Dr. Gaby's reply

Townsend Letter for Doctors and Patients,  May, 2004  by Alan R. Gaby

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It appears that Dr. Abraham has a financial interest in magnesium and malic acid (Super Malic[R]; Optimox Corporation), and I believe it would have been appropriate for him to disclose that fact in his letter. It is true that my review of magnesium and fibromyalgia might seem arbitrary, since one of the positive studies cited was not a controlled trial. My reasons for classifying parenteral magnesium as beneficial were: 1) one open trial of intravenous magnesium showing positive results, 2) one controlled trial showing that intramuscular magnesium is effective for chronic fatigue syndrome (a condition related to fibromyalgia), and 3) personal clinical experience showing dramatic improvement in fibromyalgia in 50% of patients treated with intravenous magnesium, as a component of the "Myers' cocktail." My reasons for labeling magnesium and malic acid as ineffective were: 1) the only published controlled trial failed to show any benefit, and 2) the results with oral magnesium and malic acid in my own experience, and in the experience of a number of my colleagues, have been disappointing. There appears to be a fairly large placebo response in patients with fibromyalgia, so open-label trials must be interpreted with caution. If Dr. Abraham were to perform a doubleblind study showing that any dose of magnesium and malic acid is beneficial for fibromyalgia, then I would change my opinion.

Alan R. Gaby, MD

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