Applied quack studies
"The patient is reasonable"
Do you know how to distinguish a real doctor from a charlatan who promises to diagnose you and prescribe treatment using a "unique" method? And asks for substantial money for his services?
Alexey Vodovozov's book "Patient Reasonable", which was included in the long list of the 2017 Enlightener Prize of popular science literature, will tell you what modern diagnostics is and how to distinguish a professional from a fraudster.
Applied quack studies
There are many pseudodiagnostic techniques, and their number is constantly growing: then a genetic test of abilities based on fingerprints will appear, then a diagnostic system based on selfies. Let's analyze the classic, most well-known methods of quack diagnostics, which have become the basis for a multibillion-dollar business around the world.
Probes and electrodes: the Voll method
Many myths have developed around the personal life and professional activities of the German physician Reinhold Voll (1909-1989). He is credited with membership in the notorious Nazi organization Ahnenerbe, and the SS rank, and experiments on concentration camp prisoners, and access to the secret archives of Tibetan monks, and much more that does not correspond to reality. The only thing that all sources agree on is Dr. Voll's great interest in oriental medicine, which he became interested in at the end of the 1930s.
Having tried to cross two directions – traditional Chinese and technological Western, in the late 1950s Foll announced the creation of electroacupuncture diagnostics. The idea was quite simple and theoretically quite feasible. In Chinese traditional medicine, there is a teaching about Qi, which circulates in the body, warms the so-called dense (for example, liver) and hollow (for example, stomach) organs, and also moisturizes the skin through the pores. By influencing certain points of the meridians of the human body, it is possible to change the parameters of Qi and thus cause certain physiological effects.
Foll reasonably suggested that Qi is a kind of energy that is easy to detect with the help of electrophysiological recording devices. After all, there is, say, electrocardiography, which allows you to isolate and record the electrical activity of the heart. Since Qi "comes out" on the surface of the skin, that's where it should be looked for. For example, using a galvanic effect and fixing the occurrence of current between two electrodes.
During the experiments, the German doctor found areas of the skin (biologically active points – BAT) where the device did not give the same readings as in other areas. They could be connected to each other and get a kind of meridians, however, not exactly coinciding with the Chinese ones. Nevertheless, Voll considered that he had only clarified and updated the data accumulated by Eastern medicine, and decided that changes in skin resistance in the 850 points found could have diagnostic significance.
The inventor of a new diagnostic method has compiled extensive tables where he painted which pathology and in which organs correspond to deviations in one or another BAT. He also developed his own scale of values from 0 to 100, within which the arrow of the electric measuring device deviated. The range of 45-55 corresponded to the norm, more precisely, to the "balanced state". Numbers greater than 55 indicated inflammation, and the closer to 100, the more intense this process is. The shift of the arrow to the left, that is, from 45 to zero, indicated stagnation or degenerative processes in the organ.
The standard procedure for electroacupuncture diagnostics was as follows: the patient took a passive electrode in his hand, and the doctor consistently pressed the active electrode (probe) on all the BAHT. The obtained data were entered into a table and then interpreted. But that's not all. If the patient took a medicinal product in his hand – any, including homeopathic, or even a noble stone, cosmetic, etc. – the arrow was also rejected.
Voll concluded that the withdrawal from the area of unbalanced values to the balance zone is observed if the drug is suitable for this particular patient and is able to heal the ailment. Finally, according to Voll, a weak electric current that can be supplied to the BAT from the same diagnostic device, and in itself has a therapeutic effect. The convenience is incredible: both all diagnostics and super–effective, individually selected treatment take place on the spot - you no longer need to run to different specialists and be exposed to unnecessary effects of medicinal "chemistry".
The first transistor device, which Voll assembled with the help of engineer Fritz Werner, was named Dermatron, after which Foll diagnostics began a triumphant march around the planet. Gradually, the cumbersome and lengthy methodology was subjected to modifications and upgrades. So, one of Voll's students, Helmut Schimmel, reduced the number of tested bats from 850 to 60, some modern follists have enough and 40 readings taken with a probe from the right and left periarticular rollers on the fingers and toes, and express screening is satisfied with 20 points on the hands. In addition, with the development of computer technology, there was no need to fill in tables manually, the analog arrow became a thing of the past. Now the readings are recorded in a special program, which also makes a final verdict in the form of a list of diagnoses and helps to select treatment, including creating "informational copies of medicines" on any media.
A series of errors
If everything had been as Foll thought, he would definitely have gone down in the history of medicine along with the inventor of the first optical microscope or electrocardiograph. And he would certainly have received the Nobel Prize in at least two nominations – "physiology and medicine" and "physics". However, follistics is a classic pseudomedicine, and there are a number of weighty reasons for such a statement.
