Edoardo Cervoni, GPwSI (ENT) West Lancashire PCT NHS, L39 2BY Re: Was the study really good enough? 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Christopher I Pelton, General Practitioner Wellington Medical Practice Telford TF1 1PZ Re: Why not test the ultimate magnet? 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Helene C Faure, Editorial Project Manager Current Controlled Trials, 34-42 Cleveland Street, London W1T 4LB, UK Re: Randomised controlled trial of magnetic bracelets for relieving pain in osteoarthritis of the hip and knee 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, (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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Victor. C. Green, Director Weydon Mill, Weydon Mill Lane, Farnham, Surrey England GU9 7QL Re: WHY NOT TRY MAGNETS ON ANIMALS 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Curtis Bennett, Engineering Technologist Canada V1X6A5 Re: Re: Was the study really good enough? 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - David Gurwitz, Director, National Laboratory for the Genetics of Israeli Populations Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, ISRAEL Re: Better studies on magnets for relieving pain in osteoarthritis of the knee must include objective laboratory tests of synovial inflammatory markers 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 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.