they not subject to safety tests?

    There is often an assumption that, if an alternative therapy has a physiological effect on the human body, then this must be entirely beneficial. There is no rational basis for this. The human body cannot judge, at the biochemical/cellular level, what is beneficial or harmful.

    If I invent a tablet that lowers blood pressure, I can’t just work out a sensible dose regime and market it. I have to subject it to years of expensive safety tests to prove that it doesn’t do more harm than good. Essentially, orthodox medical therapies are considered unsafe until proven safe.

    So why are alternative therapies considered different; exempt from this rule? If a magnetic bandage heals my leg ulcers, how do I know that the increased rate of tissue turnover won’t cause cancer in the future? Notwithstanding the lack of evidence that this therapy will help me, where is the evidence that it won’t kill me?

    I wouldn’t dream of taking or recommending a treatment with no safety tests; I don’t see why alternative therapies should be different.

    Maybe I should be campaigning for full safety tests for alternative therapies.

    Ludo

  4. amoebic vodka said,

    March 4, 2006 at 11:29 am

    We thought homeopathy had been available on the NHS since it was started. Wouldn’t that be the first placebo then?

  5. potsy700 said,

    March 4, 2006 at 12:07 pm

    Ludo,

    RE: safety tests for alternative therapies.

    The ‘alternative’ crowd have a bit of a blank spot in their reasoning, which basically goes:

    Alternative = ‘natural’ = always beneficial and safe

    also

    Natural = doesn’t contain any chemicals (!)

    There seems to be this very bizarre notion that human beings and the universe are somehow attuned and perfectly adapted to each other, and therefore ‘natural’ equals good.

    From a natural selection point of view, of course, we are adapted to our surroundings only just enough to enable enough of the population to live long enough to procreate. So lots of natural things are good, and a heck of a lot of them are bad. There are far more ‘natural’ chemicals and naturally occurring events that can have a harmful effect – if you take the view of a human being as an organised machine for a moment, then there must be far more possible interventions that will stop the machine working by introducing disorder, than will enhance the machine by happening to introduce more order.

    Following this logic it is far more beneficial to study biochem / pharmacology / molecular pathology etc. and produce drugs and therapies deliberately targeted at specific mechanisms in the human body. But the ‘alternative’ crowd don’t see that.

    The question that arises is: why are they so uncomfortable with it?
    Is it lack of education / understanding that makes them somehow resentful?
    Is it paranoia about some sort of conspiracy between doctors, government and scientists?
    Or is it just that the thought that we might not be in tune with the universe, and that we might just be incidental and not the reason why the universe is here, is a little frightening and not particularly pleasant?

  6. Ben Goldacre said,

    March 4, 2006 at 12:46 pm

    amoebic: we didn’t know homeopathy was no better than placebo at the time it was incorporated into the nhs in the 1940s.

  7. A Reader said,

    March 4, 2006 at 1:24 pm

    Never mind the benefits of placebos – the NHS should not spend money on this fraud. These manufacturers should not be given anyone’s money, least all of ours channelled through the state.

    Potsy, on why people are so loyal to alt therapies – here are the “reasons” I was stupid enough to believe in them at one time:
    – they’ve been around for hundreds of years and so have been proved effective and safe
    – trad remedies can’t be patented, so pharma companies have to look for less good alternatives which would earn them more money
    – there’s no money in the alt world, so practitioners are doing it out of the goodness of their own hearts (they casually let you see their empty diaries when they’re booking you in for an appointment, and you think “3 or 4 clients a week at £30 a shot – these good people are on the breadline”)
    – all the manufacturers are small-scale and conscientious, with high standards of manufacturing which mean they have tiny profit margins
    – doctors only get one day/one week of nutrition lectures in their whole degree, and that might have been decades ago, so they can’t be expected to know about the new findings on selenium/Vit E/wheatgrass/green-eyed shark bile
    – the NHS is overworked, so it’s an act of social conscience to pay for your own treatments for minor ailments.

    It’s a clever blend of truth and bullshit, and it’s all served up with a massive dollop of honour, bravery and passion. If you want to beat these, you have to get back the moral high ground. I’d suggest a campaign poster with “Ten Myths about Alternative Medicine”, and a graphic illustration of why each one is garbage. A cartoon of a top-hatted capitalist representing one of the multi-million manufacturers alongside a chart of their profits last year, for instance. But you have to disprove each one, not just some of them, and you have to avoid looking bitter or condescending while doing it.

  8. A Reader said,

    March 4, 2006 at 1:38 pm

    I should have said that when I say “you” have to avoid looking bitter, etc. I didn’t mean you personally, of course, potsy. I meant all of us.

  9. Pedantica said,

    March 4, 2006 at 1:44 pm

    If a magnetic bandage is more expensive than a standard bandage and no more effective then it cannot truly be cost effective as a treatment. I wonder if what they mean is “given the small amount of money spent on these magnetic bandages by the NHS a full blown investigation into their use would not be cost effective”. That might well be the case. Either way, as you say, it would be nice to have the figures available.

    Your point about efficacy and informed consent is a tricky moral one though. Should a medical practitioner lie to their patient about a treatment if lying can be demostrated to have a medical benefit in itself? Maybe it should be a choice for patients. We can put an option on our medical files:

    […] I give my consent to be lied to by qualified NHS staff about a course of treatment if this deception will most likely benefit me.

    Would you tick the box?

