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History of “Electromedicine” and Electrodermal Testing
The first reported use of electricity in medicine was in 2750 B.C., described in Egyptian tombs, using the fish species Malopteurus electricus. Several descriptions of therapeutic benefits, including pain control from exposure to the electric eel, were described by the Greeks in the first century.Around 1600, William Gilbert, and English physician, coined the word “electric” and established the difference between the electricity and magnetism. In 1752, Johann Schaeffer published the book “Electrical Medicine.” By that time, many physicians were reportedly using electricity in their practices. In 1830, Carlo Matteucci, a professor of physics at Pisa showed that electrical current was generated by injured tissues. In 1858, Dr. Francis, a Philadelphia physician, was first to describe the relief of dental pain by electricity. After 164 successful tooth extractions using “galvanism,” he received a patent on May 25, 1858. Although his device was denounced by the Pennsylvania Association of Dental Surgeons, the methods used by Francis spread throughout America and Europe. In that same year, W.G. Oliver of Buffalo claimed the discovery of “electrical anesthesia,” reporting a 98 percent success rate using a vibrating generator for dental pain. Again in that same year, Harding, at the University College Hospital, London, confirmed Oliver’s results with studies of 40 tooth extractions. He also set up a control subject who had results when the current was applied but did not experience any change under the same conditions without current. By the late 1800’s, the use of electricity in medicine was wide spread and described in such medical texts as Osler’s “Practice of Medicine.”
At the turn of the century, the business atmosphere in the United States “…reflected laissez-faire policy at its extreme. High government officials were corrupted by the railroads, the public was swindled by flagrant stock-market manipulations, embalmed beef was shipped to soldiers in the Spanish-American War. Advertising contributed to the immorality of business with its patent-medicine ads offering to cure all the real and imagined ailments of man. There was a `pleasing Medicine to cure cancer,’ another to cure cholera. No promise of a quick was too wild, no falsehood too monstrous.” A variety of electric gadgets emerged and were marketed in a similar manner to snake oils and other patent medicines by various charlatans. This problem, together with the “almost total lack of standards in medical education and practice at that time, produced a deplorable situation.” To investigate this situation, the Carnegie Foundation established a commission headed by Abraham Flexner. The commission’s final report was published in 1910, and it produced an almost instantaneous revision of medical education. Electrotherapy became a scientifically insupportable technique, and it disappeared from medical practice. Doctors using electric instruments of any sort were branded as quacks and charlatans. In the backlash of this mindset, electronic devices of diagnostic or therapeutic value have been slow to be accepted. Even now, a great deal of suspicion surrounds the use of electrodiagnosis and electrotherapy.
In spite of the virtual disappearance of all electrical therapy, investigation has continued into the electric nature of biological systems in health and disease states. A great deal has been discovered, and legitimate diagnostic and therapeutic devices based on these sound discoveries have emerged.
In the early 1950’s, Reinhold Voll, a German medical doctor, developed an electronic testing device for finding acupuncture points electrically. He was successful in finding acupuncture points and demonstrating that these points, known to Chinese acupuncturists for millennia, had a different resistance to a tiny electrical current passed through the body, than did the adjacent tissues. Many other researchers have also verified that electrical conductance at the acupuncture points is significantly greater than the surrounding tissue. Voll then began a lifelong search to identify correlations between disease states and changes in the electrical resistance of the various acupuncture points. He thought that if he could identify electrical changes in certain acupuncture points associated with certain diseases, then he might be able to identify those diseases more easily, or earlier, when treatment intervention was likely to be more effective. Voll was successful in identifying many acupuncture points related to specific conditions and published a great deal of information about using acupuncture points diagnostically. (Until Voll, these points had been used mainly for treatment) He found, for example, that patients with lung cancer had abnormal readings on the acupuncture points referred to as lung points. Changes also occurred in the electrical conductance of the acupuncture points supplying musculoskeletal structures that are inflamed.
