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TX: 15.08.05 - Medical Magnets

PRESENTER: WINIFRED ROBINSON
Downloaded from www.bbc.co.uk/radio4

THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

ROBINSON
Now how many magnets do you think you own? One on the fridge, maybe one to hold your paperclips. Well the fact is we're surrounded by magnets, everything from your television to your computer, and if you have a car then add on another couple of hundred there. Magnets are now an everyday part of life. But 3,000 years after the first naturally occurring magnets were discovered there's an increasing interest in the medical applications for them. There are two types of magnets - static magnets, think of the bracelets that are supposed to ease arthritis, and pulsing magnets. The medical efficacy of the static ones is still unproven but the medical establishment is getting very excited about the possible treatments offered by pulsing magnets, as Carolyn Atkinson has been finding out. Among the people she spoke to is Gwendolyn Cobb from Sevenoaks in Kent. She experienced nearly 20 years of depression and the different treatments that she tried had had little effect.

COBB
I felt it wasn't worth - life wasn't worth living really. I didn't want to go out, didn't want to meet people. I was just so depressed that I thought anything to get me out of this. And now I mean I'm leading quite an active life because we go [indistinct words] bowling once or twice a week, go out on outings with the active retired people over 50 club. When I felt bad I didn't really want my cat, but I mean I love my blue cat, you know.

ATKINSON
In fact controversial ECT or electroconvulsive therapy was the only option remaining. But then she tried a new magnet based therapy called trans-cranial magnetic stimulation or TMS and her life changed dramatically.

COBB
They get a cotton cap and they put it on your head and then they measure so much in one place and they mark the cap, so you wear the same cap every time so they know where to put the - it's like a hammer sort of like going like [tapping noise] tapping ...

ATKINSON
Tapping your head.

COBB
Tapping my head yes. Didn't hurt, I wasn't frightened of going there like I sometimes am at the dentist. And Dr Edwards said I could go back for some more if I needed it but I've never needed it.

EDWARDS
I'm delighted to hear how well Mrs Cobb has done, I can't say that the improvement was a surprise, I think we expect that now with this treatment but it is very pleasing to know that she has continued to do so well.

ATKINSON
Magnetism has a 3,000 year history, it was first discovered in naturally occurring loadstone rock. Legend has it that a shepherd wandering through the region of Magnesia in Asia Minor found himself pinned to the ground when the magnetic rock attracted the nails in his boots. The potential uses of magnets were first spotted by the Chinese who developed early compasses. And Dr Treasa Ní Mhíocháin from Trinity College, Dublin says magnets and magnetism have been a recurring theme throughout history from Aristotle to Charles Dickens, who apparently insisted his bed always faced magnetic north.

NÍ MHÍOCHÁIN
Cleopatra wore a magnetic amulet on her forehead to guarantee her youth and beauty. It was believed that if a magnet was placed on the pillow of a guilty wife she would confess to all of her sins. It was believed that onions or garlic would take away the power of a magnet but then these notions developed into sub-cultures and little industries, for example. One of the most famously colourful characters in the history of magnetism would be Anton Mesmer, hypnotist and healer, from whom we have the term of mesmerism. And he coined the notion of an animal magnetism and in fact so popular was this notion that Mozart incorporated this into his opera Cosi Fan Tutte.

ATKINSON
But while the superstitions and stories may amuse, the apparent bizarre powers of the magnet prompted the beginning of a medical fascination, which continues to this day.

ACTUALITY
BARKER
Now how are we going to solve this problem about the isolated and the un-isolated power supply to it?

ATKINSON
This is the Royal Hallamshire Hospital in Sheffield, home to Professor Tony Barker, the UK's leading expert on magnets and their medical uses. So what is a magnet?

BARKER
A magnet is a device that produces a magnetic field, so the question I guess is what is a magnetic field? It's a force field, if you like, it sounds a bit like something out of Star Trek, but it's a force field rather like gravity is a force field, gravity acts on mass to hold us down, for example, on to the planet and magnetism acts on material to put mechanical forces on it, that are similar but different to gravity.