  10. Ben Goldacre said,

    March 4, 2006 at 1:53 pm

    i think the thing you have to remember about the alternative therapy industry is that its a diffuse network, so somebody with a professional interest in not lying, like a doctor, might not have to lie themselves in order to make an alternative treatment effective.

    the best example of this is the food supplement industry: in their adverts in the sunday glossy magazines, they do not make medical claims for their products, as that would be illegal: but in the alternative therapy columns in those same sunday glossy magazines, medical claims are made for those food supplements very clearly and unambiguously, as we often document here.

    likewise, a doctor perhaps wouldn’t tell their patients that magnet bandages are effective in the absence of evidence, but the media will, and the packaging will say “clinically proven in NHS trials” and so the patient will come away believing that their doctor is simply being finickety, or is ill-informed. indeed, this may come at such cost to the doctor patient relationship that doctors might feel it is more pragmatic to say as little as possible on the subject of whether they work or not, and let patients gather information from other sources, in the name of preserving good faith and therefore clinical benefit elsewhere.

  11. BobP said,

    March 4, 2006 at 2:12 pm

    Amoebic –
    Medicine has evolved. I suspect that 90% of Victorian medicine would now be categorised as placebo – lots of mercury, arsenic, chloroform and the like. When I was a kid in the 1950’s there was a medical trend to remove surplus bits of anatomy from children – tonsils, appendixes, that kind of thing – no evidence base at all that I know of. And doctors wore white coats, and talked as though you weren’t there, and I’ve never had a serious illness since then so look how good it was.
    Ludo/Potsy –
    Alternative therapies are subject to safety checks. Acupucturists no longer re-use needles, and herbal remedies no longer include ingredients such as ephedra and aristolochia. If you go to websites such as www.rchm.co.uk and www.acupuncture.co.uk you’ll find plenty about safety.
    The alternative practitioners that I know (admittedly, not many now) are very aware of their limitations and would send anyone with a serious illness straight off to the appropriate conventional channel.

  12. Tessa K said,

    March 4, 2006 at 2:15 pm

    Don’t forget that it’s also easier to become an ‘alternative’ practitioner than a doctor/bio-chemist/pharmacist etc. At worst, all you need is a few week’s ‘training’, a couple of wall charts, some essential oil to make your room smell nice and some ‘ethnic’ clothing.

    It’s interesting that there are no ‘alternative’ dentists who offer a bit of arnica instead of an injection and fill your teeth with crystals.

  13. BobP said,

    March 4, 2006 at 3:01 pm

    Tessa –
    That’s not true.

  14. BobP said,

    March 4, 2006 at 3:06 pm

    Correction – my previous posting should point to www.acupuncture.org.uk

  15. geoff seago said,

    March 4, 2006 at 3:50 pm

    Has anyone ever done a test of the placebo effect on two groups – one aware of the placebo effect and one not all othet things remaining constant

    Am I jeopardising myself by being well informed?

  16. Ben Goldacre said,

    March 4, 2006 at 4:38 pm

    bobp: what did tessa say that’s not true, that any old joe frequently sets himself up as an alternative therapist after a weeks work, or that there are no alternative dentists?

  17. j said,

    March 4, 2006 at 6:22 pm

    google finds alternative dentists; apparently there’s even a book – www.petervarley.com/book/index.html I’d imagine that the use of homeopathic remedies instead of local anaesthetic would be less popular, though ;)

  18. Terry Hamblin said,

    March 4, 2006 at 6:26 pm

    When my patients ask for the ‘natural’ alternative I always tell them that sharks and snakes are natural.

  19. Tessa K said,

    March 4, 2006 at 6:28 pm

    As I typed it, I did wonder. I still doubt if anyone would be prepared to have a root canal job done with a bit of chanting and some aura massage.

  20. potsy700 said,

    March 4, 2006 at 6:38 pm

    Mmm. I’ve been told that my wisdom teeth need removing by my dentist. One in particular keeps giving me jip. My dentist can’t do it so I need refering to a max-fax surgeon.

    It’s all going to be a right kerfuffle. But, if I can find an alternative dentists, it would be an interesting experiment to see what they suggested…

  21. potsy700 said,

    March 4, 2006 at 6:41 pm

    I did a quick google search on alternative dentists – and quickly found one who describes himself as a ‘mercury free dentist’. But what about my fillings?

  22. j said,

    March 4, 2006 at 6:47 pm

    I don’t know – people are prepared to have all their mercury fillings removed in order to remove ‘unnatural’ things from their mouth…and for people with lots of fillings that does sound like something which in other circumstances would be seen as torture. There’s reports on the net of ‘some’ people finding that homeopathy means they don’t need anaesthetic for dental treatment, but yeah you’d expect that means that far more people find they do still want it!

  23. BobP said,

    March 5, 2006 at 9:57 am

    Sorry, the comment was about qualification to become an altenative practitioner. Both acupuncture and herbal medicine are moving towards statutory regulation, and if you want to be on the register it will require three years full time training.
    Until statutory regulation is in place, Tessa is quite right that there are no guarantees. And I don’t know anything about other alternatives.

  24. Foggy said,

    March 5, 2006 at 10:33 am

    Christ Almighty!

    How the hell could you stretch “stick needles in idiots” or “Natural = Good” out for three years?

    *despairs*

  25. sam said,

    March 5, 2006 at 11:32 am

    cor blimey potsy

  26. potsy700 said,

    March 5, 2006 at 11:48 am

    Statutory regulation? Does this mean that the patients will have to sign a consent form, stating pros and cons of the procedure as when go see a surgeon?

    I.e. will the patients have to sign a form saying “I accept that there is no evidence that this therapy does anything”?

    Why not just get them all regulated by the GMC and have to adhere to their standards?