These changes in acupuncture point resistance related to lung cancer have been verified more recently by researchers from UCLA and USC. In a double-blind study, 3 patients with lung cancer and 20 controls (who had negative chest x-rays) had the electrical resistance of several acupuncture lung points and several small intestine points measured. There was an 87 percent correlation between the testing results and the results of the x-ray diagnosis for the lung points, and no correlation with the small intestine points. Of interest, there were no false negatives and 4 “false” positives. Two of these false positive readings were from the same patient who had an “inconsistent shadow” on his lung X-ray but had shown no evidence of disease with tomograms and a CT scan. These “false” positive readings could have been from lung cancer not yet diagnosed, or some other degenerative disease process, or could have been merely incorrect readings.
Another study from the Pain Management Clinic, Department of Anesthesiology, UCLA School of Medicine, evaluated the ability of electrodermal testing to identify, in a blinded fashion, areas of pain. Forty patients were determined by medical examination to have musculoskeletal pain. Each patient was draped to hide any physical evidence to suggest where the pain might be. The physician conducting the electrodermal testing had no prior knowledge of the patient’s history, and was not allowed to talk to the patient. Based on increased skin conductance at specific acupuncture points of the ears, the physician determined, with greater than 75 percent accuracy, the location of the pain, a highly significant result. This study also pointed out that electrodermal testing technique “is often sensitive to pathological problems of which the patient is only minimally aware. When some patients were told of their auricular diagnosis results, they suddenly remembered having a minor or old pain problem in that bodily area, a problem which they had neglected to mention during the medial evaluation,” and thus were considered to be “misses” in the statistical analysis. The results of this test were therefore more impressive that the statistical analysis would indicate.
A great deal has been done throughout the world correlating changes in electrical conductance at acupuncture points with various disease entities. Much of the German, French, Japanese, and Chinese literature has not been translated. Only a few examples of the many articles related to finding and measuring acupuncture points electrically are referenced in this paper.
Voll discovered that certain acupuncture points showed abnormal readings when subjects were reacting allergically. He made several serendipitous discoveries related to “allergy” testing. He noted some unusual readings on certain acupuncture points when a patient had a bottle of medicine in his pocket. He could remove the bottle and consistently get different readings when the bottle was in his pocket compared to when it was not. At first he was baffled as to how a closed bottle of medicine outside the body could affect the acupuncture readings. It was even more baffling when he discovered that the glass bottle of medicine could change the readings when it was in contact anywhere along the closed electric circuit involved with the testing procedure. Voll and his colleagues then began work to identify the nature of this strange phenomena. They inserted a metal plate into the circuit and demonstrated that many substances that precluded changes in acupuncture point readings when ingested could produce the same changes when placed on the plate (even in closed glass bottles). They assumed that there must be some kind of electro-magnetic energy fields somehow travelled along the electric circuit to the body (perhaps like the energy waves representing a person’s voice travels along the electric circuitry of a telephone line).
Voll and other scientists have conducted various experiments in an attempt to characterize the energy form that is being measured. As yet, no clear consensus of opinion exists as to exactly how this phenomenon functions. For that matter, no clear consensus exists how any electric phenomena function. Although is used to be thought that electricity was fairly straight and well understood, many discoveries in the last few years have made many scientists question older theories. Robert Beck, a physicist well known for his pioneering work in various areas of electromagnetism, said the following, “Man is an extremely complex biocosmic resonator….People ask me occasionally why this or that works and I tell them the truth, that although I’m a physicist, I don’t know what electricity is. Neither does anybody else. But we can certainly build a lot of marvelous things with is, from toasters to television sets, to computers. And it will be quite a few years before even the effect of some of these simple stimulation type devices are well understood, much less fully understood.”
