Amusing to see that the NHS Prescription Pricing Authority have apparently put Magnet Bandages on the formulary:
www.timesonline.co.uk/article/0,,2087-2058902,00.html
(Even more amusing to see the Times mentioning that old “iron in blood is magnetic” chestnut again).
What’s interesting to me about this is that it may be the first time the PPA have put something on the NHS formulary on cost effectiveness grounds, but in the full knowledge that it very demonstrably, in well conducted trials, only works as a placebo, as the recent BMJ paper (amongst others) showed.
I ought to say I have no problem with placebos, I think they’re very effective, and it’s very much a contemporary cultural peculiarity that means medics don’t make use of the effect any more: click “placebo” on the right and see lots of articles on the subject.
three tigers said,
March 2, 2006 at 8:34 pm
Have a look at my favourite guide to statistics (www.graphpad.com/instat/instat.htm) and go to ‘View the InStat guide to choosing and interpreting statistical tests’ on the left hand-side. Everything you would ever need to know is explained very well and in simple language, e.g. page 12 p values, page 13 null hypothesis, page 15 multiple comparisons, etc.
Paul said,
March 2, 2006 at 9:14 pm
I’ve just read my previous post which seems, inexplicably, to have been cut off early on. Presumably my fault, but not sure why it happened.
All I was going to say was that, if you set a p value threhold at, say, 0.05 then you are allowing yourself to refute the null hypothesis (that there is no “significant” result/difference) with a 1 in 20 chance that you might be wrong. So if you do 20 different comparisons you give yourself 20 chances of being wrong (i.e. of having a false positive result). So a 1 in 20 threshold set across 20 comparisons means that you’ve guaranteed yourself a false positive somewhere in the 20 comparisons. So if you want a spurious result that nevertheless manages to jump through the statistical hoop, just take loads of measures and do loads of comparisons.
Alastair said,
March 2, 2006 at 11:33 pm
Sorry to burst anyone’s bubble over the “iron in blood is magnetic” chestnut, but iron in blood IS magnetic. I am a Chemistry Masters student and have recently done a course in macromolecules which include metalloporphrines like oxyhaemoglobin and deoxyhaemoglobin.
Deoxyhaemoglobin has a property which is known as paramagnetism. This means that if placed in a magnetic field it will reinforce that field. This does make it, albeit weakly, magnetic. This property is actually exploited in fMRI scans. However, how much the individual molecules of deoxyhaemoglobin would move under the influence of a small magnet such as those mentioned in this article is negligable.
However, for a practical demonstration that paramagnetism is *real* magnetism get yourself some liquid oxygen (perhaps easier said than done) , which is also paramagnetic, place it in a test tube on the end of a piece of string and hold a decent sized magnet to it: the tube swings towards the magnet.
Apologies for being such an unashamed gimp, but thought you’d all like to know this useless crap!
Ray Girvan said,
March 3, 2006 at 12:29 am
Yeah, we do know this. But general readers don’t know about paramagnetism (or diamagnetism for that matter): any product marketing that plays the “magnetism” card is going to make people think of ferromagnetism, which is outright wrong.
David Colquhoun said,
March 3, 2006 at 7:37 am
The whole magnet saga is as good an eaxmple as any of double standards in the NHS.
No form of CAM has ever been referred to NICE, they tell me. The best chance of getting something done might be a NICE assessment. The decision of whether or not to recommend anything to NICE rests, unfortunately, with the Department of Health, BUT anyone can suggest a topic.
I have just suggested that homeopathy as a whole be referred to NICE. The objection is likely to be that there is not a suffciently good evidence base for NICE to deal with it. That, of course, is exactly why NICE should deliver a verdict. To say otherwise is to perpetuate the existing double-standard. I tried to counter this argument in the comment section.
The best chance of success is probably for them to get a flood of requests. I suggest you all go to www.nice.org.uk/page.aspx?o=topicsuggest and suggest homeopathy, and get all you friends to do the same.
potsy700 said,
March 3, 2006 at 10:09 am
How bizarre! You can ‘pick’ a topic you’d like to be investigated. Is that what NICE is for? Shouldn’t all new forms of treatment go through NICE, not just the ones they pick and choose from a suggestion box?
I wonder if they would take on homeopathy, given that there is no evidence base and the NHS is spending money on it these days. I’ll certainly fill in a form.
Stephen said,
March 3, 2006 at 10:40 am
So a 1 in 20 threshold set across 20 comparisons means that you’ve guaranteed yourself a false positive somewhere in the 20 comparisons
Sorry to be pedantic but no you haven’t.