  27. Ben Goldacre said,

    March 5, 2006 at 12:58 pm

    the industry, despite charging £20 to £100 an hour for their services, and having professional bodies who grandly crow and write shouty letters at me and my editors, have failed dismally to organise themselves into professional regulatory bodies to regulate themselves and stop their members behaving badly. apart from the serious philosphical issues of what regulation of a made up fairy intervention with no evidence base could be, they seem to lack the will anyway.

    here are some hilarious examples of people setting themselves up as alternative therapists:

    www.asa.org.uk/asa/adjudications/non_broadcast/Adjudication+Details.htm?adjudication_id=40725

    www.asa.org.uk/asa/adjudications/non_broadcast/Adjudication+Details.htm?adjudication_id=40747

    www.asa.org.uk/asa/adjudications/non_broadcast/Adjudication+Details.htm?adjudication_id=36413

    and here’s a hilarious bit of infighting over the number of angels on the head of a pin from the society of homeopaths:

    www.asa.org.uk/asa/adjudications/non_broadcast/Adjudication+Details.htm?adjudication_id=34687

    i…just… love it when quacks fight between each other over who’s right and who’s wrong.

  28. Mojo said,

    March 5, 2006 at 1:01 pm

    “The PPA, to be fair – and they were allowed to tell me this – only assess on things like cost-effectiveness, and safety.”

    How can they assess whether something is cost-effective without also figuring out whether it works? Anything that doesn’t work is a waste of money, surely?

    Or is it just a question of “well, if the patient goes away and stops bothering their doctor that’s good enough for us”?

  29. Matt said,

    March 5, 2006 at 3:08 pm

    Picking up on Ben’s theme of ‘fulfiling our own professional fantasies of rationality’ – at the expense of what’s effacacious. This hits the nail on the head. In this context, ‘rational’ might be defined as what’s currently explicable within the boundaries of medical science. The situation is that placebo has a demonstrable effect on clinical outcomes in numerous situations, but with the current state of our knowledge we are unable to explain precisely why.

    I’m not a doctor, but I sense that many of the posts here are presenting a false dichotomy. Why shouldn’t it be possible for conventional medicine to use some of the findings that research into placebo is uneathing? If cultural meaning, interaction, setting etc are found to be important in treatment, then why not learn from this ….keep the white coat, and maybe even pay special attention to using the right washing powder to keep them as white as possible.

    Contrary to what some of the posts above are suggesting, this is not tantamount to rejecting the scientific method, double-blind testing and the quest to find new treatments. It’s just recognising the current limitations of our knowledge and doing what most benefits the patient.

    Obviously this begs the question where to draw the line. This would need serious consideration. Off the top of my head, I would suggest that we shouldn’t be spending loads of money lining the pockets of people flogging magnetic bandages and other such quackery – but this clearly isn’t an easy one to resolve. My point is that it’s not quite as black and white as some seem to believe.

  30. Tessa K said,

    March 5, 2006 at 4:42 pm

    Nearly all dentists offer mercury-free fillings. They are the white ones that cost the most.

    Matt – I don’t think anyone here would have a problem what something that is now considered alternative being tested, found to work and incorporated into mainstream medicine. After all, many of our medicines are derived from plant-based cures. There’s no such thing as ‘alternative’. If it works, there is a scientific reason (which may not yet be known).

    As to placebos, orthodox medicine has long known that they do work, if not how. The problem is that many alternative practitioners are charging a lot of money for sugar pills, claiming that they are better than prescribed medicine. The real research into placebos IS being done by scientists. Quacks may know they are using a placebo but don’t know how they work because they are not scientists with an understanding of brain chemistry.

    So I agree with you that there are elements to treatment that need further investigation (the therapeutic environment, for example) but they must be tested before being unleashed in the public. There’s a difference between a doctor givng a sugar pill to someone he has examined and knows to be healthy and a quack handing out sugar pills based on some bogus theory of how the body functions. Even if they have the same effect on some patients (with non-existent or placebo-responsive ills), others could be seriously harmed.

  31. geoff seago said,

    March 5, 2006 at 4:57 pm

    does anyone know why a quack is called a quack?

  32. Ben Goldacre said,

    March 5, 2006 at 5:14 pm

    i think this idea of a conflict, between taking advantage of the placebo effect on one hand, and not lying to patients on the other, is a really interesting one. the magnetic bandage example shows, to my mind, how rational biomedical structures can get around this conflict by exploiting grey areas and ambiguities: a magnetic bandage can be used at NHS expense, with tacit NHS “brand” endorsement (even if that endorsement didn’t come from an assessment of efficacy data), and any placebo benefit exploited, but at the same time the doctor can still say: “well, there’s no actual evidence to say that it does work…”

  33. potsy700 said,

    March 5, 2006 at 5:29 pm

    I don’t think there is a problem with a doctor taking advantage of the placebo effect, as long as he is aware that that is what he’s doing.

    When I was a student, one of my tutors was a consultant, quite elderly, who told me that one of the most valuable lessons he’d learnt in years of practise was to make sure, every time you prescribed a drug for a patient, to look the patient in the eye and say “this will make you feel better.” As opposed to saying “well, try this, if it doesn’t seem to work, we can perhaps think again….”

    You don’t have to lie to the patient to get a placebo, you just have to give them a reason to have faith. One GP I had a placement with used to change his manner and language entirely, and even take his tie on and off depending on the age and social status of the next patient. It was quite remarkable sitting in one of his surgeries, to watch him adapt his apparent personality to match that of the individual patient. Unsurprisingly, they all loved him.

  34. Paul said,

    March 5, 2006 at 5:44 pm

    “does anyone know why a quack is called a quack? ”

    I seem to remember being told that it comes from the days of people hawking their medicines to the crowds – a Quacksalver was .

