Diagnosis by Applied Kinesiology
Those of us promoting the application of scientific skepticism to medical claims deal with a very broad range of claims, from just at the edge of acceptable science to abject magical thinking. It is useful, and unfortunately necessary, to deal with the full range of pseudoscience, but I admit a particular fascination with the pure magic end of the spectrum. What thought process is going on in people who casually accept the impossible as true?
Take, for example, a recent news report of a Canadian man who apparently has suffered from pain for years. The reporting in the article, not surprisingly, is horrific. There isn’t a hint of journalistic skepticism, no consultation with a medical expert, and not even a token attempt at balance. I have learned that this means the journalist, Doug Hempstead, likely approached the article as a “human interest” story, which means there is no apparent need for any journalistic integrity, accuracy, balance, or important background or story details. All that matters is that there is a human interest and some sensational element.
The core of the story is that Eric Bertrand, who has suffered muscle pain for years despite treatment from real doctors, was finally pressured by his family to consult an alternative practitioner. The article mentions naturopathy – naturopathy, essentially, is medicine without science (or even basic reason and common sense, in my opinion). Naturopaths use a hodge podge of prescientific, fanciful, unproven or even disproved modalities. There is no real theme or consistency to what they use – anything goes.
However, Bertrand consulted Ottawa practitioner, Tony Brunelle, who is a chiropractor. (Brunelle now proudly displays his mention in the Ottawa Sun – nice free advertising). Brunelle used a technique known as applied kinesiology to diagnose Bertrand’s problem.
The background story we are given about Bertrand is that he has had leg pain for years. His doctors diagnosed him with compartment syndrome, a syndrome in which there is pressure build up within a compartment of a limb, and enclosed space lined with dense fascia or connective tissue. The fascia has a limited capacity to expand, so when the pressure builds up it can squeeze the structures within causing pain. If it becomes serious enough it can even block off the blood supply and cause serious damage. Bertrand, we are told, has had surgical procedures to release the pressure, which did help his symptoms, but he continued to have chronic pain. There are many details about this story we are not told and therefore it is not possible to formulate any medical opinion based on this story alone about Bertrand’s condition.
Apparently none of this history mattered to Brunelle, who used the following technique to diagnose Bertrand:
Bertrand was told to keep an outstretched arm held strong while answering questions about various organs in his body. He was to reply that the organ in question was healthy and if Brunelle couldn’t easily budge the arm, that would prove it. When the doctor asked about Bertrand’s liver, the arm slid down with ease.
He repeated the process, listing different liver ailments until the arm once again slid down.
Diagnosis: liver parasite.
This is reported in the Sun without the slightest hint of irony or skepticism, as if it makes perfect sense. This is a good description of applied kinesiology, which was developed by a chiropractor. The idea is that the body is all connected in some vague way by magical life energy (the kind of vitalistic force that traditional chiropractors believe in), so that when there is a problem with one part of the body (like the liver) then the muscle that corresponds to that organ through this mysterious energy connection will be weak. Not only that, just thinking about your unhealthy organ will make your muscles generally weak (the whole “mind-body” thing), or (as in this case) falsely stating that the organ in question is healthy will significantly weaken your muscles. I bet you didn’t realize that humans were such frail creatures. Just telling a lie can make us collapse like weak kittens.
This video is a good demonstration of applied kinesiology. One simple hypothesis to explain the apparent weakness resulting from negative thoughts or untrue statements is that it is simple suggestion. It does not require either person to be consciously faking. One thing to note is the give and go nature of the “weakness” on display in the video. The person’s arm goes down in ratchety, non-smooth fashion. We call this “give way” weakness, because initially there is greater strength which then gives way. This is a reliable sign of decreased effort, as opposed to genuine weakness. The decreased effort does not need to be conscious, however. It simply means that the muscles are not truly weak, but the decreased resistance is due to reduced activation coming from the brain. This is all consistent with suggestion, rather than a true physiological effect.
There is also the possibility of more or less effort on the part of the person doing the testing. So both people may be adding to the subjective nature of this test. How can we tell for sure? Well, if both the tester and subject were blinded as to what was being tested then we can eliminate the variability of effort. When proper blinding is put into place the effect completely disappears (here is a good summary). Phenomena that disappear under proper blinding conditions are not real – they are artifacts of suggestion or imagination.
