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AK: Nonsense on Full Automatic

I start these entries about a week before their due date, and when I saw Dr Hall’s Applied Kinesiology (AK) post from Tuesday, I thought the heck, there goes my post for Friday.  After reading Harriet’s post, I think mine will be both complementary and alternative, and perhaps even integrative, to her entry.  I do have one quibble with her post. She said

“we skeptics don’t dismiss AK just because it sounds silly.”

AK doesn’t just sound silly, it is silly.  I have found over the years writing for SBM that I have developed an increasing bias around the concept of prior probability.  As best I can tell there is a well described reality, and that reality constrains what is not only probable, but what is possible.  Within the limitations of our current understanding of reality, some processes are impossible, i.e. have zero prior probability. AK’s prior probability is exactly zero.   I sometimes think the blog should be called Reality Based Medicine.  Science gives us understanding of reality and AK, like many a SCAM (Supplements, Complementary and Alternative Medicine) discussed in this blog, parted company with reality from the beginning.

This blog has two often overlapping purposes.  Blogs offer timely commentary on contemporary issues, and this blog certainly fills that role.  More than other blogs, SBM also has the opportunity to be a reference source on various SCAM’s .  I have had the recent opportunity to reread the entire oeuvre of SBM, and it is impressive in the breadth and depth of topics covered in its three plus years.  It is not yet encyclopedic and there are many topics not yet reviewed in the blog, such as Applied Kinesiology.  So many many SCAM’s, so little time.

I tend to read about medicine and it’s alternative goatee wearing evil twin  in a nonlinear way.  I have 30 plus years reading about medicine and quackery, so day to day I add to my understanding incrementally, adding a brick here and a daub of mortar there to the edifice of my knowledge.  Such a Victorian metaphor.  Sometimes I need to go back and review a topic from scratch, as if I have no prior knowledge.  I have places to start when I need to review a topic from the beginning.  For infectious diseases I start with The Principals and Practice of Infectious Diseases, the ‘bible’ of my field. For SCAM’s I start with Google, and the Wikipedia entry usually pops up at the top of the list.

AK is like many other SCAM’s having its origin in the epiphany of one practitioner, in this case a chiropractor, George J. Goodheart, who, as Wikipedia mentions, ‘invented’ the process.  Invent.  When I hear the word invent, I think of Edison or Macaroni  Marconi. Damn auto correct.  I do not think of invent when applied to works of fiction, although I suppose Tolkien did invent his characters and world.  Still, invent somehow doesn’t fit, and later the Wikipedia says he originated AK in 1964, which is more in keeping with its fictional characteristics. ‘Made up’ would fit the situation best.

Evidently Goodheart was having difficulty diagnosing and treating problems in his patients who were not responding to the chiropractic conceptual framework. What a surprise: processes that were neither understood nor treatable by standard chiropractic.  That would appear to account for hmmm, let me see, everything.  No wonder he was at an impasse with his patients.  Undeterred and guided by the Triangle of Health, the Chiropractic concept of structural balance,  and a ring of power, by long trial and error he cobbled together AK. Unfortunately for AK, Goodheart was not guided by anatomy and physiology, reality not being a strong point in his understanding of disease.

AK has the following underlying principals:

1) Specific health problems will cause specific muscles to test weak.
2) Testing for muscle weakness can be used to indicate a treatment.
3) Treatments that increase muscle strength demonstrate efficacy of the treatment.

I think I have discovered the cause of obesity: the last century has seen a marked increase in the number of pathways by which SCAM modalities function: all the meridians of the various forms of acupuncture, the connections of reflexology, of iridology, and now of AK, and more are crammed into one small volume of flesh and blood.  Since a major aspect of SCAM the faux understanding that wishing it so makes it so, they are responsible for the proliferation of formerly imaginary pathways in the human body and they only way for all these pathways to fit is for the people to get larger.  The way I lost weight was to quit believing in acupuncture, and when the meridians faded I lost 45 lbs.  Pretty nifty.