Electrodermal testing devices have been extensively studied by Dr. William Tiller from Stanford, who is a professor in the Department of Materials Science and Engineering. He has written extensively in an attempt to explain the electric behavior of the skin and how electrodermal diagnostic and treatment instruments function. Dr. Cyril Smith, PhD physicist in the Electrical Engineering Department at the University of Salford, England, has also written extensively in an attempt to explain various electromagnetic phenomena. Including electrodermal testing and acupuncture points. Other world leaders in bioelectric medicine include Robert O. Becker, M.D. and his landmark book entitled, The Body Electric- Electromagnetism and the Foundation of Life, and Bjorn Nordenstrom, M.D. and his book, The Electric Man, and Biologically Closed Electric Circuits.
Whether or not a diagnostic of therapeutic modality is fully understood has absolutely no bearing on its effectiveness or usefulness. It is beyond the scope of this paper (and of this writer), to attempt to explain the phenomena involved in electrodiagnostic testing. In fact, it would seem better to have no explanation at all than have an incorrect theory. For example, the drug Hydergine has been shown to be effective for improving cerebral function in older people in a number of double-blind controlled studies. The mechanism was thought to be through increasing cerebral blood flow. When further studies failed to show increased blood flow, the drug was thought by many to be ineffective, and fell into disfavor. More recent studies have shown a variety of actions that could explain the results of therapy, and it once again has become widely used.
Evidence for Reliability of Electrodermal Testing
There is a great deal of controversy in medicine today over the issue of what techniques are considered experimental, and which ones are considered to be adequately proven. This issue was investigated by the Office of Technology Assessment of the Congress of The United States. They produced a 133 page report entitled “Assessing the Efficacy and Safety of Medical Technologies.” This report stated that “it has been estimated that only 10 to 20 percent of all procedures currently used in medical practice have been shown to be efficacious by controlled trials.”
The chairman of the Utah Unproven Health Practices Committee in 1985 was asked what constitutes adequate evidence that a technology has been adequately proven? His reply was that a good double-blind study is reasonable proof, and that several double-blind studies reported by researchers from different centers is excellent proof.” Others involved in this issue have suggested that the agreement of experts in the field of the effectiveness and usefulness of the technology is good proof. Also, the clinical use of a technology by various medical practitioners is also good proof of its efficacy.
Electrodermal testing instruments have been around for over thirty five years and have been used widely in Europe and virtually around the world for allergy testing as well as for a variety of other purposes. These instruments, however, have been used for only a few years in this country. Electrodermal testing instruments have been manufactured in Germany, Japan, China, France, Denmark, Russia, and more recently in the United States.
Many double-blind studies have been done using this technology. In fact, most of those practitioners who use them have set up a blinded test situation of one kind or another before they really believed that these instruments actually work. Besides the double-blind study describes earlier in this paper, we have tested hundreds of patients in a double-blind fashion where the patient did not know what they were being tested for, and the instrument operator did not know anything about the patient’s reactivity. These tests usually compare favorably to the patient’s history and to testing by other techniques.
Perhaps the most convincing evidence for the accuracy and reliability of electrodermal testing came from using this testing to quickly identify correct optimal treatment doses for patients who had unpleasant reactions to provocative testing. An effective dose to turn off the response would often take more than an hour by trial and error, but would almost always be found within seconds using the instrument. On those few misses, the optimal dose was within one dilution, and could easily be found.
Another physician who has evaluated electrodermal testing in his office is William Rea, M.D. from Dallas, an internationally known pioneer in environmental medicine. Besides serving as the director of the Environmental Health Center in Dallas, Dr. Rea has been appointed as the First World Professorial Chair in Environmental Medicine, Robens Institute, University of Surrey, England. Dr. Rea set up a simple double-blind situation using a number of people who had reacted adversely to a challenge test with various antigens, and for whom an optimal treatment dosage had been found to turn off those reactions. Neither the patients nor the instrument operator knew the correct dosage. A series of dilutions were tested, and the electronic instrument identified the correct optimal dose dilution determined by trial and error, making it easy to find the optimal dose in those “misses.” Dr. Rea describes using these instruments as part of his practice to find optimal treatment doses for very sensitive patients before provoking symptoms, so that he can quickly administer an effective treatment dose in case of severe reactions.
