Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Was the study really good enough?
- Edoardo Cervoni (17 December 2004)
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Why not test the ultimate magnet?
- Christopher I Pelton (17 December 2004)
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Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee
- Helene C Faure (17 December 2004)
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WHY NOT TRY MAGNETS ON ANIMALS
- Victor. C. Green (17 December 2004)
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Re: Was the study really good enough?
- Curtis Bennett (17 December 2004)
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Better studies on magnets for relieving pain in osteoarthritis of the knee must include objective laboratory tests of synovial inflammatory markers
- David Gurwitz (17 December 2004)
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Which bracelet?
- Bernard Badley (18 December 2004)
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Re: Was the study really good enough? Clearly not!
- David Jameson (19 December 2004)
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Conclusions of this study are overoptimistic
- Miquel A Belmonte (19 December 2004)
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Re: Better studies on magnets for relieving pain in osteoarthritis of the knee must include objective laboratory tests of synovial inflammatory markers
- Christine Harrison (20 December 2004)
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Blinding optimism attracts magnet researchers to wrong conclusion
- Peter H Canter (20 December 2004)
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Re: Which bracelet?
- Christine Harrison (20 December 2004)
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Re: WHY NOT TRY MAGNETS ON ANIMALS
- C Gill (21 December 2004)
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Re: Why not test the ultimate magnet?
- C. R. Gill (21 December 2004)
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Re: Which bracelet?
- Victor C. Green (21 December 2004)
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Re: WHY NOT TRY MAGNETS ON ANIMALS
- Sarah M D Fishwick (21 December 2004)
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Re: Which bracelet?
- Ray Padfield -Krala (21 December 2004)
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Tiny bracelets
- Hugh de Glanville (22 December 2004)
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(Carpal) Tunnel Vision!
- Valerie M Daykin (22 December 2004)
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Magnets and severity of OA--Is there a corelation?
- ABHIJIT M. BHOSALE (22 December 2004)
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The study draws the right conclusions- authors reply
- Tim N Harlow, Colin Greaves (22 December 2004)
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Forget scepticism - give it a try!!
- Kathleen B. Robinson (22 December 2004)
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Re: Re: Which bracelet?
- Kay A Gill (22 December 2004)
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Misleading article
- N A Shah, M N Shah (27 December 2004)
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Magnets: Significant results, or placebo power?
- Ano L. Lobb (29 December 2004)
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Re: Re: Was the study really good enough? Clearly not!
- Daniel E Moerman (29 December 2004)
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Re: Misleading article
- Tim N Harlow (29 December 2004)
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Which bracelet? The one with CRP (Central-Reverse-Polarity) a money refund guarantee and a first class after sales service.
- David W Haslam (30 December 2004)
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Re: Magnets: Significant results, or placebo power?
- Tony Floyd (30 December 2004)
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Re: Misleading article
- Curtis Bennett (30 December 2004)
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Unethical to ignore
- Jim York (30 December 2004)
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Re: Re: Which bracelet?
- Ray Padfield-Krala (31 December 2004)
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Re: WHY NOT TRY MAGNETS ON ANIMALS
- William N. Elwood (2 January 2005)
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More Open Minded Attitude Required
- Bill Lawson (3 January 2005)
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Many forms of bias
- Everett L Williams (4 January 2005)
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Re: Re: Was the study really good enough? Clearly not!
- c gill (6 January 2005)
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Re: Many forms of bias
- Chris Gill (8 January 2005)
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Re: Misleading article
- Christine Harrison (8 January 2005)
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Absence of radiological report
- Christopher J F Potter (10 January 2005)
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Placebo? It could be a two-edged sword.
- Chris B Thayer (11 January 2005)
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Re: Misleading article
- Richard L Peacocke (12 January 2005)
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Very interesting study
- Matthew L Grove (12 January 2005)
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Clinical Trial????
- Loretta Mutton (19 January 2005)
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Magna Mallarca
- Dr. Herbert H. Nehrlich (20 January 2005)
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Re: Magna Mallarca
- chris gill (21 January 2005)
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Re: Re: Magna Mallarca
- Dr. Herbert H. Nehrlich (23 January 2005)
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A typical cross section of views!
- Chris Sergeant (28 January 2005)
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The effects of magnetic bracelets for relieving osteoarthritic pain and its relevance
- Sita M Bierma-Zeinstra (3 February 2005)
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Not a placebo!
- Kevin Mathis (12 June 2005)
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Mechanisms of Magnetic Bracelets
- Kenneth J. Dillon (4 July 2005)
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Re: Which bracelet?