The basic concept is that an illness in say, the lung, manifests by making a specific muscle or muscle group weak, and by improving the underlying problem the muscles strengthen.  I still think craniosacral therapy is goofier, but AK is giving it a run for the money.

An example from the first web page I found searching for asthma and AK

Reflex areas that stimulate either the deltoid or the lungs stimulate both. If an individual has a lung infection or an abnormal function in one or both lungs, he or she will probably exhibit weakness of one or both deltoid muscles. Not only would there be a lung infection, but because of deltoid weakness a problem may develop in the shoulder. Under normal circumstances, once the lung infection clears, or if the body adapts to the infection, the deltoid muscle will return to its normal state. On the other hand, if a chronic, low-grade infection lingers, the patient can be left with a weakened deltoid muscle. The applied kinesiologist evaluating the patient will need to stimulate the nerve and blood supply, as well as lymphatic drainage and acupuncture energy to the lungs in order for them to clear. Once the lung problem is resolved, deltoid muscle function can return to normal.

As I said, AK doesn’t sound silly.  It is silly. Multiple videos are available on the interwebs with a quick Google search to get a good idea of the silliness.

While, like all SCAM’s, there is not process to which AK is not applicable, it appears to be most often used diagnose and treat to allergies and food intolerance. The verbs and nouns in the preceding sentence need quotes, as the words diagnose, treat, allergy and food intolerance,  have no resemblance to how the words are used in real medicine. As is often the case in SCAM’s, words are used as if they have one meaning when in fact they have another.  It is like pointing at a chair and using the word dog.  It is the SCAM aphasia.  I wonder where the lesion would be on MRI.

The allegedly  toxic/allergic substance is held in one hand, often in a vial,  and the muscles on the other arm are tested for weakness.  If you cannot resist the force Anakin, then you are allergic/intolerant to the substance. The AK practitioner then does some adjustments or acupuncture or beams a laser on you, then retests and, if the intervention was successful, the weakness is gone. Success.

I think of allergies as an interaction of an antigen (in my world it is often an antibiotic) with antibodies, with a subsequent cascade of physiologic events leading variably to rashes, hives, interstitial nephritis and other adverse physiologic consequences.  Muscle weakness is not involved.  But that is the reductionist in me, trying to understand a process from the level of the antigen/antibody to the effects on the whole human with the allergic reaction.

I live in a word where, although we use short cuts on occasion, language is meant to be precise to describe a situation.  Precision of language represents precision of thought.  It is important to be precise in medicine.  Is it a  Staph infection?  A Staph aureus infection? A methicillin resistant Staph infection?  What is done diagnostically and therapeutically depends on how exactly the problem is described. Reading the kinesiology ‘literature’ indicates that allergy has a far broader, aphasic, use.

…allergies are viewed from a holistic perspective based on Oriental Medical principles and defined in terms of the effect an allergic substance has on the energy flow in the body.

An allergy is a condition of unusual sensitivity of a person to one or more substances which may be harmless to the majority of other individuals. In the allergic person, the allergic substance (known as an allergen) is viewed by the brain as a threat to the body’s well-being. When contact is made with an allergen, it causes blockages in the energy pathways called meridians, disrupting the normal flow of energy through the body’s electrical circuits. This energy blockage causes interference in communication between the brain and body via the nervous system which begins a chain of events that can develop into an allergic response.”

So all diseases are due in part or in their entirety to an allergy.

What do cellulitis, sprue, and cataracts have in common?  Vitamin C allergy. And a vitamin T allergy leads to “low immunity”.  I am not entirely sure what vitamin T is, evidently it is found in sesame seeds, and I pity the  fool who is deficient in vitamin T. So my allergy, and AK allergy are not the same thing. My use of the term allergy is relatively narrow. For the AK practitioner, it may describe everything and anything.

The weird thing, as if the whole process is not weird,  is that the tested foods or chemicals are often in vials. How the allergen, or its essence,  gets out of the vial into the human, sets up a cascade of effects that lead to muscle weakness is not explained.  Glass and plastic are far more porous than I ever suspected.

