Kinesiology as (not is) CAM
Some time back I discovered, amongst the piles of leaflets advertisers are permitted to display in the foyer of my favourite local cinema, material promoting the services of one or two providers of things CAM, including: holistic massage therapy, Reiki (yeah!), reflexology,
face tapping Emotional Freedom Techniques, and something (misleadingly) termed ‘kinesiology’. Only £40/hr! What’s to complain about? Well, it read like common-or-garden pseudoscientific bullshit to me. Regardless (or even more so because) of the logo displaying affiliation to some authoritative accrediting body, a common obfuscating marketing device. You know, not unlike the homeopaths’ resort to the imprimatur of the British Homeopathic Association and/or the Faculty of Homeopathy. A sheen of officialdom and professionalism making for a handy promotional vehicle. Nevertheless, despite its suspicious appeal to an authoritatively science-y name, it has tended not to register too highly on my pseudometer, and this propaganda was thrust into my pocket and later thrown on to a reference pile… and forgotten. Until a few days ago when I was stimulated into giving it some attention.
I learn that this particular leaflet does not describe kinesiology per se, but a CAM misappropriation of it, as marked by its coupling with a preceding qualifier. If you are unfamiliar with this quack bastardisation, take a quick wander over to the Association of Systematic Kinesiology (which is a bloody charity! I ask you!) and view its two minute introductory film. Yes, that telegenic young fella apparently really does want you to believe that:
“… each muscle is related to an energy pathway called a meridian, and each meridian is associated with an organ…”
“… if a food a client [sic] suspects they are intolerant to is placed within the electromagnetic field of the body, and that causes the muscle to go weak, that indicates the food is causing an energy imbalance…”
and with accompanying visual demonstration…
“… if I place sugar on [client], look what happens: she goes weak and cannot resist my pressure because sugar tends to be detrimental to health…”
Convinced? Do you not wonder why on earth our educated and highly trained medical professionals have bothered wasting all that time, effort, study and money these past couple of centuries? What mugs, when it is all so bloody easy!
Still, each to their own. If people want to spend their own money… blah, etc. Why does it bother me? Well it perhaps wouldn’t so much, were (a variant on) it not being given an academic hand in the form of a paper from a bunch operating out of the Complementary & Integrated Medicine Research Unit, which shelters (paradoxically) under the Faculty of Medicine umbrella at the University of Southampton. If you are a biomedical research scientist who, during a data dry spell, has ever pondered the societal worthiness of your particular investigative line (a state of tension, I can tell you), then console yourself in the knowledge that there are academics who are funded to investigate such clinical crud.
I don’t know the (subtle) differences (if any) which give rise to fractionation of CAM-kinesiology into (for example), Applied Kinesiology (AK), Systematic Kinesiology (SK) and Professional Kinesiology Practice (PKP) varieties. I assume those offering the latter – of more recent development (1980s) than the originating AK (1960s) – are either emphasising that they expect to get paid for it, and/or are seeking to avoid associating themselves with earlier versions disparaged as pseudoscience. These belief systems and their schisms, eh? The paper’s Introduction provides references for those who consider it worthwhile investigating any actual distinctions, of which I neither know nor care. Because they are all essentially wrapped up and passed off under the trendy guise of ‘energy medicine.’ The same first paragraph gives the game away:
‘PKP is a goal-oriented educational process that employs a non-standard muscle test to select manual techniques derived from chiropractic, practices from traditional healing methods and acupuncture theory, lifestyle and dietary advice alongside psychological approaches said to reduce emotional stress and improve coping strategies.’
This panacean language is all very interesting from a group that has previously published findings which could be interpreted as arguing the non-existence of homeopathy (not dissimilar to this other example). One of its pre-occupations is the devising and/or utilisation of alternative trial and research methodologies. Here, due to impossibility of double-blinding, because the practitioner cannot not know he/she is administering PKP, a single-blind approach was used. Subjects were allocated to one of three groups: a ‘waiting list control’ (WLC) – presumably sulking at being delayed and lacking the wit to drop a few painkillers – was left sitting around in discomfort; and two treatment groups, one ‘real’ PKP, the other sham. Note that both treatment versions were delivered by the same sole practitioner, with the sham treatment using ‘a polite conversation avoiding topics assumed in PKP to be of therapeutic value such as feelings, problem impact or goal setting.’