Paul said,
March 3, 2006 at 11:10 am
Sorry – just re-read this myself – can’t think why I put it this way – of course you haven’t “guaranteed” yourself a false positive (Is that the term you’re objecting to? If not, perhaps you could enlarge). Perhaps it should be put the following way – for every 20 comparisons that you do with a threshold set at p=0.05 then you will, on average, get one false positive.
Please don’t apologies for pedantry – I see it as vigilance.
Janet W said,
March 3, 2006 at 12:42 pm
Thanks Paul, I get it. Thanks to all the tigers too.. will print off pdf and plough thru it sometime. Wouldn’t it be great if someone used this approach to generate a spoof study showing a non-existent relationship between 2 variables? I rather like the FSM pirates vs global warming, but would be nice to have a medical version.
Can we be pedantic about spelling too?
aspiring pedant said,
March 3, 2006 at 12:50 pm
Janet W. – Yes we can be pedantic about spelling – you mean “through”.
Janet W said,
March 3, 2006 at 3:56 pm
accepted abbreviation in informal writing?
RS said,
March 3, 2006 at 4:23 pm
Have submitted my NICE application for homeopathy. A pity they’d never consider it really.
Steffan said,
March 3, 2006 at 4:57 pm
So what’s the consensus here? Should medical professionals pander/lie to their patient’s anti-scientific beliefs, if it helps them and saves money for the NHS, or should medical professionals tell the truth – thereby contributing to scientific rigour, but at the cost of removing the placebo effect and raising costs for the NHS?
A medical professional lying to their patients is wrong. Diverting money away from treatments that are proven to work, towards treatments that are proven not to work is also wrong.
On the other hand, a medical professional’s primary duty is to the patient – not necessarily to the truth. Spending more money on treatments that the patient doesn’t want, instead of cheaper treatment’s that patients DO want (and believe to be as effective, if not more so) is also wrong.
Which is the right policy to adopt?
NeilMac said,
March 3, 2006 at 5:23 pm
Perhaps we should only give people treatments that they believe will work for them. Over time Darwinian selection would then take care of the homeopaths etc.
potsy700 said,
March 3, 2006 at 5:58 pm
I think NeilMac has the solution. Offer patients the choice. Advise them of the risks and benefits of the conventional treatment, and let them sign a disclaimer if they opt for alternatives.
The problem is that you get a lot of people who have both, and then claim that the alternative therapy made all the difference. There was a girl in the Mail a few weeks ago who had cancer. She was treated with chemotherapy and also changed her diet and took vitamin supplements. She was quoted “I believe my vitamins and healthy diet made all the difference.” Never even mentioned the bloody chemo! A few people dropping dead because they had ONLY alternative treatments might make a difference to attitudes in future.
But then medicine is the art of applying the science to people, I suppose, so you have to take account of the individual psyche. Some of my patients have waffled about alternative medicine, and will say that they’ve read that there are ‘studies’ showing the effectiveness of homeopathy etc. Unless I give them all a lecture in basic medical statistics and the concept of peer review I’m not sure what I can do. If I just say I don’t believe in it, it plays into their hands.
At the end of the day, they tend to come running back when something gets serious.
Stephen said,
March 3, 2006 at 7:10 pm
yes an average frequency of 1 false discovery is correct. Sorry again to be pedantic but it is a common slip.
Do you think it would be right to lie to a patient about the efficacy of chemotherapy? Even if it makes them feel better? No thought not– why does it suddenly become OK with homeopathy?
Firstly I think it is perfectly OK for a patient to go and have reflexology or acupuncture or massage. This will relax them and make them feel better while they have treatment. You can tell them that a spot of relaxation will help them cope or fell better with the stressful treatment. Tell them the truth though that the chemotherapy is the treatment and the reflexology is just a spot of fun like having a facial or getting your nails done.
Secondly doctors or other medical staff should not be doing this. If you remove the lie that these are treatments then it is certainly cheaper to get medically unqualified staff to carry them out. Frankly I resent the doctors at the London Homeopathy Hospital being paid for stuff that a well trained beautician might do.
potsy700 said,
March 3, 2006 at 9:00 pm
I would agree with that – I think there is a place for therapy that is relaxing, enjoyable, stress-relieveing, especially if you’ve got a potentially terminal illness. A bit of pampering is certainly acceptable. But that’s all. Why the NHS pays for homeopathy I don’t know.