- Eric D Knapp (22 October 2007)
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Edoardo Cervoni, GPwSI (ENT) West Lancashire PCT NHS, L39 2BY
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Sir, I am surprised by the decision of the BMJ Editorial Board to publish this article. Still appreciating the efforts of the Authors to elucidate the role, if any, of magnetism in the management of OA pain, I strongly feel that this study does not add anything to our current knowledge on the matter. Unfortunately, it may be misleading instead. First of all, static magnets are widely used for the relief of pain and evidence about their efficacy in osteoarthritis has been contradictory. I would have expected a more substantial pool of patients to be allocated in each of the 3 groups studied...And, also then, I would have more clearly acknowledged that placebo effects are actually impossible to control because of the easy detection of magnetism. Speaking about placebo effect and magnetism in a field where magnets have been anectodically used for centuries,while considering the baseline characteristics of participants randomised to standard, weak, and dummy magnetic bracelets, instead of just age, and body characteristics, I would have also considered educational and cultural backgrounds. Moreover, it seems that painkillers were used more frequently in the dummy group before starting the treatment. Finally, there is not mention of the type and modilities of administration of NSAIDs/painkillers in the groups during the 12 weeks with relative statistical figures. Was the study really good enough? Competing interests: None declared |
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Christopher I Pelton, General Practitioner Wellington Medical Practice Telford TF1 1PZ
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If there might be a genuine dose-response effect as the article implies, it would be worth assessing the analgesic effect of the intense field generated in a Magnetic Resonance scanner. Competing interests: None declared |
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Helene C Faure, Editorial Project Manager Current Controlled Trials, 34-42 Cleveland Street, London W1T 4LB, UK
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Dear Sir, I have read with interest the recent article in the BMJ in which the results of the trial entitled "Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee" are presented (http://bmj.bmjjournals.com/cgi/content/full/329/7480/1450?etoc). As you may be aware, this trial is publicly registered with an International Standard Randomised Controlled Trial Number(ISRCTN): ISRCTN92332799 (1). It is an important part of the unique numbering scheme that trials quote their ISRCTN in all publications arising from the trial. This is to ensure that all papers resulting from a trial can be easily identified. We hope that you and your colleagues will agree to quote your ISRCTN in the title and/or abstract of any future papers arising out of this trial. You may also be interested in the recent article (2) published in the BMJ about making trial registration a condition of publication. Yours sincerely, Helene Faure (1) http://www.controlled- trials.com/isrctn/trial/ISRCTN92332799/0/92332799.html (2) Abbasi K: Compulsory registration of clinical trials. BMJ 2004, 329:637-638 (18 September 2004). [http://bmj.bmjjournals.com/cgi/data/329/7466/DC1/1] Competing interests: Employed by Current Controlled Trials, who developed the International Standard Randomised Controlled Trial Number (ISRCTN) scheme. |
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Victor. C. Green, Director Weydon Mill, Weydon Mill Lane, Farnham, Surrey England GU9 7QL
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We market magnotheraphy products designed for use on people and animlals. It seems that whenever there is any report in the media of the beneficial use of magnets there is almost always an immediate knee-jerk response that the benefit is probably a placebo effect. It is clear from the anecdotal reports we receive, that the vast majority of our(human) customers receive undoubted benefits (in terms of pain relief) from using the products. What is more they invariably also report that the pain will return if they cease wearing the product and leave again when they wear the product once again. It seems inconceivable that this is due to a placebo effect. Even greater confidence in the merits of magnotheraphy can be gained from observing the effect on animals from the application of basically the same products. Animals generally respond in the same way as humans, their pain appears to reduce or disappear altogether after a few days of wearing the products (based on their ease of movement), and will return if the product is removed etc. Whilst this is still anectdotal (based on reports from the owners)and cannot in any way be regarded as a clinical trial, it can perhaps lead to the placebo argument being discounted and a re-focussing of attention on further, deeper studies into the positive benfits obtainable . Competing interests: we market magnotheraphy products for people and animals |
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Curtis Bennett, Engineering Technologist Canada V1X6A5
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I applaud the article and look forward to more studies on magnetic influence on human physiology. There is always room for improvement on any study but it takes initiative and this can serve as a baseline. Hydration levels of subjects could have been mentioned. Dr. Michael Weintraub (New York) did a study on specific magnetics and the effect on patients with diabetic neuropathy with astounding results. Magnetic Fields are all different and design related to application requires specific engineering, not just " a magnet ". My education includes designing magnetic fields as well as the ability to image changes in physiology with any treatment. Magnets designed properly can increase circulation and Dr. Ronald Lawrence wrote about it in his book "Magnetic Therapy, The Pain Cure Alternative". The idea of being able to localize an area and increase circulation with zero side affects has many unrealized applications as your circulatory system feeds and cleanses every cell in your body. Medications treating symptoms are going back into watersheds feeding our food sources and though they may be a good business, they are environmentally horrific. In North America, it was just released that Celebrex increases risk of heart attacks, Vioxx killed 27000 and hurt many more. Congratulations for doing a study that will only be expanded on. Competing interests: design magnetic fields related to electrical applications and image physiological changes with any treatment. |
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David Gurwitz, Director, National Laboratory for the Genetics of Israeli Populations Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, ISRAEL
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This response is concerned with both the fascinating print article and the debate responses posted on the BMJ site soon thereafter. The debate about the usefulness of static magnetic field devices for relieving pain in osteoarthritis of the knee is not going to resolve, if we just continue to criticize and argue about the validity of blinding and the extent of placebo effects in trials of static magnets. What we definitely need are larger clinical trials, blinded or not, that would include, in addition to pain self-questionnaires, objective laboratory markers for local knee inflammation, such as synovial fluid levels of inflammatory cytokines and activated macrophages (1). In-vitro studies have repeatedly shown that static magnetic fields are capable of reducing inflammatory responses, such as PHA-mediated mitogenesis, in cultures lymphocytes and macrophages (2-4). There are also some encouraging reports on anti-inflammatory effects from animal studies which included histological estimations of inflammation (5, 6). If the magnetic bracelet field is so lucrative, as evident from the original article and the ensuing hot debate, it is time for the private companies making such devices to contribute towards more scientific trials: such that include laboratory markers of local inflammation in addition to subjective pain assessment. References 1. Sweeney SE, Firestein GS. Rheumatoid arthritis: regulation of synovial inflammation. Int J Biochem Cell Biol. 2004;36:372-378. 2. Flipo D, Fournier M, Benquet C, Roux P, Le Boulaire C, Pinsky C, LaBella FS, Krzystyniak K. Increased apoptosis, changes in intracellular Ca2+, and functional alterations in lymphocytes and macrophages after in vitro exposure to static magnetic field. J Toxicol Environ Health A. 1998;54:63-76. 3. Jajte J, Grzegorczyk J, Zmyslony M, Rajkowska E. Effect of 7 mT static magnetic field and iron ions on rat lymphocytes: apoptosis, necrosis and free radical processes. Bioelectrochemistry. 2002;57:107-111. 4. Onodera H, Jin Z, Chida S, Suzuki Y, Tago H, Itoyama Y. Effects of 10-T static magnetic field on human peripheral blood immune cells. Radiat Res. 2003;159:775-779 5. Mizushima Y, Akaoka I, Nishida Y. Effects of magnetic field on inflammation. Experientia. 1975;31:1411-1412. 6. Weinberger A, Nyska A, Giler S. Treatment of experimental inflammatory synovitis with continuous magnetic field. Isr J Med Sci. 1996;32:1197-1201. Competing interests: None declared |