ATKINSON
You've got a round metal disc, you've got a foot sort of gauge.

BARKER
It's a foot switch and I'm about to press it, let's see what happens to the metal disc.

ATKINSON
[Laughing] That was - there was something magnetic or force like going on there, I can definitely say. You pushed the switch and this metal plate came whizzing across the room.

BARKER
Let's do it again.

ATKINSON
Right what does that prove apart from you've got a big toy?

BARKER
It shows that coming out of this magnetic stimulator is an enormous pulse of magnetic field which causes currents to flow in my metal disc which causes magnetic fields which repel each other and it's a very good way of firing metal discs around a big room. There are basically two types of magnets that are used in medicine - at one end of the range there is the magnet that you can strap on to yourself, a little permanent magnet, that is claimed to cure a variety of ailments, almost every human ailment you can imagine people will sell you a magnet to try and cure it. It doesn't sound very plausible that so many diverse complaints could actually be affected by the magnetic field because in general static magnetic fields don't actually appear to have any effect on the human body.

ATKINSON
So the claims that it sort of increases blood flow, in your view, is that not proven?

BARKER
Well that's the classic claim is that putting a permanent magnet on your skin increases blood flow. The trouble is it's very easy to test that and the tests aren't successful. If you put a magnet on your skin and it increases blood flow then your skin will go pinker, we know that - if you put your hand in hot water it goes pinker because the blood flow increases. If you put a magnet on your skin it doesn't change colour in general. So there's no very obvious evidence that blood flow can be affected by static magnetic fields.

ATKINSON
Now I've come to a large pharmacy - it sells everything from wheelchairs to toothpaste, to perfume and it also has quite a lot of products that are magnetic in some form or other that claim to help with pain. Now with me is Kate Llewelyn from Arthritis Care. Kate, we've got one here and it's a magnetic massage support, it's basically a cushion that goes behind your back and it also has magnets in it and it claims that it enhances relief of pain, improves blood flow. Over here we've got a whole stack of quite impressive looking bracelets which look really quite like jewellery, rather than health items. Does it surprise you at the range that are on sale and that people can get hold of?

LLEWELYN
I think in the last few years we've seen a proliferation of products that are now on the market, so a few years ago it was mainly pendants and bracelets and certainly now the ones here do look a lot more like jewellery than the ones previous - they kind of stuck out as being more medical. But the main issue with magnetic therapy is actually there is no evidence that it is effective and there have been a few trials but the number of people involved in those are very small. Until wider tests are done I don't see that there is much efficacy is that.

ATKINSON
But a lot of people say it works for them.

LLEWELYN
There's a lot of anecdotal evidence, certainly coming through Arthritis Care we do hear of some cases where people swear by them. Equally we hear of plenty of others where people have spent an awful lot of money buying a product which doesn't work.

ATKINSON
Now I'm in the lab here in Sheffield with Professor Tony Barker, who's waving a sort of table tennis bat at me.

BARKER
As well as static magnetic fields, in medicine we often use pulsed magnetic fields. So I've got what is essentially a coil of wire here, it's about 15 centimetres across, and the stimulator is firing and you can probably hear a click every few seconds as it's actually firing. And all I'm going to do is to just put this coil of wire on your arm and ...

ATKINSON
So it's going - I can feel - oh my goodness me [laughing] ...

BARKER
It's going through - this pulse of magnetic field, is going through your jacket and through your skin and down to the nerve and it's causing currents to flow in the nerves and other parts of your body as well and your hand is moving.

ATKINSON
It certainly is.

BARKER
And whilst you're looking a little bit nervous you're not screaming with pain so it clearly can't be hurting too much.

ATKINSON
It's not hurting - it's amazing. So you're putting a pulse through me, it's going down my nerve and it's making my thumb and my fingers sort of jump basically.

BARKER
And I haven't mentioned this before - magnetic stimulation can also stimulate the brain without hurting you.