    Happy to be told that I’m wrong on this one…

  35. Paul said,

    March 5, 2006 at 5:46 pm

    Sorry – the full message was:
    “does anyone know why a quack is called a quack? ”

    I seem to remember being told that it comes from the days of people hawking their medicines to the crowds – a Quacksalver was someone who quacked (boasted) about his salves (treatments)

  36. geoff seago said,

    March 5, 2006 at 6:03 pm

    you might be right dictionary.com has it as obsolete middle dutch in origin and was shortened to quack

  37. keyrawn said,

    March 5, 2006 at 7:16 pm

    Before considering magnetic bandages for ulcer treatment In detail it is worthwhile looking at the patents involved GB 2 377 179 and GB 2 384 433; both patents show Derek Price, MD of Magneto-Pulse Ltd., as inventor and both are currently in force.

    The earlier one shows a magnet for therapy with means for attaching it to clothing. It can be used to treat impotence when placed by the femoral atrery, create a cosmetically pleasing effect when placed near an erect penis and treat period pains when placed near an artery. It currently stands in the name of Ladycare Health Products Ltd.

    The later patent specifically mentions the treatment of skin ulcers when the negative pole (sic) is placed adjacent a user’s flesh. It currently stands in the name of Magno-Pulse Ltd.

    Magno-Pulse and Ladycare are registered UK trade marks.

    Full details are available from the Patent Office site. www.patent.gov.uk

  38. potsy700 said,

    March 5, 2006 at 7:43 pm

    “Create a cosmetically pleasing effect when placed near an erect penis…”

    WTF does that mean?

    Am I missing something really obvious…?

    “treat period pains when placed near an artery…” any artery in particular or will any do?

    “treat impotence when placed by the femoral artery” surely you have to put a magnet over both femoral arteries…….otherwise you might find yourself bending to one side. Just a thought.

  39. Sarah said,

    March 5, 2006 at 8:12 pm

    Apologies if anyone has already mentioend this, but if the NHS won’t tell you what the presented evidence was, then do a freedom of information request. That shoudl get you answers.

  40. stever said,

    March 5, 2006 at 10:54 pm

    In rural india patients expect an injection when they go to the doctor, whatever the problem. there’s an idea (meme whatever) that injections cure things and if people dont get one they leave unhappy. Doctors consequently use vitamin shots very librally, for pretty much anything, or even if theres nothing wrong atall, to justify the fee and let the patient leave happy.

  41. Tessa K said,

    March 5, 2006 at 10:58 pm

    Stever – that’s a bit like people expecting/insisting on antibiotics for flu. And look where that’s got us.

  42. Ben Goldacre said,

    March 5, 2006 at 11:32 pm

    do the french stick their homeopathic remedies up the bottom, like they do their proper medicine?

  43. Pedantica said,

    March 6, 2006 at 12:05 am

    Potsy700 said “I don’t think there is a problem with a doctor taking advantage of the placebo effect, as long as he is aware that that is what he’s doing.”

    The problem comes with informed consent I think. If the placebo effect relies on a lack of knowledge on the part of a patient then it would seem to be in conflict with informed consent, whether the medical practitioner is actively misleading the patient or simply not correcting, and relying upon, an existing misconception. Hence my only half in jest idea that patients could choose whether or not to give their consent to be misinformed at a future date.

  44. potsy700 said,

    March 6, 2006 at 12:25 am

    Pedantica

    I agree – I made the point about informed consent somewhere above. But if the doctor simply says ‘ this will work ‘ when actually he knows it will only probably work, it’s not really deceit, but it may help the patient.

    Equally, I know that myself, and other doctors tend not to tell patients about the side-effects of drugs we prescribe, unless they are potentially serious or unless the patient specifically asks, because if you tell them, they usually go on to develop the side effects! But you can argue that there is still informed consent because of the leaflet that comes with the drugs, explaining the side effects. You simply take advantage of the fact that most patients won’t be arsed to read it.

    rich

  45. Bob Millar said,

    March 6, 2006 at 6:24 am

    Pseudoscience or placebo, I don’t know, but I can tell you that my memory has improved dramatically since I started to use magnets on my fridge door to hold notes etc. It must do something to the food or the beer in there.

  46. Mark Smith said,

    March 6, 2006 at 8:25 am

    Good article, Ben, but the wrong conclusion.

    “But I reckon, although I can’t be sure, that this might be the first time 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 a major cultural shift”

    The NHS provides many treatments that have a very flim scientific/ evidence base. For example surgery for glue ears and tonsils. The NHS certianly is only partially an evidence based organisation and is influenced by politics, social norms and professional interests at least as strongly.

    You could write a very good column exploring this.

  47. Mongrel said,

    March 6, 2006 at 9:37 am

    Here’s a counter argument for the “Big Pharmas are only in it for the money” statement. AstraZeneca has withdrawn plans to launch the blood thinning drug Exanta while it was still in the clinical trial stage astrazeneca.com/pressrelease/5217.aspx

    What this means in real terms is 4 or 5 years of research and safety trials down the drain. So whilst they’ve got new ground on some novel new molecules (AZD0837) I don’t think it’s be unfair to guess at them losing millions of pounds of investment from this

  48. Janet W said,

    March 6, 2006 at 10:27 am

    I thought it was a very funny column, and made some good points in an entertaining way.

    Comedy, ethics and a bit with a dog: that’s what they like.

  49. Morag said,

    March 6, 2006 at 11:33 am

    BobP claimed that “The alternative practitioners that I know (admittedly, not many now) are very aware of their limitations and would send anyone with a serious illness straight off to the appropriate conventional channel.”

    What I want to know is, how can we know that an alternative practitioner would recognise someone with a serious illness? Diagnosis is the hardest part of medicine, and the subject which probably occupies the largest part of a medical course. Some conditions which are potentially very serious may not seem that way to the layman.