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Bernard Badley, Physician Halifax, NS, Canada. B3H1A1
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I read, with considerable interest, the article by Tim Harlow et al (BMJ 2004;329:1450-1454) which reported benefit from using magnetic bracelets in patients with osteoarthrirtis. This study showed that effective magnets had a mean strength of 186 (range 134-197) mTesla and that major differences existed in the type and strength of magnets available. As someone with osteoarthritis who spends several hours each week with a bunch of similarly affected old geezers with creaky joints I am interested in these findings. Unfortunately, as a relic who survived (with difficulty) the change from grains to milligrams and (even later) the switch from milligrams/100 ml to millimoles/ liter, I have no idea what mTesla means. When I look at potential vendors of magnetic bracelets I see values that describe the number of gauss in the bracelets. Now that even Celebrex is likely to be removed from the market, how do I translate one set of values for another? Specifically, how do I advise my fellow sufferers what kind of bracelet to buy? Competing interests: None declared |
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David Jameson, Engineer BT6 8DD
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The authors claim that "around a third of participants in the standard and dummy groups were correct in their beliefs about their bracelet". However, looking at the data it appears that 54% of the standard (strong) magnet group believed they had the real magnet, while 47% of the dummy group correctly guessed (or worked out) that they had the dummy magnet. Overall, a highly significant number of the patients correctly determined which group they were in (54% of the standard magnet group thought they had the magnet, while only 38% of the weak group and 16% of the dummy group thought they had a real magnet). Furthermore, the results show that the main reason why they thought so was because they detected the magnetic force (32% of the standard group, 20% of the weak group and 6% of the dummy group). It therefore seems likely that the "significant" results are due to the placebo effect, caused by the patients noticing the magnetic force. Competing interests: None declared |
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Miquel A Belmonte, Consultant in Rheumatology Hospital General de Castellon, Spain
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It's really surprising to read the conclusions of this study. I've always been sceptic -and still I am- about the effects of low power magnetic fields on arthritis. At face value, I don't see the physiological basis for relieving pain originated at distance of the places where the magnetic brackets are worn. Dr. David Gurwitz gives bibliography reagarding the effects of magnetism on cells submitted directly to very high magnetic fields. Though very interesting, this is not at all the case of this study. Besides of this, the size effect of the intervention is quite low. In the Analysis of Outcomes we see that differences are only (barely) significant between the standard/strong treatment and the dummy/placebo group, but not for any of those versus the weak group. This suggests a trend, confirmed in Table 2, but not a superiority of the standard treatment. Thus, a hidden bias or a statistical type I alpha error cannot be ruled out. I subscribe the caveats expressed by Edoardo Cervoni Finally, the authors show contradictory thinking. In their Discussion, they state "We found evidence of a beneficial effect of magnetic wrist bracelets on the pain of osteoarthritis of the hip and knee." However, two paragraphs later they wrote: "... the result is only a trend and needs confirmation. Therefore, we cannot be certain whether our data show a specific effect of magnets, a placebo effect, or both." If the last is true (and I agree with it) then the first paragraph cannot be stated so strongly. This will lead to misleading conclusions, giving false support to an still unproven therapy. Larger trials are needed, but I really doubt that manufacturers of brackets will ever undertake them, because their lucrative business will be at risk in case of negative conclusions, and they have now customers enough to stay in the market without those studies. In any case, it's always intresting to have more information on his conflictive issues and I encourage BMJ to keep publishing them, but always requesting the strongest scientific methodology to the authors. Competing interests: None declared |
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Christine Harrison, Distributor 7 Grafton Drive, Upton, Wirral. CH49 0TX
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The suggestion of David Gurwitz that manufacturers of magnotherapy products should be funding this type of research might seem a valid point. In reality, the results of any trial from such funding would be seen as biased and therefore invalid. As a distributor of Bioflow magnotherapy products, I have naturally been awaiting the results of this report with eager anticipation. I know from experience the power of the products and am often frustrated with those who deride the many thousands of testimonials we receive from grateful customers and anecdotal evidence. I applaud this report and look forward to more research into alternative therapies that will free those in pain from the unbearable side effects of conventional medications and pain relief. Competing interests: Independent Distributor of Bioflow magnotherapy products |
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Peter H Canter, research fellow Complementary Medicine, Peninsula Medical School, 25 Victoria Park Rd, Exeter EX2 4NT
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The interpretation by Harlow et al (Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee)of subject blinding data is most creative. In a successfully blinded trial we would expect equal proportions of each group to believe they had been given the standard magnet. Not only is there a large difference between standard and dummy groups in the proportion believing they had received real magnets(54% and 17% respectively), there is also an intermediate proportion (38%) in the weak magnet group, suggesting, a dose -response relationship between magnet strength and unblinding. This is not surprising given the large proportion who noticed the magnetism or deliberately tested for it. The correct conclusion from this data is that the attempt to blind treatment has failed and therefore the results are invalid. Harlow et al report similar effects in those individuals who said they did not notice the magnetic field. This type of post hoc analysis is suspect. Furthermore, the individuals enrolled in the trial will have known they might receive real or dummy magnets and it is quite likely that many will have concealed testing or noticing magnetism in order to tell researchers what they believed they wanted to hear. Competing interests: None declared |
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Christine Harrison, Distributor of magnotherapy products 7 Grafton Drive, Upton, Wirral. CH49 0TX. UK