In one hospital in which I work, the post-graduate education centre had a poster up for a homeopathy course….gggrrrrrrr
David Colquhoun said,
March 4, 2006 at 11:00 pm
It occurs to me that I should have added the following bit to the NICE recommendation
It is now over 5 years since the House of Lords Select Committee (www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12302.htm#a1) said
“We recommend that the Medicines Control Agency (MCA) help the public identify regulated products more clearly. We also recommend that the law against illegal or misleading labelling be rigorously enforced.”
The giovernment accepted this report, but so far nothing has been done. NICE is clearly now the appropriate body to do the recommended assessment.
Ben Goldacre said,
March 4, 2006 at 11:13 pm
i think this is an excellent idea, perhaps we should find a big homeopathy media event, like “homeopathy week”, when they are celebrating, and use that time to suggest it to a wider audience?
Delster said,
March 7, 2006 at 11:45 am
Potsy700 in post 65
You mentioned people only having “alternative” treatments dropping dead. Well that happened in a cancer case over here in Dublin area. The homeo treating them magaged to convince them to give up conventional treatments. After the guy dropped dead an inquest was held and the homeopath was called to give evidence. When she failed to show up they slapped her with a fine….. all of 5 euro’s (thats about £3 from those still in UK)
As for alternative treatments such as massage…. i can recommend that for physical injuries. it’s amazing how much pain relief a good massuse can provide. I admit it’s only temporary but combined with physiotherapy it’s quite valuable.
Roger Macy said,
March 7, 2006 at 1:20 pm
The Independent carries a full page piece on the subject today in their ‘Helath’ pages.
I’ll post it in full below for the record. You’ll see from the lead-in that Jeremy seems to have kept more control of the presentation than on another piece, discussed elsewhere (‘Miracle Cures’).
The last section ‘Magnets do they work?’ is more prominent on the printed page. But I don’t suppose that Ben would have minded if Jeremy had lifted from this site some of the discussion about getting a ‘sham device’ to be a convincing control.
The main heading on the printed version (but not online) is ‘The big attraction’ with an illustration of a standard ferromagnet and attracted iron filings.
Magnets: How effective is the latest NHS treatment?
Cherie Blair is a fan – and now they’re available on the NHS. But Jeremy Laurance wonders whether magnets really can treat everything from period pains to backache and insomnia
Published: 07 March 2006 The Independent
Professional sceptics of alternative medicine got their comeuppance last week with the disclosure that magnet therapy, said to be favoured by Cherie Blair, was to be made available on the NHS. Magnets have been used as a remedy for centuries, and widely marketed in Britain for over a decade, but this was a seal of scientific approval.
You can buy a magnetic hairbrush said to stimulate hair growth, a magnetic mask to reduce wrinkles, magnetic insoles to boost energy, and magnetic jewellery to ward off arthritis. Some researchers claim to have shown that magnets can ease period pains, lift depression and cure aching joints. Separate studies at Harvard University, in the US, and the Peninsula Medical School, Plymouth, even found that wearing a magnetic sleeve eased the pain of osteoarthritis of the knee.
Magnets’ healing powers are said to have enthused Cleopatra, and current users are reported to include Bill Clinton and Sir Anthony Hopkins. But when the NHS includes a product in the Drug Tariff, you have to sit up and take notice. Since last week, a device called the 4UlcerCare – a strap containing four magnets that is wrapped around the leg – has been available on prescription from GPs. Its maker, the Bristol-based firm Magnopulse, claims that it speeds the healing of leg ulcers and prevents their recurrence.
The announcement has created excitement in the world of alternative medicine. Every purveyor of magnetic devices has been pumping out press releases and advertisements, hoping to capitalise on the new development. Lilias Curtin, one-time therapist to Cherie Blair, sent a poster-sized announcement to newspapers last week declaring her “sincere belief that, in the next five to 10 years, magnets will be seen in first-aid boxes”. Kleshna, a maker of magnet jewellery, claimed in another release that magnets created “a whirlpool effect to the iron in our blood to get it pumping round much faster than usual”.
People may scoff at the idea that the lumps of metal used for sticking notes on to the fridge have healing properties, but, presumably, those who control the NHS purse know what they are paying for. And anyone who doubts that magnets have physical effects on the body need only try an experiment conducted at the Institute of Neurology in London. Ask Professor Tom Rothwell to wave a magnetic wand over the left side of your head, and watch your right arm jump involuntarily. The excitation of the neuronal pathways that this demonstrates suggests, according to Professor Rothwell, that the technique might be useful in the rehabilitation of stroke victims. A trial of transmagnetic stimulation of the brain in stroke-sufferers is soon to begin.