    The scenario which worries me most is that of the person who has had some apparently positive experience with an alternative therapy in the past, when presenting with something minor and self-limiting, and who then becomes a devotee of that therapy, believing the often-encountered nonsense about how patients should always consult the alternative therapist first, because of course real doctors are no good. If such a person were subsequently to present to the alternative practitioner with symptoms of a genuinely serious illness, can we really trust that the alternative practitioner is such a skilled diagnostician that he or she will *realise* that the patient needs to see a real doctor? Frankly, I doubt it.

    Take a look at this little discussion, for one example.

    www.hpathy.com/homeopathyforums/forum_posts.asp?TID=1716&PN=3

  50. Pete said,

    March 6, 2006 at 11:44 am

    I think, having read the comments, I may have spotted a way to blind test magnetic bandages, in keyrawn’s post about the patent information, I quote

    “the treatment of skin ulcers when the negative pole (sic) is placed adjacent a user’s flesh”

    So the blind trial consists of two sets of bandages, where, to quote Doctor Who, you “Reverse the polarity” of the second set. According to the patent, these should not work, but the magnets will still stick to fridges etc.

    I know this is simplistic, but as the patent specifies the orientation of the magnet, you would prove the bad science wrong, or at least, open up the possiblility that some enterprising person could produce cheap copies, but with the poles reversed, if the study shows no difference. This would avoid patent infringment.

  51. Martin said,

    March 6, 2006 at 1:33 pm

    What I object to with these magnetic bandages is the cost. They may only cost a little more than normal bandages, but they still cost more. This is removing money from an already cash-strapped public service to pay for treatment which has no medical benefit (if it’s no better than a placebo, then there must be no ‘medical’ benefit).

    Why should the NHS pay for these bandages? Why should the NHS even pay for clinical trails or the PPA? Surely Magnopulse, if they stand to make such a huge profit from these magnetic bandages, should be funding sufficient trials to prove conclusively that the bandages have a medical benefit. If they can’t prove this then the NHS shouldn’t pay for them. If they can, then the PPA or NICE (or whoever) can give them a green light.

    The same argument goes for alternative therapies available on the NHS, eg, the Bristol Homeopathy hospital (see Bad Science November-ish). I’m sure the surviving relatives of hundreds are glad that operating theaters and wards are being closed up and down the country so that the NHS can fund such rubbish.

    Unfortunately, this argument does begin to lose some ground when you talk about drugs like Herceptin, which has a medical benefit, but patients suing for access to it are forcing the NHS to spend money on legal fees.

  52. ACH said,

    March 6, 2006 at 3:10 pm

    I don’t think the argument loses ground – the Herceptin (an other drugs subject to postcode prescibing) issue is a good example of why non-proven therapies shouldn’t be available on the NHS. If people want magnetic or herbal placebos, put them in the queue for NICE and make people wait. Though I also don’t see why NICE should spend money on evaluating placebos when they are dragging their feet over Herceptin and even more expensive therapies (some orphan drugs) which have been through RCTs and are licensed, but patients are still being told they can’t have them because they’re too expensive.

  53. Mr Magoo said,

    March 6, 2006 at 3:52 pm

    Don’t want to get into a Herceptin argument, but the main problem is a licensing one – if a drug isn’t licensed to do something, technically speaking doctors shouldn’t prescribe it for that condition – Herceptin currently isn’t prescribed for early stage breast cancer (see for yourself – SPC is available freely online at emc.medicines.org.uk/ and search under Herceptin) … from what I understand Roche are desperately trying to get it licensed for that very thing right now, but until they do doctors are completely in the right now to prescribe.

    As for magnetic bandages, they sound excellent… and if they ‘create a pleasing cosmetic effect when worn near the penis’ (I’m sorry, but the whole bandage thing is actually a bit of a turn off), how long until we see magnetic condoms? ;-)

  54. Martin said,

    March 6, 2006 at 3:57 pm

    I’m waiting to see which of the national newspapers goes for this story: Beer fights heart disease: official (www.theregister.co.uk/2006/03/06/beer_effects/)

    Fortunately the report on The Register makes it clear that it’s an in vitro experiment, but how long do we think it’ll take someone to write a lovely puff-piece on the health benefits of beer? Unfortunately, you don’t need to read too far into the piece to see that non-alcoholic beer produces the same effect – but do we really wat to drink Kaliber?

  55. Ben Goldacre said,

    March 6, 2006 at 5:31 pm

    I think, having read the comments, I may have spotted a way to blind test magnetic bandages, in keyrawn’s post about the patent information, I quote

    “the treatment of skin ulcers when the negative pole (sic) is placed adjacent a user’s flesh”

    So the blind trial consists of two sets of bandages, where, to quote Doctor Who, you “Reverse the polarity” of the second set. According to the patent, these should not work, but the magnets will still stick to fridges etc.

    pete, that is absolute bloody genius.

  56. Ben Goldacre said,

    March 6, 2006 at 5:42 pm

    morag, that forum link is great, were you rolfie? do you know who she is?

  57. Pete said,

    March 6, 2006 at 7:21 pm

    Ben Goldacre said,
    “pete, that is absolute bloody genius.”

    Why thank you Ben (takes a bow)

  58. Natalie said,

    March 6, 2006 at 8:57 pm

    not debating herceptin…but its actually only useful for a very small percentages of breast cancers which have amplification of a certain gene (ERBB2). what makes me mad about this whole situation is when they parade these bandages on this morning, a researcher had worn it for two hours and apparently his painful shoulder was feeling alot better. once again i find myself yelling at the tv…”the plural of ancedote is not data!!”

  59. Melissa said,

    March 6, 2006 at 10:37 pm

    Wow, Morag, this Hpath thread is great reading! Thanks.

    It’s really interesting how quickly homeopaths resort to emotionally-charged attacks in lieu of rational discourse. Probably because rational discourse isn’t part of their extensive training.