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In response to Bernard Badleys plea of how to choose from the huge number of magnotherapy products currently on the market. I too went from one retailer to another asking what I considered to be relevant questions of “how strong is this magnet” or “what is the Gauss measurement of that bracelet”. With hindsight I now know it is also important to be asking what guarantees the products come with. Does the manufacturer have enough confidence in their products to offer your money back if it does not have the required affect? Do they guarantee the quality of the workmanship? Is there a guarantee on the life of the magnetic module? Can they offer an after sales service or will they simply take your money and run? Does this all sound too much to be asking for? Absolutely not! In this market, if a product is sold for a specific purpose and does not perform as expected, the customer should be entitled to a refund even when it is as subjective as pain relief. Ask the above questions and if you are not satisfied with the answers – do not buy the product. Competing interests: Distributor of magnotherapy products |
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C Gill, PR for MagnaMax MagnaMax HU17 9HG
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A double-blinded clinical trial, which I helped with was carried out on 30 dogs. The study was at a Vet's practice in Beverley and the out come was positive, I have the results available, (which I don't believe have been published yet) along with, a newspaper article and BBC look North TV feature on CD, about the MagnaMax Collar. These where organized to increase awareness of the Vet's trial & to find more dogs in pain (with bad mobility) for the trial. I'm sure there have been other trials done on animals available on the net. For more information please e-mail me on either chris@magnamax.co.uk or chrisgill22@hotmail.com Competing interests: Involved in a Magnatherapy Org. and with Trials on the Magnamax device |
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C. R. Gill, PR MagnaMax Ltd. HU17 9HG
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What is an ultimate Magnet? Do you have one of those scanners available if another study was being done and the researchers would find this scanner beneficial as you mentioned it would? if not do you know where they are available? Competing interests: None declared |
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Victor C. Green, Director Weydon Mill, Weydon Mill lane , Farnham, Surrey GU9 7QL
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The products involved in the study were "Bioflow" wristbands manufactured by Ecoflow plc, a UK company based in Cornwall. I know this because the units used in the trial were standard "Bioflow" units employing central-reverse-polarity (CRP) TM magnetic modules; only Ecoflow products have CRP, it is their patented design. Victor Green
Competing interests: My company is a registered authorised Distributor of Ecoflow's products (including the Bioflow wristbands). |
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Sarah M D Fishwick, Independent Distributor of Ecoflow plc magnetic products 52 Emesgate Lane,Silverdale, Carnforth,LA5 0RF
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I sell Bioflow magnetic products manufactured by Ecoflow plc which were used in the clinical trials. Many of my customers have purchased our dog collars for their pets and have reported some remarkable accounts of the improvement in their animals wellbeing. Customers often only believe the magnets work when they have seen the difference they make to the quality of life in their animals; they then purchase for their own use! One man earlier this year purchased a dog collar for his much loved pet. This elderly dog had progressively deteriorated and was having difficulty walking any distance on the fells near his home, but after a fortnight of wearing the collar all the time, it had amazed him by jumping a wall. This was something it used to enjoy doing but had, prior to wearing the collar, found impossible! He rang me on a Sunday specially to tell me how delighted he was! I also remember one customer who found that the magnets in her wristband helped her aches and pains but decided that £25 was too much to pay to help her 17 year old cat. Instead each evening she placed her magnetic wristband around the cat's neck for about an hour. After a few weeks she realised her cat was eating better and its overall condition improved. She then came back to me and bought the cat its own collar! You can tell an animal it will get better wearing one of our products, but unlike a human their is no placebo effect. To the best of my knowledge animals do not understand English and the symptoms will only lessen or disappear if the animal no longer experiences pain. Competing interests: I am an Independent Distributor of Ecoflow plc magnetic products |
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Ray Padfield -Krala, Director MAGNETiC Steers Farm Willingale Ongar Essex CM5 0QF
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With reference to both Bernard Bradley and Christine Harrisons comments I would like to add why use the word "bracelet". As far as I am aware this term implies a piece of jewellery? This term was also picked up by the media who also showed images of various items which bear no resemblance to the products used in the trial. More care should have also been taken when using the word tesla as most people selling these products wouldn't know what this was let alone the public, for Mr Bradley's sake .5 mTesla is 5.0 Gauss. Why mention the price? There are products out there within this Gauss/Tesla rating that are cheaper and work equally as well but may well now be artificially inflated to meet the criteria. Another important criteria in judging a products effect is not only the strength of the magnet on the surface but its penetration factor! A magnetic field strength drops away the further away from the surface so whilst a magnet with 2000 gauss on the surface seems ideal it will not work if it is so small that the magnetic field that penetrates the area treated is only 25% of that on the surface!! Which is why a distinction between that what was used in the trial and a "bracelet" with smaller and sometimes weaker magnets should have been made. Christine Harrison is right when she says questions should always be asked and guarantees offered but then this is not the job of the study group, however I feel more care should have been taken knowing that this report was going to published in the public domain. Competing interests: Manufacturer of magnetic field therapy products |
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Hugh de Glanville, retired Weybridge KT13 9EQ
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The caption to the lone figure in this paper refers to "a standard magnetic bracelet (20mm diameter)". Twenty mm is four fifths (0.8)of an inch 0.8 inches. An oval such as the wrist is not normally described as having a "diameter". Hence one may imagine that what is meant is perhaps the diameter of a bracelet before application, when it might assume a roughly circular shape. Even so, under an inch suggests a bracelet that might just fit a little finger rather than even an infant's wrist. Am I missing something? Competing interests: None declared |
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Valerie M Daykin, Independent Distributor Of Ecoflow plc. Supply Teacher 22 Hayburn Road Offerton Stockport SK2 5DB
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'percentages'... 'proportions'... 'relieving pain originated at distance from the places where the magnet brackets are worn'... ' statistics'... ' sceptics' ... ' conclusions overoptimistic' ... I taught Specialist P.E. for the first twelve years of my teaching career. Injuries led to the complete removal of my lateral left knee cartilege (leaving bone-on-bone) in 1976. As advised, some years on, it became arthritic, along with my right knee and low back(other P.E.injuries). I took nine years out to start my family then returned to Primary teaching for thirteen years, where even my eight year old Key Stage 2 pupils could tell the difference between weak and strong magnets!! 1998: knees and back really a problem: wouldn't take Brufen long term
- only for a month prior to my holiday to mobilise me. Other supplement
alternatives tried upset me -wasted money.
Aug 2000: stumbled across Bioflow - good guarantees - money-back - worth a
try. Fantastic! After 6-8 weeks, up and down stairs normally again after 2
years step together: in and out of low chairs/cars with ease: no pain:
greatly increased mobility: brilliant help to both my knees and back (even
though magnet module is worn on my wrist) - the same strong, single,
module as used in the trials.