Doctors from England have for some time used electrodermal testing for allergies. One of these medical doctors reported a study in the British medical literature.
There have been at least three double-blind assessments of electrodermal testing reported in the American medical literature. In 1989, Ali reported in the American Journal of Clinical Pathology the results of a double-blind test comparing the results of IgE antibody levels (using a microELISA procedure) for a variety of pollens and molds to electrodermal testing for the same antigens. The results showed concordance between the two tests of 73 percent.
In 1985, Krop did a double-blind test comparing electrodermal testing to sublingual and intradermal testing for a variety of foods, chemicals, and inhalants. In 66 percent of the 227 tests, the electrodermal testing identified exactly the same “neutralizing” (optimal treatment) dilution as did the intradermal and sublingual testing.
In 1984, researchers from the University of Hawaii compared 6 different diagnostic modalities for assessing food allergies. These tests included history, food challenge, skin, RAST, IgE antibodies, and electrodermal testing on 30 volunteers. The testing was done in a double blind fashion, with the patients not knowing what antigens were being tested, and the instrument operator not knowing anything about the patient’s food sensitivities. In over 300 tests, electrodermal testing matched the history 74 percent of the time, the food rechallenge test 77 percent of the time, skin testing 71 percent of the time , and RAST testing 69 percent of the time. The authors concluded that “EAV (electrodermal testing) data obtained in this experiment demonstrates the highest degree of compatibility with the food challenge test, which is considered to be the most sensitive of the currently available diagnostic techniques for food allergy. In addition, the EAV results were comparable with both skin and RAST tests.
Krop points out that in his study, the subjects were only tested to things to which they reported an adverse response. He expressed the opinion that these apparent “false positives” were not false at all, but merely reflected a greater sensitivity of the electrodermal testing compared the more traditional testing to which it was compared. The results of the other two studies mat also have reflected this greater sensitivity with electrodermal testing. When trying to evaluate the accuracy and dependability of electrodermal testing for food allergy testing, a number of factors about food allergy must first be understood.
- Food allergy is a complex issue. It is not just a yes or no situation. Various types of food reactions have been described, including the following.
- Fixed allergy - A person with a fixed food allergy will react to that substance each time they come into contact with it, often even with a very tiny exposure. It doesn’t matter how long it has been since the last exposure, re-exposure will still produce a reaction.
- Cumulative allergy - A person with a cumulative allergy to foods will only react to a specific food when they ingest enough of it to exceed their allergy threshold for that food. It may take a substantial amount of that food to evoke a reaction. A specific food may be tolerated just find one day, but if ingested the next day will likely product a significant reaction.
- Variable allergy - A person with variable allergies may react at certain times when eating a food, but tolerate it well on other occasions. Some people react to specific foods when certain pollens are in the air, but not at other times. This may represent a complex cumulative response to common antigenic material in several foods, or a reaction to a combination of a food and pollen. Some women react adversely to certain foods during a particular phase of the menstrual cycle, or during pregnancy. In most cases, the reason for the variability is not clear.
- The mechanism or mechanisms causing adverse reactions to foods are not clear. Although much early attention was focused on the role of IgE antibodies, it is clear that many reactions are mediated through other mechanisms. Much recent attention has focused on the role of IrG antibodies, and some workers believe that IrG antibodies correlate more closely with the clinical picture of food allergy than do IgE antibodies. Prostaglandins and related hormones have been shown to play a role in some cases. In other cases, adverse reactions may be non-immunologic responses.