Oh wait.  It is quantum. I just started laughing as the speaker wrote quantum physics  in the board as he started the talk. I couldn’t get Dr. Science out of my head.  He Knows More Than You Do! The subsequent talk has nothing to do with the quantum physics I learned back in the day for my undergraduate degree. Oh. Sorry. I was wrong. The speaker doesn’t really explain how quantum physics is connected to AK.  Bummer.

And why, as an aside, is he wearing scrubs?  In the hospital we wear scrubs in part to avoid dragging  environmental material into clean areas of the hospital, and in part to avoid  getting blood and other body fluids on street clothes.  Just what kind of AK is he doing that needs scrubs?  Or perhaps it is an Ozian conceit.  I see someone is scrubs outside the hospital, I think doofus.

But others are clearer in the explanation.  I am using clearer and explanation in the SCAM aphasic manner,  just to see what it is like.

This brings us to our theoretical understanding of kinesiology: When you test the viability of a given statement, you are determining whether or not the wave function will collapse.[8] Only something that is true has existence in reality.

Conclusion: AK has no existence in reality.  But I knew that without a wave function collapsing.

Put simply, truth collapses the wave function. If you test a particular statement like “Today is Monday” and your arm (i.e. muscles) stays strong, a wave function collapsed, signifying that it is indeed Monday. Conversely, if you test weak (i.e. your arm drops to your side), there is no collapse of the wave function denoting that your statement was untruthful. Although it may seem counterintuitive, when your arm stays strong while testing a statement with kinesiology, a wave function collapses, but if your arms collapses (i.e. goes weak), there is no affect in reality.

That is more  a Korsakoff’s syndrome than an aphasia, don’t you think?  Neurology is not my strong point.

I see little  difference between AK muscle testing and Power Band muscle testing, just variations on a theme.  Richard Saunders  has nice demonstrations of the amazing quantum physics ability of people to fool themselves and others with muscle testing.

I am old enough to remember when there was not the huge number of clinical trials to help guide clinical decisions. We had a saying when I was a resident:  One patient was “in my experience, 2 patients were “in a series of cases” and three were “in case after case.” But still anecdotes, and still worthless.

The International College of Applied Kinesiology has all the collected papers available online, almost all some version of the saying mentioned above.  While a wide variety of anecdotal cases are presented, my favorite was ROCK MUSIC  AN ENVIRONMENTAL STRESSOR, where they concluded

In this selected group of patients, physical tests of muscle weakness and neurological disorganization appeared after exposure to rock-n-roll music.

It is remarkable the time and energy expended on publishing the fiction of AK, although World of Warcraft has a similar draw I suppose.

Still, there is no tooth fairy science that should go unstudied, no matter how ludicrous.  Much to my surprise there are no Cochrane reviews on the topic.  If homeopathy, why not AK?

There was a review in 2007, Chiropr Osteopat. 2007 Mar 6;15:4. Cuthbert SC, Goodheart GJ Jr. On the reliability and validity of manual muscle testing: a literature review  which concluded that AK was of benefit:

More than 100 studies related to MMT and the applied kinesiology chiropractic technique (AK) that employs MMT in its methodology were reviewed, including studies on the clinical efficacy of MMT in the diagnosis of patients with symptomatology. With regard to analysis there is evidence for good reliability and validity in the use of MMT for patients with neuromusculoskeletal dysfunction. The observational cohort studies demonstrated good external and internal validity, and the 12 randomized controlled trials (RCTs) that were reviewed show that MMT findings were not dependent upon examiner bias.

Conclusion
The MMT employed by chiropractors, physical therapists, and neurologists was shown to be a clinically useful tool, but its ultimate scientific validation and application requires testing that employs sophisticated research models in the areas of neurophysiology, biomechanics, RCTs, and statistical analysis.

The best they could conclude was that AK muscle testing was valid, not that it lead to effective interventions, noting

One shortcoming is the lack of RCTs to substantiate (or refute) the clinical utility (efficacy, effectiveness) of chiropractic interventions based on MMT findings.