  60. Ben Goldacre said,

    March 6, 2006 at 10:45 pm

    yup, you think if you’ve seen one flame war, you’ve seen them all, but the hpath page absolutely made my day. the smugness was too much. are there many more where that came from?

  61. keyrawn said,

    March 7, 2006 at 12:03 am

    Mr Magoo should look at Google. He will find “Magnetic condom,
    US Patènt # 6863070 : Invèntors: Shapiro; George (25 Old Sprain Rd., Ardsley, NY 10502); Nigro; Anthony (56 Forest Ave., Cortland Manor, NY 10567)
    Appl. No.: 417274 Filed: April 16, 2003
    The patent gives full details of the condom and its benefits. Ugh!

  62. Melissa said,

    March 7, 2006 at 1:43 am

    I can just imagine a whole new fetish community being birthed by this invention.

    Ugh. I’d rather imagine something else… anything!… Help…

    (thinks about kittens)

  63. Tessa K said,

    March 7, 2006 at 12:08 pm

    What metal are piercings made of? Nothing magnetic I hope, otherwise there could be some unfortunate incidents with the magnetic condoms.

  64. Ian said,

    March 7, 2006 at 12:22 pm

    piercings are made out of precious metals (gold, silver, platinum), plastics (eg ptfe) or surgical steel, which is not affected by magnets enough to worry about. I have several piercings and have yet to be dragged toward passing large magnets.

    They don’t get picked up by metal detectors, either… however, I’m not sure if they mess up MRI – anyone know?

  65. Mongrel said,

    March 7, 2006 at 1:29 pm

    “morag, that forum link is great, were you rolfie? do you know who she is?”

    Rolfe is a regular over at the JREF forums. Here’s a thread concerning Rolfes’ Voodoo Vetinary website (link in first post) forums.randi.org/showthread.php?t=47441 and the ‘fun’ of dealing with Homeopaths.

  66. Andrew Clegg said,

    March 7, 2006 at 5:18 pm

    Ian, I’ve had fMRI, and they made sure I’d taken all my piercings out first (easy as I don’t have any). I think the field strength is so great that even alloys with a small proportion of ferromagnetic material will get pulled out of your skin.

    Andrew.

  67. Francois Gould said,

    March 7, 2006 at 7:14 pm

    ok, just one point. Sorry Dr Goldacre, but you’re comitting Bad History. Informed consent and patient autonomy are very recent developements indeed in the history of modern medicine. The shift you correcty identify that banishes the role of ritual etc.. is a change in the perception of disease that occurs around the end of the XIXth century. In the new perception, symptoms (ie the personnal experience of disease) are viewed as the manifestations of a single causal agent (the germ). As a result, medicine and the doctor no longer need to attend to the patient and his experience of the disease beyond using it as a diagnostic tool. Informed consent and patient autonomy are in many cases the result of a patient reaction against the dehumanising nature of early modern medicine.
    This does not excuse the NHS, at the very least they should provide theevidence on which they license their stuff, particularly if they genuinely believe on informed consent.

  68. Alex said,

    March 7, 2006 at 8:04 pm

    You people obviously seem to have a good idea of what you are talking about. Correct me if I am wrong Ben, but havn’t I seen Rolfie around here. She certainly sounds like she was from around here. Keep up the good work and slap those silly quaks silly. ;-D

  69. Ben Goldacre said,

    March 7, 2006 at 9:21 pm

    francois, i’m sorry you’ve a bee in your bonnet about doctors being horrible, but the point i was making was this: not being able to lie to the patient is a new problem created by the conflict with patient autonomy and informed consent. it’s only in the last generation that you’ve had doctors writing out huge surgical consent forms, telling patients their diagnoses instead of “holding back the full truth for their own good”, explaining treatments, what they are, how they work, asking their opinion, etc, and all that’s obviously incompatible with lying to patients about the options. i fail to see how the untenability of lying to patients is connected to your fanciful ideas about 19th century germ theory, or how horrible doctors are.

  70. glowinginthesun said,

    March 8, 2006 at 8:20 am

    Quote:
    “Here’s a counter argument for the “Big Pharmas are only in it for the money” statement. AstraZeneca has withdrawn plans to launch the blood thinning drug Exanta while it was still in the clinical trial stage …”

    Well, this is definitely no counter on Big Pharma and money, as the Germans apparently weren’t that lucky. Here it was released to the market and about two weeks ago withdrawn due to serious liver damage – which had been quite obvious during the clinical trials. So about 2000 patients were potentialliy harmed. For the money – and only for the money.

    I’m an german pharmacist, btw.

  71. Mark Gould said,

    March 8, 2006 at 11:13 am

    You will be delighted to hear that not all government agencies are hoodwinked by these people. The Office of Fair Trading has just announced that it has started High Court Proceedings against Magno-Pulse for their misleading advertising.

    The full press release is at www.oft.gov.uk/News/Press+releases/2006/47-06.htm

  72. Ben Goldacre said,

    March 8, 2006 at 11:39 am

    That is properly the funniest thing ever.

    OFT seeks court order against magnetic goods manufacturer

    47/06 8 March 2006

    The OFT has issued High Court proceedings against Magno-Pulse Limited, and its officers Derek and Wendy Price. It is seeking an injunction against them under the Control of Misleading Advertisements Regulations 1988.

    Based in Bristol, Magno-Pulse Limited is a manufacturer and retailer of magnetic therapy products for humans and animals, including back and neck wraps, magnetic drinking coasters and pet beds. The OFT is seeking an injunction preventing publication of advertisements making the following claims about the company’s products:

    * the products have a therapeutic effect, caused by a specified physiological mechanism, due to the magnets they contain
    * the therapeutic effect of the products, due to the magnets they contain, is clinically proven or established by scientific trials, or is widely accepted in the scientific or medical communities
    * unqualified claims the products have a therapeutic effect and/or that wearing products containing magnets will always produce such an effect, due to their magnets
    * that products magnetise or ionise water as a result of the magnets they contain.