I think we’re supposed to be impressed by the fact that ‘All the treatments took place at the private kinesiology clinic…’. But who, when afflicted by some chronic condition (such as non-specific low back pain) for which their GP cannot provide succour, goes to a private clinic for alternative treatment? One who believes it will do them good, perhaps? Would that be one who already has an inclination towards things CAM? So, although the participants in this PKP study had not specifically encountered PKP before – and so were deemed unlikely to deduce whether they had been assigned ‘real’ or sham – they would likely have turned up expecting empathetic attention involving ‘polite conversation’ as to their feelings, problems and goals. Wouldn’t they? Otherwise, we might predict suspicion and/or dissatisfaction. Yet the authors incorporated measures to ensure that those allocated to ‘real’ or sham remained oblivious to which treatment they were receiving – ie, by the end of the trial, the sham group still believed they were receiving PKP from a PKP practitioner. That ‘blinding was secure’ therefore apparently argues for a significant specific effect for PKP.
Well does it?
Published in Forschende Komplementärmedizin (Research in Complementary Medicine; Editor-in-Chief: H. Walach) – of which the ‘Aims and Scope’ (‘… to bridge the gap between traditional [sic] and complementary/alternative medicine on a sound scientific basis, promoting their mutual integration’) are all music to Proper Prince Charlie’s King Lears – this paper is is awash with caveats:
‘It is possible that our findings are not representative of all kinesiology practitioners reflecting the skill of the practitioner rather than the intervention… and may have been due to a particularly responsive group or might be an indication that we have discovered a very powerful intervention for the treatment of chronic low back pain.’
‘It is impossible to generalise the results of this PKP study to different types of kinesiology because currently there is insufficient data to ascertain if the mechanisms and clinical effects are the same in the other branches of kinesiology and furthermore different kinesiology practices may approach the treatment of back pain differently.’
But they all use ‘muscle testing’, don’t they? Is this an effort to keep PKP clean of the pseudoscientific taint of the originating, chiropractic-based version?
‘The sham treatment whilst designed to be minimally effective may not necessarily have been so which could introduce bias minimising the real treatment effect.’
Meaning sham was more effective than intended, or less? I struggle to get my head around this statement.
Perhaps there are other possible explanations. For instance, although ‘blinding was secure’, sham group participants might just have come to feel that the practitioner wasn’t sufficiently interested in them, and so lost interest themselves. Or would that lead to participant deduction of sham allocation? I don’t know.
But was the actual physical aspect – the ‘muscle test’ – the same for both groups? The WLC got nothing (at least not for a while); but where was the group receiving only a standardised muscle test session, without the verbal cuddle? Well, that’s easily resolved, isn’t it? Round up a bunch with bad backs, do away with the polite, empathetic chit-chat, and simply spend a bit of time levering their arms. Ah, silly me… my ignorance is telling. I forget… the arm levering is not remedial, and there is no ‘standardised’ treatment; it depends on the individual, and thus can only be developed through the preceding “journey” taken with the practitioner. Because, as with simply packing them off with some homeopathy pills, if we pull from under their feet the warm rug of anticipation engendered by that lengthy personal attention, then there can be no benefit wrought by mere arm levering alone. I don’t know whether this is why the ideometer effect merits no considered comment.
The authors disclose no conflicts of interest. Though I note that the first author and PKP practitioner who delivered all the ‘treatments’ features in this promotional dreck, in which she talks up its findings of effect sizes “quite a lot bigger” than those for chiropractic and acupuncture. That’s some boast, considering the reverence afforded chiropractors and acupuncturists among the CAM-ites. Oh, and she employs the term “energy medicine” (@ 1:28) in all seriousness (as well as the “journey” quoted above). Because she believes it works. In which case, is there an effect on the effect when she knows she is administering sham? She would have to be a very good actor to prevent the picking up on the fact that her heart wasn’t in it. Were an un-blinded clinician to administer some placebo to volunteers on a drug trial, then that placebo will likely ‘work’ less effectively. Which is why such trials are double-blinded. Otherwise, the result would misleadingly enhance the effect of the real drug under test.
I find interesting the exclusion of:
‘… serious spinal pathology or systemic illness, psychosis, litigation pending or in receipt of disability allowances, previous spinal surgery or awaiting surgery, pain radiating below the knee, weighing more than 15 stone and treatments other than analgesics.’
That is, definite (back) conditions with known aetiology and either defined correction/treatment, or untreatable. No point PKP going there; instead, it is confined to:
‘… musculoskeletal pain generally described as being between the lower ribs and inferior gluteal folds and further defined as chronic if patients had had pain at least 3 months previously and pain during the last 3 weeks.’
That is, intermittent, variable and non-specific in location and intensity, with often unknown aetiology, and which comes and goes, with sufferer’s subjective measure of severity. Fertile qualitative territory for CAM.
What worth suggestion of ‘very powerful intervention’? What worth this study?