Firstly, the concept of Qi is not limited only to energy, especially electrical, even if we take into account its interpretation in traditional sources. By and large, Qi, as Chinese doctors understood it, is any substance involved in the vital activity of the body or supporting the functional activity of organs and tissues. In this sense, the air we breathe is also Qi.
Secondly, it has never been possible to measure what is called "Qi energy", although attempts have been made repeatedly, there are even systematic reviews of such studies. One might assume that only the Voll device is capable of this due to some secret chip, but in essence it is an ordinary galvanometer, an analogue of the tester that many home and professional craftsmen have. Schemes for assembling your own follower device can be easily found on the Internet, there is nothing secret in them.
Thirdly, even if we assume that the diagnosis of Foll involves some unknown phenomenon, the effectiveness of the technique can still be assessed, thanks to the scientific tools of evidence-based medicine. Remember dogs sniffing out infection and pigeons diagnosing cancer? Exactly the same experiments can be carried out with the use of follistics. For example, we take people with proven allergies to cat hair or house dust mites. There are no problems with confirming their disease: a provocative test with an allergen immediately demonstrates the attack in all its glory. Also, the diagnosis can be verified in at least two ways: a skin test and a study of specific antibodies (IgE) in blood plasma. Next, we recruit the same number of healthy volunteers, we confirm their lack of allergies in the same ways. And then, in a random order, we send both those and others to the diagnosis of Foll.
In 2001, scientists from Southampton did so. Moreover, not only university researchers were involved in the experiment, but also specialists from the city Center of Complementary Medicine, so that specially trained and experienced people were engaged in the search for a diagnosis. Three follists with the Vegatest device blindly tested 15 allergy sufferers and 15 people from the control group – each in three rounds. Moreover, the alternatives significantly simplified the task by naming six potential allergens – it only remained to establish them for each specific case. In total, each participant of the study went through 54 diagnostic sessions. And what was overdiagnosed with the help of the Voll apparatus did not coincide at all with what was cross-confirmed by other methods.
Fourth, errors are inherent in the technology of collecting primary information itself. Skin is a poor conductor of electricity, it initially has a fairly high resistance. However, in some situations, it is significantly reduced, for example, with the release of sweat, with increased breathing (sometimes – right during the Fall diagnostics); this phenomenon is called the "galvanic skin effect", and it was described a couple of hundred years ago. This can be checked by any home tester. In addition, it was found experimentally that the position of the arrow is significantly affected by the force of pressing the probe (active electrode) into the skin. The explanation is simple: when the probe dives deeper, a large surface area of the body begins to come into contact with it, the contact improves, the signal received is amplified. And the idea of checking medicines for compatibility, holding them in your hand, is completely ridiculous: the tested drugs are often in plastic or glass vials, jars or ampoules, but the listed materials are dielectrics, that is, they do not conduct current, which is confirmed in experiments.
Mines in the legal field
There was so much evidence-based compromising material that supervisory and regulatory authorities had to pay attention to it. Back in the early 1970s, the American Food and Drug Administration (FDA), whose approval is also required for medical equipment to enter the market, stopped issuing permits to local diagnostic Foll devices and completely closed access to similar equipment produced in other countries in the United States. Then the manufacturers went to the trick and began to call the devices percutaneous neurostimulators or complexes for the study of biofeedback. As a result, the FDA has to constantly "beat the tails" by issuing prescriptions banning individual devices to specific manufacturers. For example, in 2015, ZYTO Technologies with devices of the ZYTO series, as well as ONDAMED, Inc with devices of the same name, were distributed. At the same time, the department focused on the potential danger that the Fall technique brings to patients, misleading them and making non-existent diagnoses. The FDA's claims also related to advertising brochures, which spoke about the high efficiency of diagnostics, its scientific validity, etc.
Many practicing follists were even prosecuted for fraud, working without a license, causing death to a patient by negligence and other offenses directly related to their professional activities. Similar actions have been repeatedly taken by regulatory authorities in the UK, Australia and Canada.
Pushed out of the West, Foll diagnostics found refuge and beneficial soil for prosperity on the territory of the former USSR. It was gladly adopted by various multilevel marketing systems (MLM) that distribute dietary supplements and other miracle drugs. On the one hand, this technique is not mentioned in the Decree of the Government of the Russian Federation dated April 16, 2012 No. 291 (ed. dated April 15, 2013) "On licensing of medical activities (with the exception of these activities carried out by medical organizations and other organizations that are part of the private healthcare system on the territory of the Skolkovo Innovation Center)". On the other hand, in the leading medical universities of the country, doctors can take thematic refresher courses, and more than a dozen dissertations have been defended on the basis of data obtained with the help of Foll diagnostics.