    Magno-Pulse Limited contends that the advertisements are not misleading and has refused to stop publishing adverts making these kinds of claims. Accordingly, the OFT has issued proceedings so the courts can decide the matter. Magno-Pulse Limited has indicated it intends to defend the proceedings.

    The worldwide market for magnetic therapy products for treatment of humans has been estimated at around £3bn a year. The size of the market for these products for use on domesticated animals such as dogs and horses is not known, but would be in addition to this figure.

    Christine Wade, Director of Consumer Regulation Enforcement said:

    ‘Where advertisements claim products have therapeutic effects it is important they do not mislead consumers. The OFT is asking the High Court to decide if Magno-Pulse Limited’s advertisements are misleading.’

    NOTES

    1. Whilst the OFT has issued proceedings and Magno-Pulse Limited has indicated it intends to defend them, it is for the High Court to decide whether the relevant advertisements are misleading under The Control of Misleading Advertisements Regulations 1988 (the CMARs). No date has yet been scheduled for the High Court hearing.

    2. The CMARs came into force on 20 June 1988 implementing the EC Directive on misleading advertising. The CMARs aim to protect consumers and businesses from misleading advertisements and advertisements that make prohibited comparisons. The OFT’s main role under the CMARs is to support and reinforce the existing advertising controls exercised by other bodies, such as the Advertising Standards Authority (‘the ASA’), not replace them. The OFT will usually step in where action by those other bodies has not resolved complaints about an advertisement and it is in the public interest that the OFT should act.

    3. The ASA referred Magno – Pulse Limited’s advertising to the OFT for consideration under the CMARs after the ASA had received, and sought to resolve, complaints about that advertising.

    4. The OFT can only act under the CMARs when a complaint about an advertisement is received. To come within the scope of the CMARs, and be restrained by an injunction, an advertisement must be misleading (i.e. it must deceive or be likely to deceive the recipient and be likely to affect their economic behaviour, or for those reasons harm the interests of a competitor), and be published in connection with a trade, business, craft or profession, in order to promote the supply or transfer of goods or services, immovable property, rights or obligations. The OFT can take action against anyone appearing to be concerned or likely to be concerned with the publication of a misleading advertisement.

  73. Stever said,

    March 8, 2006 at 11:55 am

    hahahaha. thats fucking brilliant!

    …and they are going to defend themselves in court. What a joy thats going to be.

    but BLOODY HELL – the market is worth 3 BILLION!!!

    is this is linked to the Guardian piece btw?

  74. Martin said,

    March 8, 2006 at 12:36 pm

    OK, so Magno-Pulse are being touted by the PPA and sued by the OFT.
    That’s joined-up government for you!

    Note: OK, so the PPA and OFT aren’t government, they’re quasi-autonomous non-governmental organisations, but “that’s joined-up quangos” doesn’t have the same ring.

  75. ACH said,

    March 8, 2006 at 3:17 pm

    So, who’s going to tell the PPA? It would be a great result if they actually withdraw their approval, and let funds be spent on REAL therapeutics.

  76. ACH said,

    March 8, 2006 at 3:22 pm

    Actually, I wonder if “But it’s approved by the NHS” is going to be part of the defence.

    If the PPA has shot itself in the foot, do you think a magnetic bandage would help?

  77. Francois Gould said,

    March 8, 2006 at 9:32 pm

    Ben,
    fair point, I was a little off the mark in my comment. The point you make about how medicine is practiced currently is valid. However, the fact that modern medicine refuses to use the placebo (indeed the very fact that we have described such a thing as the placebo effect at all) is due to a change in the perception of disease and its treatment that makes disease eradication (to some extent), independant of symptom aleviation. This is not a fanciful idea, it’s documented historical shift (look at the records kept by XIXth sentury French doctors in hospitals, who did not intervene much on their patients in order to observe the progression of disease and thus associate different symptoms together as products of a single entity). My point, and it’s probably a rather trivial one, is that modern medicine’s aversion to the placebo is older than informed consent.
    incidentally, I haven’t had very many bad experiences with doctors beyond the run of the mill oerworked NHS variety. On the whole they are lovely people and I even contamplated becoming one, but opted for Evolutionary Biology instead.

  78. Ben Goldacre said,

    March 8, 2006 at 9:38 pm

    i’m sorry, but again, that’s nonsense. the “change in the perception of disease and its treatment that makes disease eradication (to some extent), independant of symptom aleviation” sounds nothing like the diverse forms of above all pragmatic medicine which i see practised all around me every day. in fact, this description sounds like the hopeful fancy of somebody studying the history of medicine, with no experience of how everyday practical medicine is practised, who wants to make a pet theory ring true, and the contents of some 19th century french doctors notes are neither here nor there. in fact, they’re so neither here nor there, that i have to ask: is this a very subtle and elaborate joke to wind me up?

  79. Dave said,

    March 9, 2006 at 4:45 am

    Ben, I think a good topic here as a spin off would be the obvious flaw in the pharmaceutical industry where companies are permitted to selectively file research into drugs.
    So in the case of anti depressants, where 1/3rd of studies showed a benefit, 1/3rd showed no change and 1/3rd showed a worsening, they only filed the first 1/3rd of the studies showing a benefit.

    Subsequent research shows anti depressants are no better than placebos.

    A simple rule obliging drug companies to file all studies conducted would improve the process in this area.

  80. Martin said,

    March 9, 2006 at 7:59 am

    Great idea to force drug companies to publish the results of all studies, but how are you going to police it? The drug companies will invest in either more document shredders or more creative writers for the study summaries, which are the only bit most people read.