ATKINSON
Now this is - this is all very exciting and hilarious to watch my thumb moving but in a practical way how can that be used usefully on somebody for either diagnosis or treatment?

BARKER
There is increasing interest in the therapeutic use of magnetic stimulation, where we actually cause currents to flow in the brain. That's got all sorts of applications simply because it is so easy to stimulate the brain. Now a lot of interesting work is going on at the moment suggesting that you can use magnetic stimulation to help people recover from disabilities such as stroke, to excite them and then give them conventional physiotherapy afterwards and the physiotherapy is more effective because their brain has been, if you like, gingered up by the magnetic stimulation. There's some work going on, just starting in fact, at the Institute of Neurology in London being led by Professor John Rothwell.

ROTHWELL
This machine in front of us called the trans-cranial magnetic stimulator, that means it can stimulate the brain through the skull - trans-cran. What we're going to do with this machine is use it in conjunction with normal physiotherapy - we might have a paralysed arm or leg on one side. We'd get the patient here and we'd give them a few seconds, about half a minute, of stimulation everyday for five days or 10 days and then we give the patients their normal physiotherapy. The hope is that the brain will react better to the physiotherapy and learn faster so that the patients will actually recover faster.

ATKINSON
From the patient's point of view if they can grip the cup harder or the ball harder or whatever it is that's going to make a practical difference to their life, they can pick up a cup of coffee more easily and not drop it.

ROTHWELL
That's exactly right. We're not trying to create miracles here but you've put your finger on some very important features. Just the very simple matter of being able to pick up a cup better than you could before is really an extraordinarily good achievement.

ATKINSON
And it's not only potentially useful for stroke, spinal injury patients are finding it helps bladder control, in fact Professor Tony Barker at the Royal Hallamshire Hospital says results are exceeding even his expectations.

BARKER
There are several thousand scientific papers that have now been written on applying magnetic stimulation to different parts of the body for different purposes and they're coming out on average at about one per day now across the world, so there's a lot of scientific interest in the subject.

ATKINSON
So are we going to get what you might call medical breakthroughs?

BARKER
I think the developments will be incremental, we will be able to help stroke victims recover faster, we will be able to help paraplegics keep their muscles in good working order. I think they will be incremental rather than breakthrough, with the possible exception I think of treatment of depression.

ATKINSON
Back in Kent Dr Denzil Edwards is convinced that trans-cranial magnetic stimulation or TMS is the most exciting development in the treatment of depression since the emergence of modern antidepressants or SSRIs almost 20 years ago. Up until now if antidepressants fail the only other option has been controversial electroconvulsive therapy or ECT, which induces a fit under anaesthetic and can often result in severe side effects including short term memory loss.

EDWARDS
I think personally TMS is the greatest advance in the treatment of depression since the SSRI drugs came out, these are the antidepressants with a more specific effect on depression and far less in the way of side effects than older drugs like Amitriptolene and Imipromine.

ATKINSON
No one is suggesting that trans-cranial magnetic stimulation is more effective than ECT but the results of a three year long trial are imminent and Dr Denzil Edwards, who carried out the TMS on Gwendolyn Cobb, is hoping to be the first consultant in the UK to offer it to carefully selected NHS patients.

EDWARDS
It is my hope and I think it's quite likely to be that way. ECT is coming under stricter and stricter regulation and it's getting harder for mental health trusts to maintain the same degree of service in ECT at the standard of safety and efficacy that's expected of them now.

ATKINSON
And for Gwendolyn Cobb, who had her TMS 18 months ago, after enduring almost two decades of clinical depression, life at last is looking good again.

COBB
Well I feel happy and now I mean I'm spending money and I wouldn't spend money when I'm depressed. I've had the garage taken down and I'm having it built to make two - a double garage. I wouldn't have contemplated it before, no. It's time I offered the builders another cup of tea I think. Would you like another cup of tea? Two have sugar and one doesn't isn't it? Yeah. Yes, yes I'm on top of the world again now.

ROBINSON
Gwendolyn Cobb ending that report by Carolyn Atkinson.

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