So Brunelle used a diagnostic test that is fraudulent. It is not based upon any valid scientific principle. The basic elements of the technique have never been established, and in fact are unscientific (the existence of vital force or its alleged influence on muscle strength), and the technique has been shown to be ineffective when tested scientifically. It’s also plainly absurd. But even absurd-sounding claims may be accepted as true if they are backed with sufficient rigorous evidence. In this case the absurd claim was exposed as false when studied scientifically.
Brunelle concluded based upon applied kinesiology that Bertrand has a liver parasite. There is no mention of any follow up testing to confirm this diagnosis. Brunelle then gave Bertrand pink root, and herbal remedy (a fake remedy for the fake illness). According to the article, Bertrand then felt better. I have no idea how accurate this report is, but even if we accept the report what can we make of that? Since Bertrand was treated for his apparent underlying condition, he may have been on the mend in any case. Chronic pain is also tricky, and often has a huge psychological component. Chronic pain medications also have an effect, and we have no idea from the article what other variables were changed recently.
But all of those variables aside, we often see similarly profound subjective effects from pure faith healing. People with chronic conditions walk out of the faith-healer’s tent feeling much better. I have personally seen this myself. There are physiological and psychological mechanisms for this – the release of endorphins, for example. Essentially this is just a placebo effect, and tends to be short lived. In cases that I have seen the recipients of the faith healing were impressed by their reduction in symptoms (even though objectively they were no different), but paid for their short term pain reduction with later worsening.
The power of self deception is well documented, and pain is particularly subject to psychological factors. Even an improvement in mood from the offer of a treatment is enough to reduce the experience of pain.
Stories like this often prompt the question – what’s the harm? Even if this is all self-deception and faith healing, if Bertrand feels better, so what? Well, we don’t know that Bertrand is actually better, if his symptoms were improving anyway, and what his long term outcome will be. What we do know is that this story is being used to promote medical nonsense. Applied kinesiology is being used to diagnose actual medical disorders, not just for a feel-good benign treatment. Belief in nonsense and pseudoscience is very pernicious, especially in the medical field.
This irresponsible article will now drive more people to consult pseudoscientists for their medical conditions, and to believe in magic.
I was going to email this to Brian Dunning or SGU but as your writing on the subject of Kinesiology:
What do you know of Kinesio tape? I’ve seen a few footballers (soccer) at the European Cup wearing it on their lower backs and necks. Normally two vertical strips on the back of the neck, maybe an inch thick. The explanation I got from a physio friend didn’t sound very plausible, something about keeping the layers of skin separate. I did a brief search on PubMed but there wasn’t a lot on there. Any ideas?
The power of belief is real. A long time ago, I was into reading a lot of motivational books. One that was lent to me was called, “The Magic of Believing”, by Claude Bristol, written back in 1948. I just now found it as a free download at:
http://www.successmanual.com/wp-content/uploads/2010/11/The-Magic-of-Believing-by-Claude-Bristol-1948-Success-Manual-Strategist-Edition-2010.pdf
(It will be interesting reading it again after more than 40 years.) Anyway, the reason some can casually accept total nonsense as true, is simply because they believe it’s true. On a lighter note, there are many who believe acts like this fellows are true:
http://www.youtube.com/watch?v=u9SS95q2kpg
William Jame, on belief (paraphrased, Ithink): IItdoesn’twork because it’s true; it’s true because is works.
William James, on belief (paraphrased,I think): It doesn’t work because it’s true; it’s true because it works.
Very interesting, with a huge number of possible threads for commentary. I was annoyed by the original article–as Dr. Novella points out, it was a “feel good” piece with little chance for real investigation. The whole method of diagnosis is laughable. But is the any likelihood that there really was a liver parasite? Probably not. One dose of pink root (if it really was pink root–this is getting harder to obtain, due to over-harvesting) is probably not going to kill an entrenched liver parasite (although it may be effective against some intestinal worms), and the effect would not be felt in a few minutes. (A bigger question–Would such a parasite produce the symptom of leg pain? It’s a bit of a stretch, but some abnormality of blood flow could, I suppose, produce lower extremity edema and, perhaps, pain.) The story is absolutely laden with placebo effect and related phenomena.
I wonder if anyone is having a similar experience observing the world of Chiropractic care and wanted some input. I have two friends who recently graduated from Chiropractic college (several years outside of bachelor). One is very “whoo”, new-agey and personifies the nonsense of non-scientific medicine. The other, however, has always been pragmatic and scientifically oriented. He seems to be working to disassociate his practice from that norm. With these two different approaches I’ve been exposed to what looks like a small but notable fracture in the Chiropractic world, as a minority feels that there is legitimate research to be done and are striving to bring in the scientific method to the (non-whoo) claims. I wondered if anyone else has run across this, or is it wishful thinking of my well-meaning compatriot.