This does not prove that magnetic necklaces have medicinal effects. But after 10 years of making and selling magnetic devices such as the 4Ulcer-Care leg wrap, Derek Price, the 64-year-old founder of Magno-pulse, is convinced that they work. Having had initial success on his dog, Kiri, who suffered from arthritis; and then on his own arthritic ankle, Price sent the leg wraps to four local surgeries to be tried on patients. To his surprise, word came back that they were helping to heal ulcers. A trial was run on 28 patients in Suffolk, Norfolk and Cambridge by the London GP Nyjon Eccles, and the results published in the Journal of Wound Care in February 2005. A second telephone survey found that 211 of 289 patients who used the device had not had a recurrence of their ulcer for at least a year, Price says.
Whether this was what convinced the NHS Prescription Pricing Authority to include it in the Drug Tariff is hard to tell. No one was available from the authority to comment last week, and a spokesman for the Department of Health could throw no light on what evidence is required before a product can be included in the Drug Tariff. “It is for the GP to decide whether a listed product is suitable for the treatment of individual patients,” he said.
The leg-ulcer wrap is worn just below the knee, above the calf muscle. It does not come into direct contact with the ulcer, which is covered by its own dressing. It is believed that the magnets stimulate the circulation but it is not known how. Leg ulcers tend to occur in the elderly and those with poor circulation such as diabetics. Their treatment costs the NHS at least £300m a year. The cost to the NHS of the leg-ulcer wrap is £13.80 – about half the retail price of £29 – and Price claims that it could save £150m a year on conventional treatment and nurses’ time.
Other experts are sceptical. Professor Edzard Ernst, head of complementary medicine at the University of Exeter, said that he was puzzled by the NHS decision. “As far as I can see, there hasn’t yet been enough research to prove that these magnets help people with ulcers. You need more than a study on 20-odd people to have a compelling case.”
More powerful electromagnets could help to heal tissue injuries, and are used in hospitals elsewhere in Europe, but that was different, he said. His own study of small magnets on arthritis sufferers had failed to yield compelling results. “There is a huge market out there and lots of money is being made, but the evidence is far from convincing.”
In January, researchers from the Kaiser Permanente Medical Center, in California, published a paper in the British Medical Journal that cast doubt on the therapeutic use of magnets. “Patients should be advised that magnet therapy has no proven benefits. If they insist on using a magnetic device, they could be advised to buy the cheapest – this will alleviate the pain in their wallet,” they wrote.
That could be good advice for the NHS.
Jeremy Laurance is health editor of ‘The Independent’
Magnets: do they really work?
* The origins of magnet therapy can be traced back to ancient Egypt, but they became popular in the West in the 1990s. Around five million Americans were using magnets in 2001.
* Magnets are said to help with arthritis, aches and pains, circulation problems, migraine, backache, period pain and sleep problems.
* Magnets used for therapy are the size of a 50p piece and eight-10 times stronger than fridge magnets.
* At the University of Virginia, in the US, researchers concluded that magnet therapy reduced the intensity of pain from fibromyalgia – a rheumatoid disorder – enough to be “clinically meaningful”.
* At Harvard University, patients with osteoarthritis were given magnetic “sleeves” for their knees, which they wore six hours a day for six weeks. The researchers found that the beneficial effects kicked in after four hours, with a sevenfold difference between those who had the magnetic sleeve and those who had a sham device.
* For a study at the University of Washington, researchers put a magnet on the shoulder of patients who had suffered chronic pain for years. After the magnet had been on the shoulder for one hour, pain levels halved.
* A study published in the British Medical Journal in January concluded that there was no evidence that magnet therapy worked, and warned magnet users that they were being exploited.
Roger Macy said,
March 7, 2006 at 1:28 pm
I agree with Delster on massage (post70). For muscle spasm, which includes a range of back problems, I find a skilled massager the obvious and effective treatment. Nothing alternative about it. But would be happy to take that to a new thread, so we don’t bore people solid with our backaches.
Delster said,
March 7, 2006 at 1:29 pm
Quote
“Professor Edzard Ernst, head of complementary medicine at the University of Exeter, said that he was puzzled by the NHS decision. “As far as I can see, there hasn’t yet been enough research to prove that these magnets help people with ulcers. You need more than a study on 20-odd people to have a compelling case.â€
More powerful electromagnets could help to heal tissue injuries, and are used in hospitals elsewhere in Europe, but that was different, he said. His own study of small magnets on arthritis sufferers had failed to yield compelling results. “There is a huge market out there and lots of money is being made, but the evidence is far from convincing.â€
and thats from a head of complementary medicine!