This lead to a response by other chiropractors, who did a complete evaluation of  Cuthbert and Goodheart, pointing out the numerous methodologic problems and concluded

Cuthbert and Goodheart conducted a review with important methodological deficiencies. When manual muscle testing as used in Applied Kinesiology is disentangled from standard orthopedic/neurological muscle testing, the few studies evaluating specific AK procedures either refute or cannot support the validity of AK procedures as diagnostic tests. In particular, the use of MMT for the diagnosis of organic disease or putative pre/subclinical conditions is insupportable.

It is an interesting to read the articles sequentially and it underscores the difficultly in conducting a review of any literature and the issues with meta-analyses.

There are other meta-analysis that conclude

There is insufficient evidence for diagnostic accuracy within kinesiology, the validity of muscle response and the effectiveness of kinesiology for any condition. The standards of reporting were low. We recommend a pragmatic study of the effectiveness of kinesiology as the most appropriate initial step to determine whether kinesiology has any clinical value.

The pragmatic study being a study where you do not worry about potential bias and ignore issues like blinding and placebo controls.

and

Several recent studies have refuted the use of applied kinesiology and provocation-neutralization in diagnosis. The placebo effect must not be overlooked as a potentially important factor in some approaches.

SUMMARY:
There have been no studies supporting the use of these techniques, and several have refuted their utility. A beneficial placebo effect may be responsible for the perceived clinical effectiveness in many cases of food intolerance.

Given the prior probability of zero that AK would be useful diagnostically or that therapies based on AK would have efficacy, I would be surprised if there were good clinical trials that demonstrated efficacy.  It is all placebo effect, and those who read the blog know my equation: CAM = placebo. Placebo = nothing.  Therefore CAM = nothing.  In the case of AK, it is less a placebo effect and more of a minor variant of the Stockholm syndrome.   It would be an interesting topic to explore: compare and contrast the placebo effect, response to CAM treatments and the Stockholm syndrome.   They probably have the same underlying psychological etiology.

I have never been fond of the meta-analysis, since they operate in part on the GIGO principle,  Garbage In, Garbage Out.  Given the issues with reading the medical literature second hand, I always prefer to read and evaluate the primary literature myself.

First up was going though the references of  Cuthbert and Goodheart.  It was the Oakland of medical literature: No there there.  There are few  controlled studies looking at the diagnostic and therapeutic utility on defined populations.   There are almost no even mediocre evaluations to asses any aspect of AK, and those that have been published suggest that AK is a little bit less than worthless. I will give the caveat that much of the literature quoted by Cuthbert and Goodheart  is not accessible, published  in journals too obscure to be available on Pubmed or my medical library. Little was added after searching the PubMeds, finding mostly case reports and pilot studies.

One reasonable study Double-blind study on materials testing with applied kinesiology, found AK was no more reliable than chance for  for determining intolerance to dental material.   They evaluated “ two dentists qualified in AK”; there are two dentists I would not want mucking about in my mouth.

No surprise that if the AK practitioner and patient are blinded,

“… results suggest that the use of Health Kinesiology as a diagnostic tool is not more useful than random guessing”

and

“applied kinesiology to evaluate nutrient status is no more useful than random guessing.”

I can see why the first hit on my Pubmed search was an AK practitioner complaining about EBM. Reality doesn’t support their practice.

At least I came across Kinetics of hula hooping: an inverse dynamics analysis,  so the time spent was not a complete waste, in the case of hula hooping, waist.  At least hula hooping is a form applied kinesiology that exists in reality.

Postscript

If you want to hear more of me rant, and really, who doesn’t, try skeptikerpodden  where I was recently interviewed.  The English, or at least the American,  begins 33 minutes into the program. And they used my fat picture on the web site, before I lost all my meridians.

The title is an oblique reference to the AK-47.  I recently read The Gun by CJ Chivers, the history the the AK-47.  Excellent.

Posted in: Chiropractic, Diagnostic tests & procedures, Energy Medicine, Science and Medicine

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