The thing is that is is highly unlikely that the scientific method will bring any result the “good” chiros want–and this is already the case; they just want to keep looking for something to try to prove their preconceived notions–like the alt med NCAAM office of the FDA keeps on looking to prove acupuncture no matter how many negative studies show that it doesn’t.
Applied Kinesiology: The application of old con tricks to part people from their money.
Name and shame to hold them accountable.
And now for a real case of misdiagnosing tapeworm.
“The Headache That Wouldn’t Go Away”
http://www.nytimes.com/2010/11/07/magazine/07FOB-Diagnosist-t.html
“The doctor focused her exam to look for any hint that this headache might be because of some kind of brain injury. She looked into the patient’s eyes with the ophthalmoscope, scanning the retina for any signs of increased pressure inside the brain. She checked the patient’s strength, coordination and reflexes. Nothing. Her exam was completely normal.
[Six months later, she has a seizure, and a CT scan shows tapeworm larvae in her brain.]
When her primary-care doctor heard that her patient had been diagnosed with neurocysticercosis, she scoured the patient’s hospital chart and then her own notes. How had she missed that? What should she have done differently?…
The young doctor called the patient to see how she was doing and to schedule a follow-up visit. She was disappointed, though not completely surprised, when the patient chose to see a different doctor at the clinic…
When patients don’t come back, the temptation is to assume they’ve gotten better. That is often not the case. Sometimes they’ve just given up.”
By the way, this story comes from Diagnosis columns that apparently inspired the TV series House.
Correction, not six months later but at least a year and six months later.
“Even an improvement in mood from the offer of a treatment is enough to reduce the experience of pain.”
Then why doesn’t the the conventional treatment work as well as the snake oil in stories like this?
Since he has been suffering for years, perhaps he had some brief respite from his conventional visit. It’s likely this sham visit will also have the same limited shelf life on his placebo and endorphin kick.
I believe this is why chiropratics flourish and are often not necessary – not unlike dermatologists, most of your patients never die, nor get truly cured.
Different people are different, and “the placebo effect” is a complex constellation of effects. Every person does not benefit from every facet of “the placebo effect” every time.
Many people will get placebo effects from conventional treatments, but “Conventional Treatment Temporarily Alleviated My Pain!” isn’t a very interesting headline. This individual apparently did not, but may have gotten placebo effects from the “applied kinesiology”.
Brunelle’s personality, methods, or approach, or some other subtle factor(s), may simply have meshed better with Bertrand’s individual psychology, giving him greater psychological benefits from the offer of treatment. If his doctors expressed only tentative confidence that the treatment they were offering might work, while Brunelle offered total confidence, for instance, the confident offer of help might have been more effective in producing a placebo effect.
Or regression to the mean just happened to coincide with Bertrand’s session with Brunelle but not with his sessions with conventional doctors. Any number of other factors might have produced a greater placebo effect during Bertrand’s visit with Brunelle than his visits with conventional doctors.
In this story, the patient suffered for seven years, was completely cured five days after his magic diagnosis, and now runs 10 kilometers easily. It’s too much of a coincidence to be regression to the mean. It could be a temporary placebo effect, perhaps similar to the surgeries that temporarily relieved his pain.
Or perhaps it’s similar to the story of Jerome Groopman, the author of How Doctors Think and The Anatomy of Hope
http://www.skeptic.com/eskeptic/07-10-24/
“He had been avoiding any pain-inducing activities on the assumption that it was telling him his body would be harmed by those activities. He re-conceptualized the pain as meaning that he was so de-conditioned that his body had been trained to irrationally protest at normal, safe activities. With an intensive training program, he was able to build up his muscle strength and mobility again and he now leads a normal life and is pain-free.”
i.e. He walked it off.
As someone with a good deal of knowledge of the Canadian military, this is unbearable. First off, no one here thinks much of the Sun, so that’s strke three right there.
Second, this artilce is so full of holes it’s hard to believe. This guy guy doesn’t work at home – he works in Gatineau, QC. The military doesn’t allow you to work at home. He also wouldn’t be hanging around for seven years if it was that bad – he’d be on what is known as a permanent medical category, and would be on his way out of the Navy.