Follists often refer to two official documents: methodological recommendations "The possibilities of computerized electropuncture diagnostics according to the method of R. Voll in therapy with reflexotherapy and homeopathy", approved by Order of the Ministry of Health of the Russian Federation No. 98/232 of March 11, 1999, and methodological recommendations of the Ministry of Health No. 0074 "Bioresonance therapy". But here's what's interesting: these documents cannot be found either in the legal bases ("Consultant Plus" or "Guarantor") or on the official website of the Ministry of Health. So the question of the legality of the diagnosis of Foll in Russia remains open. That, however, did not prevent the "run-in" of frankly quack devices, recognized by world science as untenable, in pilot projects of drug testing of students. A very revealing story happened in 2009 at the St. Petersburg State Maritime Technical University, where a mass survey of students was conducted. As the journalists of the Rosbalt news agency found out, the diagnosticians used a classic Follev device.
Money for this event was allocated from the university budget – 600 thousand rubles for the device itself and 1 million rubles each year for examination. At the same time, the diagnosis was carried out and conclusions about drug addiction were made not by narcologists, as required by law, but by employees of a private security company.
The quintessence of the whole action was a phrase said by a security guard-diagnostician to a student. The device found traces of drugs on her, and the girl claimed that she had never dealt with them in her life. "You may not have used drugs yourself, but you were close to potential drug addicts. The bioenergoinformational essence of their drugs was transmitted to you, and our device recorded it," the operator explained.
What endless horizons are opening up! For example, for lovers of hiking to the left. After the spouse accuses his partner of cheating on the grounds that he or she infected(a) gonorrhea (trichomoniasis, chlamydia, etc.), you can stand in the third position and say with a sense of righteous anger: "Dear (Dear), how could you think! It's just that I was in the minibus next to a young man (girl) of potentially easy behavior. And the bioenergoinformational essence of his (her) gonococci (trichomonas, chlamydia, etc.) was transmitted to me!"
Attempts to push the Follev technique to the state level continue to this day, but for now it is actively used in many private medical centers and dubious "wellness" offices.
The autopsy showed
In November 2014, the documentary film "Charlatans" (author – Larisa Skrypnik) was shown on Channel One in the cycle "Conspiracy Theory". Many foreign and domestic scientists were invited to participate in it: Venkatraman Ramakrishnan, winner of the Nobel Prize in Chemistry in 2009; Professor Edzard Ernst, a former homeopath who switched to the "bright side"; Vasily Vlasov, president of the Society of Evidence-Based Medicine Specialists; Andrei Vorobyov, an outstanding world-renowned hematologist, academician of the Russian Academy of Sciences; collector of quack methods Sergey Soshnikov, Senior Researcher at the Central Research Institute of Organization and Informatization of Healthcare of the Russian Federation; and also your humble servant.
"Charlatans" collected excellent criticism, many were surprised that such an adequate and as scientific (as possible) work was shown on the air of Channel One. "The arguments and demonstrations given in the film are correct and indicative. After all, they can, when they want!" – such a review appeared on the official website of the Commission on Combating Pseudoscience and Falsification of Scientific Research at the Presidium of the Russian Academy of Sciences. On the pages of the book, I will remember more than once what happened during the filming and what was told on the screen, in the same chapter we will talk about the Follev device, which was purchased for the picture, tested in clinical conditions, and then disassembled for spare parts and studied by specialists in medical technology.
The purchased software and hardware complex "Voll's Cabinet" consisted of a device that had to be connected to a computer, and of specialized software that had to be installed on the same computer.
Since, according to the manufacturers and adherents of the technique, everything is based on electrophysiology, we decided to compare how an electrocardiograph, which "removes" information about heart health from the skin surface, and a "Foll Cabinet", which takes it from there, to boiled and smoked sausage, will react. The idea is simple: the object under study obviously does not have electrical activity, which means that the diagnostic equipment either should not react to it at all, or should give a diagnosis of "No signs of life" or something like that.
The first in line was an electrocardiograph. As expected, we connected four electrodes to the sausage through saline-soaked pads to remove the ECG in the standard lead. The computerized device predictably issued an isoline. With a high degree of confidence, it can be argued that a similar reaction would be observed in an electromyograph and an electroencephalograph.