Conclusions? What arthritis sufferers want to conclude is, are magnets a reliable alternative to drugs? (my experience - YES!)The medical profession - Doctors having to prescribe/recommend pain killers etc and physios working with joint problems - need some evidence before they feel at liberty to give the green light to magnets.(my doctor dismissive - no clinical proof, until now!) It may not be/is definately not possible to set up a blind test, but nevertheless here's a test that is as fair as the materials allow. Everybody needs to know that not all magnets are as efficient, and not all carry the same guarantees. The trials carried out are a very welcome, long awaited step in the right direction. I'm just so thankful that the magnotherapy wristband that I stumbled across over four years ago is the same make as the ones which have been trialled, which I wholeheartedly recommend to others. Four years down the line I am still bone on bone, but contrary to consultants' expectations, I am also still pain-free, mobile and take no drugs! A changed life!! I recommend all sceptics to try before judging. Competing interests: Independent Distributor of Bioflow (Ecoflow) Magnotherapy Products |
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ABHIJIT M. BHOSALE, Research Fellow in Orthopaedics Robert Jones & Agnes Hunt Orthopaedics Hospital, Oswestry SY10 7AQ
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Dr. Abhijit Bhosale MBBS, M S (Orth); DNB (Orth); MNAMS Research Fellow Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust Oswestry 21st December 2004 To The Editor BMJ Sub:- Magnetic Bracelets for relieving pain in osteoarthritis of hip and knee. Dear sir, I read with interest an article called “ Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee” by Tim Harlow et al published in BMJ—18-25 December 2004 issue( pg. 1450-54). It is interesting that such therapeutic measures which are considered as an imerical therapies can actually have a real good impact on the disease process. But the article doesn’t highlight few things, which need to be addressed a)What was grade of osteoarthritis of these patients, when they entered the trial? b)How long these patients had the symptoms before the study? How many were newly diagnosed of having OA? c)Did the author ask the patients to refrain from all other medications like pain-killers while during the trial? d)Ryser L et al (1)had pointed out in their study that in WOMAC score, patients with pain and functional problems were unable to distinguish between the two variables. Did the authors considered this fact? e)How long patients were using mangnet in a day? f)Is it synergistic to use other modalities along with magnets? I appreciate the study, but it’s interesting to know whether it is effective only in early osteoarthritis and that in advanced arthritis if it could be used synergistically with other modalities of treatment. (1) Ryser L, Wright BD, Aeschlimann A, Mariacher-Gehler S, Stuckig (1999): A new look at Western Ontario and McMaster Universities osteoarthitis index using Rasch analysis; Arthritis care Res 12: 331-35. Kind regards. Yours’ Sincerely, Dr.Abhijit Bhosale Research Fellow, RJAH, Oswestry 25 Twmpath Lane, Gobowen Oswestry SY10 7AQ Ph:- 01691-404110 Cell:- 07951 770706 e-mail: drabhijitbhosale@yahoo.com Competing interests: None declared |
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Tim N Harlow, General Practitioner College Surgery, Cullopton, Devon, EX15 1TG, Colin Greaves
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We are gratified by the interest shown in the paper Some points-
The purpose of inclusion of a weak magnets group was to provide an undetectable placebo and despite the problems with contamination this seems a good way to allow for placebo in future studies . As many have pointed out, this is an area where placebo control is difficult to achieve ,and we suggest that this new methodology is the major innovative step in this study. Perhaps not all the responders have fully seen the rationale behind the weak magnet group or appreciated the caution of our conclusions. We randomised patients from a geographically discrete area with a relatively stable and ethnically homogenous population and so the concern about different educational and cultural backgrounds affecting the results seems misplaced- it is always possible to speculate about possible unmeasured confounders in any trial, The purpose of randomisation is to randomly allocate any such effects between the groups. There seems no reason to suspect this was unsuccessful here. We did look at analgesic consumption both at baseline and over the 12 weeks and consideration of this did not affect the results. There seems also to be confusion between blinding and belief. Belief was indeed higher in the standard group and (less so) in the weak group than the dummy group but this does not support the conclusion that there was either large scale undeclared unblinding or that all improvement was placebo effect. It is a fundamental mistake to assume that in true blinding there would be the same level of belief in all three groups. Belief may follow effect (pain relief) or effect may follow belief and any differences would therefore be hard to interpret. Peter Canter has in this case unfortunately been attracted to a false conclusion in his response by this mistaken premise. Readers interested in this issue can read more in Shulz’s excellent discussion of blinding issues in randomised trial [1] We recognised the methodological incorrectness of using belief as a marker for blinding and so in this study used and reported two separate approaches to deal with this difficulty. First we conducted an analysis which took into account self reported blinding status (which we had specifically asked patients about) which showed that unblinding did not affect the results. Second we used weak magnets as an undetectable placebo ( the weak magnet groups discussed above). To clarify the question about units of magnet strength, the international unit of magnetic field strength is the Tesla and 200 mT = 2000 Gauss . The suggestion of looking at the enormous magnetic field (but for a short time) of an MRI scanner is interesting but we confined ourselves to an examination of magnets as used in everyday life. The implication that, as there is no known physiological basis for such an effect it should not be studied, seems rather unscientific- if we do not know how something happens it is still worth studying, perhaps even more so. If this possible specific effect of magnetic fields on pain can be confirmed then clearly our knowledge is incomplete. Thus more work on the fundamental science of how such an effect can arise and how it may be optimised to benefit patients is indicated. Finally, this study does raise more questions than it answers, but the data suggest that this field is worth further investigation. Most importantly, the study presents a methodological tool with which to answer the questions raised. [1] Schulz KF, Grimes DA. Blinding in randomised trials: hiding who got what. Lancet 2002;359:696-700 Competing interests: We are authors of the paper |
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Kathleen B. Robinson, Distributor 25 Kendal Drive, East Boldon, Tyne & Wear, NE360UB.