- There is no 100 percent reliable test for food allergy to which other tests can be compared. With no reliable standard of comparison, there is no way that any new test can be reliably judged. Almost daily we see patients in the office who have been tested with skin or RAST tests who are puzzled by the results. They usually describe negative testing for foods to which they clearly and predictably react, and positive tests for goods which they have repeatedly eliminated and reintroduced with no observable clinical response. Each test has its limitations and shortcomings, including the following:
- History - Many patients have a history of reaction after ingestion a meal, but do not have a clear understanding of what specific food caused the reaction. Many patients ingest specific foods like dairy products or wheat several times daily, and have never deliberately avoided those and other foods long enough to see if symptoms clear. Many are puzzled by the observation that they seem to react to a specific food sometimes, but not at other times. Most patients do not have enough understanding of the nature of food reactions to have intelligently evaluated individual foods.
- Food Rechallenge - After a good is avoided for a time and then reintroduced; there may be no initial response if the reaction happens to be cumulative or variable. The best that can be determined by a onetime challenge is that the person must not have an immediate, fixed reaction to that food. A food challenge must be repeated several times over two days or so to rule out these other forms of food reaction.
- Double-blind food capsule tests - Although this test may work reasonably well for a fixed reaction on someone with a low threshold for that food, it is in general a very unreliable test for food reactivity. One study showed that this technique correlated in only 30 percent of cases with skin testing and in less than 8 percent of cases with RAST testing.
- RAST and related tests - RAST tests for IgE have shown a reasonable correlation to food reactions, but it is clear that many non IgE responses occur in response to food ingestion. IgG testing is becoming popular, and some advocates believe it correlates better with clinical responses to food challenges. Obviously, IgG antibodies also do not explain the whole realm of food reactivity.
- Skin testing - Various types of skin responses have been investigated and are reasonably correlated with clinical food response in some tests but not in others. It was long thought that the skin response was mediated exclusively through IgE antibodies. If this were the case, a better correlation between IgE antibodies and skin responses should be shown (unless both test simply have a high level of error).
Disadvantages and Advantages of Electrodermal Testing
Disadvantages- Antihistamines, corticosteroids, and other medications may suppress a person’s immune reactivity, resulting in false positive readings on the instrument. Skin testing may also be suppressed in the same way. False positive reactions may occur in response to chemicals in the environment in which testing occurs (such as reactions to perfumes, cleaners, etc.). Occasionally, for unknown reasons, the instrument fails to identify a food, chemical, or inhalant to which a person by history repeatedly reacts. The instrument may also occasionally identify an allergen as positive, even though avoidance and re-exposure fails to confirm that finding. Although not perfect, double blind studies using electrodermal testing correlates more closely with the observations of the patient than the more traditional forms of testing. Other advocates of electrodermal testing share this viewpoint. One doctor from Colorado reported the results of a survey of 109 patients tested with this technique. All had been tested by some other method in the past, and 69 percent thought that the results of electrodermal testing were more reliable than more conventional testing, with only 5 percent reporting it less reliable. The rest either thought it was the same or didn’t comment. Since there is no reliable standard by which to compare electrodermal testing, at the present time there is no reliable way to assess its accuracy.
Perhaps the biggest disadvantage of electrodermal testing is the poor acceptance of the technique by some physicians. There has been a tendency by some, with a 1910 mentality, to dismiss it as pure “quackery” without even knowing any more about it than it is some kind of electric device. According to a California colleague, a state official pronounced that he had proven that the use of electrodiagnostic instruments is pure quackery, because he had personally tested one out that he had confiscated from a local practitioner and showed conclusively that it didn’t work. Unfortunately, all too many physicians are prepared to accept this type of judgement, while rejecting all the world literature to the contrary. Even back in the 1700’s Johann Wolfgang von Goethe knew about this type of mentality when he stated “we are accustomed to having men jeer at what they do not understand.”
Advantages- Electrodermal testing seems to be at least as reliable, and probably more reliable, than other forms of allergy testing available. It is much safer than skin or challenge testing, since exposure to the allergenic substance is minimal. It is also much more pleasant for the patient than skin testing, since the testing itself is completely painless. There are also no unpleasant adverse reactions, which may last for many days with skin or challenge testing.