But the Follower device, connected to a laptop with installed software, "did not notice the catch": the arrow, upon contact with the surface of the sausage, deviated quite in the "human" style, giving out very "live" intermediate results and confirming that we are doing everything correctly and observing the examination methodology. And the result was more than impressive: our food turned out to be seriously ill. And nervous. The program found colitis, dermatitis, bronchopneumonia, chronic tonsillitis, arthritis, neurasthenia and many other diseases in varying degrees of severity.
When disassembling the device for spare parts, several interesting points turned out. So, on the front panel there is a serious 8-pin input for the cable, and only two thin wires depart from it inside. Where are the other six transmitting signals?
The chipset is quite simple:
Traco Power TMV0515D 1340;
DAC8143 F#1313 M25799999.1;
ADG1209 YRZ #1248;
TUSB2046B VHW G4;
a USB token filled with hot glue, a key that does not allow the software to run if the device is not connected.
In fact, the whole filling is an electronic tester with significantly reduced capabilities, and the bulk of the chips are responsible for flashing various LEDs. But the most interesting thing is that the wire going to the round metal cup to create "informational copies of medicines" does not get inside the device at all – it blindly ends in a common cable, not reaching the 8-pin connector. The expert estimated the approximate cost of electronics at 2000-2500 rubles, despite the fact that the complex was sold for 29,900 rubles.
The software disk is even more interesting. It is 99 percent full of images – scanned pages of books on alternative medicine. The only "sane" file is a database that was created in the standard Access application included in some versions of Microsoft Office.
It is there that the diagnoses are contained, which, in theory, should be compared with the received indications. But, as the experience with sausage has shown, this process is most likely random.
The number of gross grammatical and terminological errors, which clearly do not increase confidence in the already compromised hardware and software complex, is also depressing. For example, there is a diagnosis of "tension of the immune system", although the system is immune, with two "m". Also, in the description of one of the diagnosed parameters, "proteolytic metabolism" is indicated, although only enzymes are proteolytic, that is, splitting proteins. And the closest exchange that is suitable in meaning is protein.
The verdict on the SRND ("divorce scale for diagnosis")
Compliance with large criteria
I: the principle of operation of the methodology is described by concepts whose existence has not been proven. +5 POINTS.
II: the spectrum of the diagnosed pathology includes all medicine, except psychiatry, while the data in the scientific medical literature indicate the inconsistency of the technique and the impossibility of its use for diagnostic purposes. +5 POINTS.
IV: on-site treatment, even with the use of the same device; it is proposed to make "informational copies of medicines" that can be recorded both on homeopathic balls and on CDs (!). +5 POINTS.
V: The phrase "Beware of fakes!" is on every second site selling Folly devices. The first thing that the adherents of Dr. Voll, dissatisfied with the "Charlatans", said was that a fake "Voll's Office" was purchased for the film, and the right one would work as it should. The proposal to name the signs of the "realness" of the device caused an inadequate reaction: our opponents slipped into insults and accused the painting of being custom–made, and all those involved in it of being bought. +5 POINTS.
Compliance with small criteria
I: there is no surgical pathology in the program database. +1 POINT.
IV: no "control" pathology is detected (for example, sausage instead of a live patient). +1 POINT.
V: the results are not confirmed by existing diagnostic methods (see the example about allergies). +1 POINT.
VI: in countries where Foll devices are banned, they are renamed into something more legal. +1 POINT.
VII: on websites selling diagnostic complexes or offering services with their use, it is mentioned that Reinhold Voll was awarded the Vatican gold medal "For Services to Suffering Humanity", the Gufeland Medal and the Order "For Services to the Federal Republic of Germany". Moreover, it is emphasized that he was awarded the awards precisely for inventing a unique diagnostic method. +1 POINT.
Total: 25 points with the required minimum of 6 points.
Examples of Foll devices
Accupath 1000; Asyra; BICOM; Biomeridian; Biotron; Computron; Dermatron; Diagnose; Elision; e-Lybra 8; Interactive Query System (IQS); Interro; Kindling; Last; LISTEN System; Matrix Physique System; MORA; Omega Acubase; Omega Vision; Orion System; Propylene; Punts III; Vegatest; Vitel 618; "BIORS"; "Deca-Foll"; "Foll Cabinet"; "Miniexpert-DT"; "Peresvet".
Read more:
Vodovozov, Alexey. The Patient Is Reasonable. Traps of "medical" diagnostics that everyone should know about. – Moscow: Eksmo, 2016. – 224 p.
Portal "Eternal youth" http://vechnayamolodost.ru
04.09.2017