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It would be a shame if sceptical opinion prevented someone in pain from trying something different or new....surely you agree? I was first introduced to Bioflow magnotherapy bracelets earlier this year and decided to buy one to see if it would ease my pain - I am pleased to say that it worked very well indeed. A short while later I lent my bracelet to someone with arthritis and she very quickly experienced a dramatic pain reduction. At this point, any personal doubts about the potential of magnotherapy vanished completely and I decided to become a distributor of magnotherapy products. During a relatively short period as a distributor I have had some very positive feedback from clients who have bought bracelets and wristbands. I have also met long-term users of the single module type who claim great results in pain reduction and simply wouldn't be without their bracelets. The theory of the placebo effect has no validity when it comes to animals. Only recently I had a conversation with a lady whose dog had been wearing a magnetic collar with such success that the lucky animal had been taken off all pain-relieving medication; there are many similar stories about animals. The products I sell all come with a 90 day money-back option. Scepticism is understandable of course, some people cannot accept new ideas as readily as others. But, why worry how, or why, it works or even doubt that it can help you - give it a try because you'll never know the answer unless you do. trymagnetism4u@aol.com Competing interests: Independent Distributor of Bioflow (Ecoflow) magnotherapy products |
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Kay A Gill, Independant Distributor 28 Alexandra Gardens, Sheffield S11 9DQ
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The trials carried out used Bioflow magnetic wristbands with Central Reverse Polarity (CRP), a magnetic unit patented to Ecoflow Plc. As a distributor of these products I know that strength of the magnet is actually less important than the depth of field provided by this CRP set up. I do feel that the image used in the article should have been one of the products used in the trial. Ecoflow do not produce jewellery containing magnets, they produce high quality magnetic therapy that are registered class one medical devices, now clinically proven to work and also happen to look great. Competing interests: Independant Distributor for Ecoflow Plc - manufacturers of Bioflow Magnetic wristbands |
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N A Shah, SpR in orthopaedics Wrightington Hospital Centre for hip surgery, M N Shah
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Sir, I am amazed that your journal has published such a paper, and then responses from manufacturers of magnets, with obvious conflicting interests that encourage large number of arthritis patients to spend more money on completely unproven methods of pain relief. We are all aware of the tremendous amount of money companies have already made by pushing remedies such as glucosamine and hyalgan, all without any significant measure of reliable pain relief in the medium to long term. One manufacturer has pointed out that the depth of magnetic field and not the strength is important !!! which is a criticism of the entire methodology on this trial. Now the article is encouraging these people to go and spend (waste?) more money on magnets, with tenuous evidence being based on articles such as these. A large number of patients have correctly guessed the presence or absence of magnetism on their bracelets.There is absolutely no scientific method to quantify the placebo effect. There is no way to have any control on compliance.As Mr Bhosale has already pointed out,the severity of osteoarthritis, duration of symptoms and simultaneous intake of nonsteroidals or other medications is not corrected for.There is no laboratory evidence of reduction in inflammatory markers from synovial fluid. Having had the opportunity to specialise in joint replacements, and having seen a large number of such patients on a daily basis,I am sure you are already aware of the significant cyclical variation in symptoms that these patients get not only diurnally, but also weekly and seasonally. Can the trial rule out the fact that these patients would have felt better anyway in about 8-12 weeks just because of the natural cyclical variation, without the need to wear expensive magnets. By publishing misleading articles such as these ,on complimentary medicine, with soft endpoints and outcome measures, and incorrectly drawn conclusions which the study clearly does not support, it is merely going to lead to increased wastage of money on the part of patients, or even the health service, which is already cash strapped, and unable to rapidly provide evidence based effective treatments to patients such as joint replacements.Are we now going to recommend that all patients on the waiting lists be given magnets? Certainly a good way to get rid of waiting lists, cheaper that surgery as well !! It sounds very nice to use a complicated statistica; analysis and conducting RCT,s to test such hypotheses, but in the real world these patients need definite evidence based treatments to relieve pain and improve function.Unfortunately however the level of pain they have to put up with is such that most are willing to try any such remedy which may not have any real effect.Popularising these treatments in journals of your repute will not help the real cause, which is to recommend using limited resources on sound evidence based treatments which are effective in the long term. N Shah FRCS(orth) FRCS, MS(orth),DNB(orth) Competing interests: None declared |
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Ano L. Lobb, Research Associate Consumer Reports on Health
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In studies of alternative therapies where plausible biological mechanisms of action are lacking, and evidence of efficacy is either equivocal or also lacking, analysis of results needs to be especially rigorous to rule out chance or spurious effects. Harlow et al.’s results appear to lack such rigor in at least three instances. First, there were no significant differences in results between the standard (therapeutic strength) magnetic bracelets and the weak (sub-therapeutic strength) magnetic bracelets, only between the standard and non-magnetic bracelets. This is an important shortcoming, since the weak-magnetic bracelet was deemed a more effective placebo due to the ease with which study participants could ascertain whether their bracelet was magnetic or not. Second, the authors do not mention whether there were significant differences between the weak-magnetic bracelets and the non-magnetic ones, and from a simple "eyeball" test of the results table it certainly looks like there might have been. If the difference in results between the two placebos was statistically significant, that would certainly call into question the conclusion of this study, and raise the likelihood that placebo effect was causing measured improvements. Lastly, no mention was made about the significance of self-reported pain reduction, if there was any. It is always nice when the significance of all measures is reported. Competing interests: None declared |
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Daniel E Moerman, Anthropologist University of Michigan-Dearborn 48128 USA
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What I don't understand is why a treatment (magnets) can't seem to have a cognitive component in its effectiveness. If we concede that some portion of the success of the treatment in the strong magnet group was that people knew they had magnetized bracelets (I suppose they might pick up pins, or stop my watch), this does not change the fact of the effectiveness itself. What, after all, is the point? Competing interests: None declared |
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Tim N Harlow, General Practitioner College Surgery, Cullompton, Devon, EX15 1TG