Electrodermal testing is much less expensive (in our hands) than other forms of texting. A typical charge from a traditional allergist for a series of skin of RAST test is often between $300 and $500 dollars. Our charge at the present time for testing well over 100 items $25, and that is not for the testing per se, but rather for the doctor’s, nurse’s, or other paramedical personnel’s time in explaining avoidance and rechallenge techniques, verification of results with other methods, diversified rotary diets when indicated, and treatment options.
One of the biggest advantages of using electrodermal testing is in detecting sensitivities and identifying optimal treatment dosages instead of relying on trial and error, as used in intracutaneous serial dilution titration techniques, or with sublingual provocative- neutralization techniques.
Another useful application of electrodermal testing is in testing medications. Every doctor in primary care is faced with patients who seem to react to a lot of different medications, and who need to be given something to control blood pressure, or who need surgery, or who are on a lot of medications and there is strong evidence that they are reacting to one or more of their drugs.
There is a great deal of concern about iatrogenic disease these days, in fact believed to be responsible for about 36 percent of hospital admissions. An estimated 2 percent of hospital patients even die from iatrogenic causes. A great number of these unfortunate problems are caused by adverse reactions to drugs. Skin testing for identifying such problems is rather inadequate, since many of the drugs are not available in and injectable form for testing purposes. Even if an injectable form is available, the patient still might react to the dyes, fillers, or excipients in the oral form. Many of the reactions from drugs are non IgE, and may not even show up on skin testing. In the past, the only option was trial and error, and it was often only after several unpleasant reactions that a tolerable, effective choice was found. With trying to sort out a patient’s problems on a lot of drugs, it is even more complex. One has the dilemma of trying to decide whether to stop everything and then reintroduce medications one at a time, whether to stop only one drug at a time, or whether to try switching some of their drugs to other types. Going off of certain medications can be potentially dangerous to the patient. The electrodermal testing will usually indicate within a few minutes which medications are likely to be a problem. This testing can also indicate which medications are likely to be well tolerated, Based on that information, it is generally a simple matter to avoid the problem drug, and introduce medication likely to be well tolerated. Although this technique is not foolproof, and may not pick up every type of adverse reaction, it is certainly a lot better than a shot in the dark as with an entirely trial and error approach.
We have had several patients who experienced severe reactions to the anesthetics or other drugs used during previous surgical procedures. We have been able to test for reactions to various classes of medications needed, find presumably safe alternatives, and then have these drugs used by the anesthesiologist and surgeon, In the cases in which we have participated, the patients have tolerated the anesthesia and post surgical medications beautifully. Of course the patients and the doctors involved were told that the testing was no iron-clad guarantee that no reactions would occur, but would at least provide a good chance of a reaction free procedure.
Acupuncture points have been known for thousands of years, and the principles of electricity have been understood (at least somewhat) since before the 1600’s. It has been known for many years that acupuncture points have different electrical conduction than the surrounding tissues. Changes in these electrical readings in conjunction with disease states have been investigated extensively. Using electrodiagnostic instruments for measuring allergy responses has been around for over 35 years. This technology has been studied and utilized around the world by thousands of doctors. Many studies, including a number of double-blind studies have been done validating this procedure. The chances of these reported results occurring by chance alone are one in many millions. Electrodiagnostic testing has many advantages and would certainly be useful in every hospital and in the office of every doctor who prescribes medications.
It is the belief of this writer that the use of electrodiagnostic testing fulfills all the requirements to be considered adequately proven, including: 1. A number of double-blind studies from various centers validating its efficacy. 2. Experts in the field who deal with this technology acknowledging its usefulness and accuracy. 3. Electrodiagnostic testing having been in use around the world for many years by thousands of medical doctors. Because it has virtually no dangers and is very inexpensive, anyone who singles out this procedure for investigation above the myriad of medical procedures which are much less proven, more dangerous, and more expensive, does so arbitrarily and capriciously, and for reasons other than a concern for the patient’s health and well being.