Delster said,
March 7, 2006 at 1:31 pm
Roger,
The massage i had was not for back but for fairly wide spread injuries following a bit of a bike accident, esp the quads.
For the medical among us this included a compound open book fracture of the pelvis, broken knee and broken wrist.
Roger Macy said,
March 7, 2006 at 1:39 pm
If anyone is claiming that magnets are actually biomedically active, as opposed to a placebo, shouldn’t NICE be considering the question of safe and effective doses?
Drugs and radiation are only of benefit under prescribed regimens at standard doses.
Are magnets always ‘good’ whatever the polarity and strength?
coracle said,
March 8, 2006 at 9:14 am
Alastair
Sorry to burst anyone’s bubble over the “iron in blood is magnetic†chestnut, but iron in blood IS magnetic. I am a Chemistry Masters student and have recently done a course in macromolecules which include metalloporphrines like oxyhaemoglobin and deoxyhaemoglobin.
I was wondering whether you know of any reputable links that provide background to this? I quite often see various cranks trotting out the potential of magnetism and I was hoping to get some background to counter it.
Cheers
Delster said,
March 8, 2006 at 9:48 am
Coracle,
the whole idea of the scientific process is that you have to prove that it works…. which they can’t, as opposed to disproving it.
Unfortunatly that doesn’t seem to apply to “alternative” treatments
coracle said,
March 8, 2006 at 10:28 am
Delster,
Sure, the trouble is, as you say, the idea of proving a theory isn’t adhered to by cranks. If I have background information as to why it wouldn’t work then at least I have something that might get them to think twice. Also, the more I know about something, the less I’m likely to make an arse of myself.
Delster said,
March 8, 2006 at 10:52 am
Coracle,
one of the earlier posts pointed out that the magnets in question would only support their own weight through a thickness of a millimeter or 2 of paper. So you immediatly have a limit on the depth of penetration of the field as the strap is thicker than that,
It would be good to find out about any proper studies that have been done.
One thing i did hear about for treating ulcers and other conditions which result in dead tissues on the surface was from Russia i think. They have a place with natural hot springs containing a specific type of fish. Apparently these will eat the dead tissue leaving only the healthy tissue behind. If i get a chance today i shall have to see if i can find more on that.
raygirvan said,
March 9, 2006 at 4:43 pm
Alastair: metalloporphrines like oxyhaemoglobin and deoxyhaemoglobin
Coracle: I was wondering whether you know of any reputable links that provide background to this?
A Google on deoxyhaemoglobin paramagnetic diamagnetic finds plenty of technical sites describing blood oxygen level dependent imaging (BOLD MRI). It’s pretty neat: oxyhaemoglobin is diamagnetic and deoxyhaemoglobin is paramagnetic, so under the applied field, develop different magnetic properties that affect proton spin on adjacent water molecules differently. That means, with a suitable MRI setup, you can see a contrast between oxygenated and deoxygenated blood.
However, none of this should be taken as confirmation of “blood is magnetic” in any lay sense. Paramagnetism is typically at least a million times weaker than the everyday ferromagnetism, diamagnetism weaker still, and they generally only manifest under humungous magnetic fields.
Jay said,
March 10, 2006 at 11:46 am
From the Independent article quoted above, this caught my eye. It seems to be stated with a degree of certainty.
And anyone who doubts that magnets have physical effects on the body need only try an experiment conducted at the Institute of Neurology in London. Ask Professor Tom Rothwell to wave a magnetic wand over the left side of your head, and watch your right arm jump involuntarily.
Can anyone verify this statement: I doubted it, we’ve got some strong magnets here, and I just tried it….nothing. Further research reveals that the pulsed magnetic field mentioned induces an electrical current, and appears to be a non-invasive alternative to sticking wires through the skull. Somewhat different to the context of the article.
raygirvan said,
March 10, 2006 at 8:17 pm
Yep. Ask Professor Tom Rothwell, and he ‘ll say, “That’s not my name, matey.” Professor John Rothwell has done some work into TMS (transcranial magnetic brain stimulation). As you say, it’s a pulsed field – lots of techie details here. We’re talking about a coil driven by kiloamps to produce an alternating field of several Tesla, so it’s complete handwaving to cite it as evidence that piddly little static magnets (that produce a few milliTesla) will do anything.
Varicose Vane (sic) said,
August 17, 2006 at 3:47 am
THis thread seems to have gone quiet.
But given all the experts on it – how do you stop ulcers caused by varicose veins
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Treating cancer with magnetism « said,
September 20, 2010 at 9:50 pm
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