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I was interested to read Shah’s perhaps slightly unscientific response. I am not responsible for any responses from the manufacturers but their competing interest is there for all to see. One manufacturer’s view that ‘depth of magnetic field is important’ cannot be taken as a criticism of the entire methodology of the trial which was based on randomised controlled study of one type of bracelet as used in the consumer market. We clearly stated that while there was significant and clinically useful reduction in pain, we could not say whether this was due to placebo or specific effects or a mixture of both. There was enough to justify further investigation but that was all we concluded. We looked only at pain: there was no attempt to look at inflammatory markers and we made no claims at all about the disease processes. Of course there is the possibility of random variation, of different analgesic use and of spontaneous improvement- that was why we performed a randomised controlled trial to allow for just such factors. We looked at difference in change between groups using well validated outcome measures and pre-specified analyses. There is a curious argument in Shah’s last paragraph. He, rightly, points out the need for good evidence before advising either patients or the health service to spend money on treatments. Yet he also suggests that such investigation of ‘complimentary’ (sic) therapies is of no value and such research should not be published. This study is imperfect, has not provided all the answers and I welcome the rational debate it has stimulated. However, it is important for those who criticise the study to read the paper carefully first and to guard against emotion clouding their judgement. Competing interests: I am one of the authors of the paper |
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David W Haslam, Independent distributor of Ecoflow plc 75a Magnolia Drive, Colchester, Essex, CO4 3LP
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4 Four years ago I was on medication for gout and arthritis in both feet and the condition was slowly spreading up to my knees and hips.I was taking 2 Co-Proxamol painkillers, Zyloric and Bezalip morning and evening, when a friend suggested that I tried a Bioflow bracelet. Being a sceptical pensioner I said Iwould not waste my money on these fairy tale schemes, to which he replied that I would have nothing to lose except the pain, because if I was not satisfied I could have my money refunded in full. So I said "Dick I will try it if only to prove you wrong." Since that day 4 years ago I have not taken any medication for my gout and arthritis nor have I suffered any pain or discomfort and I became a independent distributor of Ecoflow plc products. I might also add that all my life I have had low blood pressure. 3 Years ago Iwas having my 6 monthly health check when my doctor made a remark of surprise, thinking he had made a mistake he rechecked my blood pressure, he had not, it was normal; after 65 years of being low for the last 3 years it has been normal. I cannot prove it one way or the other but surely it must be those magnets, the CRP magnets of Bioflow and Ecoflow plc. Our best recommendation for magnotherapy are pets, and of course, pets do not "suffer" from the placedo effect, they do not know the collar they are wearing is special. When owners buy a collar for their dog and see the good results, often they purchase a bracelet for themselves. The remarks of N.A.Shah is in my opinion typical of a section of the medical profession with this "head in a sack" attitude. When you consider the pressure taken off the NHS and the money saved on drug prescriptions by the number of Bioflow bracelets that the independent distributors of Ecoflow plc it has got to be worth doctors looking at magnotherapy with an open mind. Doctors remove those blinkers. David Haslam For more information contact me through my web page. www.healthflow-uk.ik.com or e-mail: travelwith.dave@virgin.net Competing interests: I am a registered Authorised distributor of Ecoflow plc (Bioflow) |
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Tony Floyd, Medical Student Newcastle University
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Ano L. Lobb (BMJ Response 29 December 2004) concluded his critique of this paper with:
> no mention was made about the significance of self-reported pain reduction, if there was any Yet Tim N Harlow (BMJ Response 29 December 2004) opined: > We clearly stated that while there was significant and clinically useful reduction in pain... Is one talking about statistically significant pain reduction with magnetic bracelets and the other using the word in an everyday sense? Poles apart, one might say.
Competing interests: Recently had to resubmit an assignment due to use of the word 'significant' |
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Curtis Bennett, Engineering Technologist Canada V1X 6A5
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Shah, Why the negativity on alternatives? Don't knock it till you have seriously researched the issue of magnetic influences. Being skeptical as you research is important but have the facts before you conclude. Magnetism is utilized all day in every aspect of our lives. Radio, television, computers, phones, electricity, eyesight, microwave, x-ray, etc, etc. As a health application, the design of the magnetic field is key to success. We have imaged physiological changes before and after the application of specific magnetics. The changes in physiology was remarkable and with zero side affects. The UK Diabetes Wellness and Research Foundation published the physiological changes. I have received emails from people saving toes and feet from amputation(magnetics increase circulation) If you want to see the article, email me at: curtis@thermoguy.com Magnetics require responsible design and will be a great compliment to medicine. What is on the market today where you can localize an area and increase circulation with zero side effects? I interviewed an MD avoiding knee replacement with specific magnetic insoles. From crippled, on vioxx to dancing and off vioxx. Studies like this are required because whatever drugs go into the body come out of the body where waste water systems are not designed to deal with trace chemicals in our water cycles. They are released back into the watershed and feed and water us again before going into oceans. The less we impact the environment, the healthier future generations will be. Keep up the great work, there is a book by an MD, PHD, Ron Lawrence and
another fella called:
Magnet Therapy, the Pain Cure Alternative
I am not a magnetic supplier, have a great day. Curtis Competing interests: None declared |
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Jim York, GP Kingscliff, NSW, 2487, Australia
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Sir, This research is of practical use to me as a GP because it provides a further option for my patients with osteoarthritis. I don't know why magnetic bracelets reduce pain in most patients as much as non-steroidal anti-inflammatory drugs or other analgesics and clearly this is a matter for further research. However at this point it appears there is reasonable evidence to support purchasing these bracelets and I will now change my algorithim for managing patients with osteoarthritis. I will now insert advice to purchase magnetic bracelets after keeping active and before taking Glucosamine, which steps precede taking Paracetamol, prescribing NSAIDs, steroid joint injections and finally orthopaedic referral. I will be fascinated to learn eventually whether the reduction in pain is due to the placebo response or some other mechanism but I personally regard it as unethical to ignore this evidence until then because we haven't got a good theoretical foundation to explain it at this point. I am grateful to the authors for this useful piece of work. Jim York Competing interests: None declared |
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Ray Padfield-Krala, owner Steers Farm Willingale Ongar Essex CM5 0QF
