[This post was transferred from the old Improbable Science page]

It’s not just homeopathy. The Sunday Times, (26 February, 2006) reports that the National Health Service has fallen for another scam.

 “IT COULD be called the Cleopatra Effect. Magnetic therapy, which has held the rich and powerful in thrall from ancient Egypt to modern Downing Street, is about to be made available on the National Health Service.

NHS accountants are so impressed by the cost-effectiveness of a “magnetic leg wrap” called 4UlcerCare that from Wednesday doctors will be allowed to prescribe it to patients.”

This is nicely timed to coincide with an Editorial in the British Medical Journal, by Finegold & Flamm (2006) (click to download pdf file). The editorial title was “Magnet therapy. Extraordinary claims, but no proved benefits“. They conclude

“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,”

For example, Carter et al,, 2002 found no detectable effect of magnet therapy for treatment of wrist pain Attributed to Carpal Tunnel Syndrome (30 patients,double blind, careful controls). Winemiller et al., 2003 (Journal of American Medical Association, 290, 1474–78), found no benefit of magnets vs sham-magnets in treatment of plantar heel pain in 101 patients.

Magnets are said to be one of Cherie Blair’s several curious and irrational beliefs. It is alleged, according to the Daily Telegraph, that “Cherie Blair did not allow her youngest child, Leo, to have the controversial MMR vaccine and instead asked a New Age healer to wave a “magic” pendulum over him”. A few more examples are documented here and here.

The accountants at the Prescription Pricing Authority have decided that the “the magnets will save money on bandages and nurses’ time by healing the wounds.” I dare say they could save even more money by removing all effective treatments.

The evidence in favour of the magnetic treatment all seems to come from a Dr Nyjon Eccles. The Sunday Times describes him as an “NHS GP in north London”, but elsewhere he is described as "Founder, CEO and Medical Director of the Chiron Clinic" in Harley Street. A look at their web site shows that they offer a full range of alternative scams. Cancer patients can get

“LYMPH DETOXIFICATION – This is achieved by non-invasive scalar, oxygen-fed light beam therapy. This helps to detoxify the tissues by assisting the body in dissolving lymph blockages and restoring normal lymph flow using the Nobel quantum scalar technology coupled with oxygen for remarkable healing potential.”

This is total gobbledygook, designed to take advantage of the desperate.

The only real evidence to be provided by Dr Eccles that the device works is a small (26 patients) double blind trial that has not yet been published in a peer-reviewed journal, and which suffered from a number of problems (dropouts, outliers). What, I wonder, does NICE think of evidence like this?

More on magnets and the PPA

In the discussion of magnets on the Badscience site, a Michael King says that 4ulcercare will be included in Part IX of the Drug Tariff because it meets the criteria of the Prescription Pricing Authority (PPA).

I presume this Michael King is Director of Planning and Corporate Affairs at the PPA, though he does not say so.

Michael King says

“There is no judgement offered about whether a product in the Drug Tariff

is more (or less) efficacious than any other, or the placebo effect.”

The criteria for inclusion in

Part IX of the Drug Tariff () include, in section 10 iii, “They are cost effective”

Will he please explain how a device can be cost-effective, if it is ineffective (relative to placebo)?

What the PPA says

Michael King has replied to my question by email (1 Mar 2006).  He says

“The cost-effectiveness threshold for inclusion in the Drug Tariff is met if the ‘effectiveness’ of the device, as seen in data submitted by the manufacturer in support of the application, exceeds its cost to the NHS. ”

Sadly this is still ambiguous. It seems to suggest that that whatever data are submitted by the manufacturer are taken at face value, without any attempt to evaluate their quality. So I phoned King to ask if this was the case. He was helpful, but he said that it was not the case. He told me that the data were subject to some sort of low level evaluation, short of the sort of evaluation that NICE would do. This seems to contradict his earlier statement (above) that inclusion in the Tariff implies no judgement about whether a device is better than a placebo.

King said also that listing in the Tariff

“. . . is not a licensing decision nor a recommendation akin to the outcome of a NICE review”

The problem is, of course, that listing is seen as a recommendation by the public, by the Daily

Mail, and certainly by the manufacturer.

One thing, at least, is clear in this case. Whatever evaluation was done, it was done very badly. But in order to try to find out exactly what evaluation was done, and by whom, I’m having to resort to the Freedom of Information Act.

The results are here and here..

What NICE says

Fraser Woodward (Communications Manager, National Institute for Health and Clinical Excellence (NICE)) writes as follows.

 “The test of “cost effectiveness” applied by the PPA when determining whether or not a device should go on the tariff is very different to the way cost effectiviness is assessed by NICE”

That is pretty obvious, but how is the public meant to know that, when they hear that the NHS has declared a treatment to be ‘cost-effective’, that statement can mean two entirely different things according to which part of the bureaucracy the statement comes from?