The reporter also fails to realise that if this officer went for an unauthorised medical treatment, he would be up the creek without a paddle – it’s not allowed. The military requires that you come to them before seeking any medical treatment, except when there is an emerency. And after that, you have to come to them. Even when you are referred to an outside specialist, you need to follow-up with your military medical personel. So, how does this guy go around taking medicine that the military certainly wouldn’t allow.
Finally, how the heck does someone go from cruches to runnin 10km with ease? This guy couldn’t run for years, yet know he’s some sort of endurance athlete?
I don’t know much about the scientific credentials of our skeptic. I’m sure he is sincere in his doubts. Accordingly, I would refer him to a new book by Dr Candy Gunther Brown, *Testing Prayer: Science and Medicine* (Harvard University Press, 2012). Dr Brown holds a PhD from Harvard. She has documented, with proper testing equipment, the reality of healing from prayer. Another important contribution is Craig Keener (PhD, Duke), *Miracles: The Credibility of New Testament Accounts* 2 Vols. (Baker Academic, 2011). Both these works are sober studies on the phenomena of prayer and healing, works which cannot be ignored by an honest skeptic if he claims to have “examined the evidence.”
Dr Novella’s scientific credentials should be easy enough to verify if you want to “examine the evidence”.
That aside,what does your comment have to do with applied kinesiology,you know,the subject of this article?
I do not know anything about Kinesiology. But naturopathy is different. Its not this what you have mentioned.
WE do not get a disease because of we could not take a physiotherapy session, or an acupuncture session or anything of that sort. All problems come because of wrong way of life and 95 % of that is due to wrong food habits. Correcting that is naturopathy. Now people have started using it for steam bath, sauna, massage, hydrotherapy, chiropractic etc.
If a therapy does not alter your food, then its not complete.
If a therapy heals you only with food modifications, its complete. Naturopathy is that.
I am a Kinesiologist/Sports therapist/Structural alignment therapist.
I spent more than 5 years of my life studying for my profession, only to see clowns like you cast doubts on it! You are probably a believer in the ‘pill for every ill’ type of pseudo science(???).
In Australia 18000 people a year are killed by medical mistakes (10% of all admissions) 1800 through traffic accidents, and 3 through chiropractic, 1 person died while having a massage, and none through Kinesiology. Medical errors in the health care system are estimated at between 3.2 and 5.4 per cent in the US, 9 per cent in Denmark, 10 to 11,7 per cent in the UK but a shocking 10.6 to 16.6 in Australia (Bedkober, B., IPA Review, March 2007).
Dr. David Eddy. found, after doing significant research, that only about 13% of medical interventions are supported by solid scientific evidence and that only 1% of the articles in medical journals are scientifically sound.
Why is that? Because most of those articles quote from other articles which make unsupported and unfounded claims.
Dr. Lucian Leape, researcher at the Harvard Medical School of Public Health, also states that only 13% of medical procedures have ever been tested for appropriateness by randomized trials.
He noted that adverse events occurred in 3.7 percent of all hospitalizations. Worse yet, 13.6 percent of those adverse events led to death!
He is quoted as saying, “Medicine is now a high risk industry, like aviation.
But, the chance of dying in an aviation accident is one in 2 million, while the risk of dying from a medical accident is one in 200!”
The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year!
That is a mind-boggling 2147 people killed daily!
That’s 7 jumbo jet plane crashes, each and every day.
That’s a 9-11 incident occurring every other day…FOREVER. God help us all.
From “Death by Medicine”, written by Gary Null, Ph.D.; Carolyn Dean MD, ND; Martin Feldman, MD; Debora Rasio, MD; and Dorothy Smith, PhD.
There’s some well written posts but it really is only the tip of the iceberg. My wife took our son to a kinesiologist to see if his fear of things that fly could be treated, the ologist decided that the problem lay with my wife and promptly suggested treating her instead of my dyspraxic son (you can’t muscle test dyspraxic people can you? Their muscles are always floppy). 6 weeks of having her arm pushed and her regressed into her childhood which really was not a good place to be, all the wounds were opened. The creative kinesiologist recognised my wifes depression and asked her to sign an agreement vindicating her from everything and walked away when she was refused. That night my wife took an overdose. Fortunately she didn’t succeed that time but untrained people delving into the recesses of peoples minds based on some coincidental arm pushing is surely a criminal offence in most parts of the world.
So, to those blindly defending this Carlos Casteneda/Quantum theoretical type of magical therapy, please bear in mind that what you don’t get told is that the people who stop using the practitioners aren’t always better.