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For Mr Glanvilles benefit: The study say the magnet was 20mm Dia not the "bracelet" itself which is the point I was making about the article being a little misleading. In fact I would like the study group to check this dimension again!If the product used is in fact the ones suggested then I think you will find that the "magnet" is actually 15mm dia and the overall 20mm size stated includes the metal casing/housing which IS NOT magnetised!!! Let us not forget that it was the effect of a magnetic field of a determined strength that was worn on the wrist held by a strap (not a bracelet) that showed the benefit, not a particular companies product. This forum is slowly becoming a advertising medium for distributors of a particular companies product, a point I made in a letter to Dr Ernst when the trial first started. To those distributors who have contributed to this discussion I might suggest you have got some of your claims wrong and you are seeing only what you want to see and that not all is what they seem! Fact: The unit used in the trial is NOT patented! The patented product is an older model, using a rectangular magnet which was not the same as used in the trial. Patent is "still" pending. Fact: The products currently offered for sale by distributors contain an even smaller magnet! Again, not used in trial! Fact: All powerful magnets have an opposing, detectable field around their edge, CRP technically is not exclusive to one product, only the term! Before distributors hijack the results, they should check that the magnet used in the trial and the one currently offered for sale are one and the same i.e of the same dimensions that the trial paper published (see above). That said, magnets of sufficient strength work! all of us who work in this field (no pun intended) have seen the results (with or without CRP!) I applaud the trial because it showed that a clinical difference was seen, not enough for some but I have seen it work for animals and for people, sometimes within minutes! More work needs to be done but in response the suggestion that companies should contribute financially to the trial will only have he results hijacked by those claiming "it was my product not yours, so mine works best" attitude. My original issue was the use of the word "bracelet" and the price range implying that a £30 bracelet that is also sold down the market for £10 now fits the criteria of the trial. In fact I have evidence that shows the same product sold at between £4.99 and £55!! I have brochures claiming a magnetic field strength of the magnets in an actual bracelet as being around 2000 gauss (200 mtesla) each, which are about 4mm in dia. The field produced on some of these magnets (not all) has a depth of 3 to 4mm and losing strength over that distance. This fits the strength criteria of the report? I have heard sellers say that because the bracelet contains 6 magnets that adds up to 12000 gauss!!! Or because it contains more than one magnet it is stronger! So much misleading information, like chinese wispers, it filters through not only into the public domain but into the scientific community which only goes to fuel sceptism. One newspaper that published the Journals findings also published a picture of a product that probably wouldn't pick up a paper clip! No wonder there is confusion! To Mr Lobb, Mr Belmonte, Mr Shah and Dr Bhosale if you wish to trial for youselves, informally, I would happy to send you some samples of "a magnet of sufficient strength in a strap" so you can conduct your own "trial". If any distributors wish to question my claims about the patent check the patent office! If you need the patent number my email is: magnetic@btinternet.com Your loyalty is unquestionable but if our ethics are true then it is the therapy that is the key not necessarily the product! For those who are looking for some scientific published work on the therapuetic effect of magnetic fields may I suggest the work of Roger Coghill in particular Something in the Air. I look forward to some interesting replies! In the meantime I would like to wish everone a very Happy New Year. R. Padfield-Krala MAGNETiC. Competing interests: Manufacturer of magnetic therapy products |
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William N. Elwood, Director (Harmony Products) 13 Lenham Avenue, Saltdean Brighton BN2 8AE
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We wish to lend our support to the use of magnotherapy with animals suffering arthritic pain. The placebo effect ,we consider, can be completely discounted with regard to animals. Having applied magnotherapy to many cats,dogs,horses and goats since our business was established in 1997,we have had almost 100% success,and we derive much pleasure from the unsolicited testimonials that we receive from grateful owners. Surely such responses are a positive indication that magnetic fields,correctly applied,have beneficial effects in cases where arthritis is a problem. We would add that the magnets we utilise are neodybnium type with a field strength of 200 mTessla Competing interests: We produce magnotherapy units (collars & bands) for humans and animals |
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Bill Lawson, Self Employed Ashness, Torthorwald, Dumfries DG1 3PS
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It is disappointing, to say the least, to read negative and narrow minded comments from members of the medical profession in relation to the trial results. It is fully appreciated why Consultants and GP’s will not, and indeed can not, prescribe or endorse any medication or treatment which has been fully researched, tested and approved. However, surely there is no harm in medical professionals suggesting to their patients that magnetic therapy might be worth a try in suitable cases, subject to the usual restrictions in relation to pacemakers, etc. The resultant feedback from their own patients might then give them first hand information on the potential benefits of magnets, and encourage them to support further research. Given that magnets have been used for many hundreds of years by the Chinese, Egyptians etc, I am surprised that study and research by the medical profession has never been carried out. The recent trial has been a step in the right direction. As already mentioned, the positive results gained from animals, particularly dogs, is surely convincing in itself. I personally have several (human) customers who started out as total sceptics, and who took a lot of persuading to even try the products. All are now total converts, and would be insulted if anyone suggested that ‘its all in the mind’! No-one involved in promoting magnets for pain relief can be blamed for taking full advantage of the trial results, given the lack of medical evidence available. All the distributors I have come across in the company I am involved with believe passionately in the effectiveness of magnets, and are always looking for new ways to convince people to at least try them. We are also keen to promote our money back guarantee, and I am sure that most, like me, would far rather refund the money to the few who find the magnets ineffective, rather than have dissatisfied customers. Most are in the business principally for the satisfaction, not the money. Apart from distributors, clearly at least one other manufacturer of such products has also been attracted to the opportunity to promote his products! I assumed the response from Hugh de Glanville was written ‘tongue in cheek’, however clarification has now been provided anyway. A more open minded attitude from all concerned in relation to the use of magnets would be very welcome. Many more people and animals might then have the opportunity of benefiting, and gaining a better quality of life. Competing interests: Independent Distributor of magnetic products. |
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Everett L Williams, Computer Consultant Ingram, Texas, USA
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