  81. Pete said,

    March 9, 2006 at 9:41 am

    Martin Said
    “Great idea to force drug companies to publish the results of all studies, but how are you going to police it?”

    Simple, set up an independant organisation that runs the trials, probably one run by some worldwide group like WHO, insist that no drugs can be authorised until this group has passed it with their clinical trials.

    Fund it with the money the Pharma companies save by not having to run the trials themselves!

  82. james L said,

    March 9, 2006 at 10:56 am

    Pete – that is a good idea but how on earth are you going to fund and run something like that. Even a small phase 1 trial costs £1M and involves 20+ staff to run. An organisation capable of running all of the clinical trials in the world would be even larger than the WHO and have a larger budget. Even if it were possible to set up, with no competition this would soon become a bureaucratic behemoth.

    I do agree that all results must be published (at the drug companies expense) and this could easily be implemented as all trials have this in their budgets anyway.

    And to my actual point- did anyone see the discussion of the magnetic therapy on the BBC news this morning. It was one of the worst ‘discussions’ I have seen with a seller of magnets claiming that it was the natural progression from MRI scans as “that involves magnets” and that “there is already magnet therapy as people are having massive doses of magnetic therapy when they have a cat scan, people have reported that they feel better after a scan.”

    (apologies if I am not word perfect but that sums up the quotes pretty well.)

    I nearly choked on my cornflakes!

  83. Andrew Clegg said,

    March 9, 2006 at 11:08 am

    I’m sure I’ve heard of a proposed initiative whereby pharma/biotech companies have to register all their clinical trials in advance, so if there’s a negative result and they don’t file results, that becomes glaringly obvious to the regulators and the public. Hmm, six trials registered, only two (positive) results filed, wonder what the other four were?

    I don’t have a reference for that though, maybe someone else can fill in more details.

    Andrew.

  84. Ben Goldacre said,

    March 9, 2006 at 12:14 pm

    publication bias towards only positive trials is nothing compared to covert duplication of positive data:
    www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9310564&query_hl=1&itool=pubmed_docsum

  85. Alex said,

    March 9, 2006 at 5:08 pm

    That last comment…ermm.

    On the subject of Magno-Pulse being sued by the OFT. Sweet! Are there any other examples of bad science being taken to court?

  86. Alex said,

    March 9, 2006 at 5:23 pm

    So I am not the first one to suggest testing bas science in the courts,

    “Letters

    Thursday May 26, 2005
    The Guardian

    Court out

    Bad science is compulsive reading, but is there no redress against the ridiculous claims Ben Goldacre exposes? I would like to see a Lawyers Against Bad Science (Labs) group set up to test these misleading ads in a court of law.
    Kurt Weithaler
    Norwich ”

    Found this on this site. Very off topic, I know. But…any comments?

  87. Pete said,

    March 9, 2006 at 9:46 pm

    James L

    As I said, fund it with the money Pharma are no longer spending on doing there own trials. I think however Andrew Cleggs idea would be easier to implement. There would have to be a strict rule though that no “unregistered” trial could be used as evidence!

  88. coracle said,

    March 10, 2006 at 9:36 am

    Andrew, Ben et al,

    As far as registration for clinical trials goes, it seems to be the journals that are pushing for this. Take a look at the links below (nature reviews drug discovery requires a subscription unfortunately). Basically, if a company wants a trial published it has to be registered in advance. This at least is the first step in getting all trials published.

    As far as 2 of six trials being published, it may be related to the stage of trial. I’m guessing that phase I (safety in healthy volunteers) and phase II (efficacy) are much less likely to get published than phase III?

    NEJM comment

    NRDD article

  89. Delster said,

    March 12, 2006 at 11:32 pm

    Pete,

    i think your idea may have merit. After all at the moment new drugs have to go through a seperate approval process for the various countries / regions that they are to be marketed in.

    What would be a good way to work it is the Pharma companies develop the drug (or whatever the treatment is to be) more or less as they do at the moment but the final clinical trials get carried out by the WHO and, if approved, this then carries approval for all counties.

    This would actually save time and a certain amount of money on the individual approvals processes as well as making sure drugs are properly tested and are better than just placebo

  90. Robert Carnegie said,

    March 20, 2006 at 1:15 pm

    Perhaps they are quite good bandages with or without magnets. No doubt a well made wound dressing is helpful in healing, particularly when the patient is pursuing an active life in the meantime and is at risk of damaging or contaminating the wound. I can’t see the magnet being especially helpful, but aren’t there bacteria which stick to magnets? So they won’t stick to the patient. but of course you want evidence, you scientist you.

    Maybe a large lump attached to a wound stimulates blood or other fluid flow by bonking against the wound as you move around.

    Let’s not overlook the possible placebo effect of an electromagnet. I want a bandage with blinking LEDs and a gentle caring bleep once a minute – when I need one, that is. How often can the NHS give you that kind of attention? On Star Trek these days you get some kind of electronic tiara. It’s techy and it’s elegant.

    It’s fascinating that the anti-impotence magnet treatment is owned by Ladycare. I haven’t found that they do, particularly. As for an effect on intimate jewellery, I think it could be either delightfully stimulating or extraordinarily painful, and given how magnetic force varies with distance it could go from one to the other quite suddenly. This time the electromagnet needs an off-switch.

    Does that thing that you put on your head really work? Not my Star Trek thing, I mean the one that looks as though they made it out of about four wire coathangers on Electric Blue Peter.

  91. geoffd said,

    March 29, 2006 at 2:39 pm

    I spent quite a lot of time wrapping rings of rare earth (i.e very strong) magnets around cocoa trees in a glasshouse at Reading University. It was actually about NMR but I am now wondering if the trees I selected in the not altogether successful series of experiments have prospered more than the others. Do trees know about the placebo effect?