MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

When we consult a health care provider because we feel unwell, the first step invariably is to arrive at a diagnosis. Sometimes this is fairly obvious but often it is not. Typically the health care provider will do a few tests to aid the process. This may involve doing some physical examinations, or taking a blood sample, or ordering some high tech investigation, like a scan, for instance.

All these tests have to fulfil certain criteria to be valid. The most basic of these is that repeated tests should produce roughly the same result. If not, the test is not reproducible, i.e. it is not better than pure guess-work.

Alternative practitioners often use diagnostic tests that are unknown in conventional medicine. But this fact does not mean that these test do not need to be as valid as any other test used in medicine. If the alternative tests are not reproducible, the diagnosis of the alternative practitioner is likely to be pure invention. And if the diagnosis is just a figment of imagination, the treatment aimed at curing it will be nonsense as well.

So, how reliable are those tests used by alternative practitioners? Amazingly, this fundamental question has attracted very little research. I have repeatedly investigated this area and found that, generally speaking, alternative diagnostic techniques are bogus. And because there is so little research, every new trial of alternative diagnostic methods is important.

A brand-new study assessed the inter-rater reliability of Ayurvedic pulse (nadi), tongue (jivha), and body constitution (prakriti) assessments. Fifteen registered Ayurvedic practitioners with 3-15 years of experience independently examined 20 healthy subjects. Subjects completed self-assessment questionnaires and software analyses for prakriti assessment. Weighted kappa statistics for all 105 pairs of practitioners were computed for the pulse, tongue, and prakriti data sets.

These pairwise kappas ranged from poor to slight, slight to fair, and fair to moderate for pulse, tongue, and prakriti assessments respectively. The average pairwise kappas for pulse, tongue, and prakriti were 0.07, 0.17, and 0.28, respectively. For each data set and pair of practitioners, the null hypothesis of random rating was rejected for just 12 pairs of practitioners for prakriti, one pair of practitioner for pulse examination, and no pairs of practitioner for tongue assessment.

The authors of this investigation conclude that  the results demonstrate a low level of reliability for all types of assessment made by doctors.

This is worrying, I think. It is comparable to a situation where you go to see your GP and he measures your blood pressure, or weight, or cholesterol, or any other parameter with a test that produces a different result each time someone tries to repeat it. Your blood pressure could be 160/90 when measured with this fictionally unreliable test and 110/ 60 when repeated two minutes later by the practice nurse, for instance. Any treatment based on such random numbers would be idiotic…and so, it seems, is any Ayurvedic treatment based on the pulse (nadi), tongue (jivha), and body constitution (prakriti).

11 Responses to Unreliable diagnostic techniques must lead to idiotic treatments

  • I did Ayervedic “testing” once–with the same seriousness that I occasionally read my horoscope or played with a ouiji board when I was 12.

    • I just did a spontaneous blood test while chiselling a dovetail joint. My blood’s red…apparently everything is ok. Way cheaper than having a lab do it – and that’s even considering the cost of the chisel. (It’s a spendy chisel.)

  • Some Traditional Chinese Medicine pulse ‘experts’ say they can even tell if someone was born with the umbilical cord around their neck from their adult pulse. Oh, I see I already commented about that here. Well, I didn’t paste the direct quote that time. Here it is, from Leon Hammer, who runs a TCM school and has published several ‘respected’ texts:

    “A Flat pulse in the Distal position may result from a birth delivery complicated by the
    presence of the umbilical cord around the neck after the head is out side of the mothers body. With this scenario the left proximal Kidney position would probably be Feeble-Absent. A search for history of birth trauma is frequently fruitful.
    It could also mean that the person had a trauma to the chest when they were in relatively poor physical condition. Pain and/or a horizontal red line under the eyelid and/or purple sore on the edge of the tongue would, for example, be a sign of physical trauma.”

    http://www.dragonrises.edu/wp-content/themes/dragon/downloads/articles/hammer-evolvingmethod.pdf

    Um, yeah… Try proving it in a double blind study rather than implanting it as a false memory, then we’ll talk…

  • Presumably both those pushing such nonsense and those seeking such cures are unable to tell yourarse from uranus.

  • I agree there is a lot of quackery out there n Ayurveda, particularly in America. However, there is a LOT to it which doesn’t include pulse – particularly if you find some lineage trained practitioners or someone who graduated with a PhD in the subject in India an doesn’t even use pulse or some of these questionable diagnostic methods. To just blow it off is kind of ridiculous. I know I’ve benefited form many of its simpler protocols.

  • Edzard,
    Empirical method of research is unreliable. In fact, flawed.
    http://perbylund.com/2008/08/why-empirical-research-isnt-scientific/

    not only as per this article but there are many other out there explaining from other vantages that are just as valid.

    Why bash something one has no understanding of? Fear? Alternative methods? When the modern medicine is actually not natural or the original which would in fact make it alternative to working with nature and natural sciences instead of trying to control it, with serious side effects i might add.

    Why all the hate of something one does not understand?

    I invite you to learn something different that does not work by the paradigm that you understand and does not get to be evaluated by your research methods either. If you were to put Western medicine up to the eyes of Ayurveda it falls apart in the first step. Really.

    I agree with you in how much crap and crap sellers there are out there. There is lack of integrity in everything everywhere. have to close the eyes to find a place without it. But it does not at all mean that Ayurveda is bogus. It means that much of the practitioners and doctors are. This is all stuff i would not expect you to know or see as much as i don’t know half of the horrendous world that exist in western medicine with doctors giving unneeded exams to make extra money or the deals between pharma reps and doctors pushing the drugs or the unneeded surgeries even.

    If you wish to learn, you need to step out of your shoes and walk with those of another. As an American that has been in the health world for over 25 years and living abroad studying that science of which you wish to squash for no other reason but to ignorance i might add, I am witnessing almost everyday that which is impossible by Western methods and understanding and as you squash this science, which is not who you should be after since it is actually stood the test of time and western medicine has not, the real bad guys are the quacks that damage the sciences, both of them. Also, the amount of bad that you are doing is horrendous. I know for a fact that if Ayurveda was brought to America in some form of real education instead of the BS it is, it would change the face of medicine and healing.

    So I invite you to ponder this stuff. i have access to the real thing if you have access in yourself to be open to actually learning instead of destruction and opinionated posts on things you have not studied so regardless of reading a research paper, you cannot have any valid words to say on the topics.

    • @Brad,
      “If you were to put Western medicine up to the eyes of Ayurveda it falls apart in the first step. Really.”

      Yep, that is correct for reasons other than you think. One is based on the “e” word (EVIDENCE) while the other is based on non-scientific, ancient nonsense. I don’t need my chakras attended to by any witchdoctor.

      “As an American that has been in the health world for over 25 years and living abroad studying that science of which you wish to squash for no other reason but to ignorance i might add, I am witnessing almost everyday that which is impossible by Western methods and understanding and as you squash this science, which is not who you should be after since it is actually stood the test of time and western medicine has not, the real bad guys are the quacks that damage the sciences, both of them.”

      Apart from the abysmal prose most 12 year olds would blanch at (the writing is shockingly bad), how did you get “abroad”? Did you fly there, courtesy of modern science, or did you use a magic carpet, in keeping with the rest of your anti-science ranting?

  • Edzard, I would be curious to know what you think of the following article published in the journal, Scientific Reports:

    http://www.nature.com/articles/srep15786

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