Detecting Kidney Disease - JAMA and Rebuttal by Harris Wolf.
Simon A; Worthies DM; Mist JA 2d
JAMA, 242(13): 1385-9 1979 1385-9 1979 1385-9 1979 1385-9 1979 Seep 28
Iridology is an analysis of health based on examination of the iris of the eye. One hundred forty-three patients had photographs taken of both eyes. Nine-five patients were free of kidney disease, defined as a creation level of less than 1.2 meg/del (mean, 0.8 meg/del), and 48 had kidney disease severe enough to raise the plasma creation level to 1.5 meg/del or greater (mean, 6.5 meg/del). Three ophthalmologic and three iridologists viewed the slides in a randomize sequence without knowledge of the number of patients in the two categories or any information about patient history. Iridology had no clinical or statistically significant ability to detect the presence of kidney disease. Iridology was neither selective nor specific, and the likelihood of correct detection was statistically no better than chance.
Western Medicine Looks at Iridology (Anatomy of a Jaundice Eye)
By Harris Wolf, M.A.
Iridology has been largely ignored by the traditional medical establishment as witnessed by lack of opinion in the medical literature. Whenever mention is made it is rejected on general principle. Rifleman, in the New England Journal of Medicine compared iridology with astrology and psychic healing, among others, and referred to them as the irrational side of the holistic Movement.(1) S. Duke Elder in his Systems to Ophthalmology, Vol. 2. referred to Iridology in his chapter on iris anatomy:
. . . Even today an extraordinary cult with a considerable following and a voluminous Literature flourishes,particularly in Central Europe, the devotees of which attribute to each minute area of this tissue an affinity for a different organs of the body, in the list of which the eye itself is included, and from an examination of the appropriate area, the initiated can dispose any disease to which the flesh may be heir. They call themselves oculodiagnosticians (irido-diagnosis, augen-diagnose, etc. . .)(2)
D.j. Stark, an ophthalmic surgeon, stated in an article published by the Medical Journal of Australia that Iridology can no longer be dismissed without discussion by the medical profession; it must be dissected, studied and discredited.(3) . The most amusing criticism of iri- dology that I've read appeared in the British Journal of Ophthalmology (1962). Here the author compared iridology with such disreputed practices as homeopathy and acupuncture. Here's a sample for your entertainment:
It is tempting to dismiss these irresponsible 19th century charlatanries as the crows that follow in the wake of the advancing sciences; exploiting what they cannot comprehend, and finally flickering on as a drawing room diversion to the under-educated and under-occupied. But, in the rootless 1960's people are still wanting a new faith rather than an old reason; hence the resurgence of astrology and acupuncture and hence also the triumphs of the black box. So, we must not altogether disregard these other curious inhabitants of our ophthalmologist nest.(4)
After reviewing the literature, I've concluded that much of the criticism of iridology is based upon the fact that iridologists have made statements about iris anatomy or neuro-anatomy that are either unsupported or proven incorrect. For example, Stark criticizes Dorothy Hall for referring to the areas senilis of the comes as the sodium ring of the iris.(5) Rejection of an entire system should hardly be made on the merits of statements or practices by individuals. An individual doesn't represent an entire system. Should we reject Western medicine because some of its key figures employed bloodletting and leeches or mercury compounds to cure syphilis? Shall we consider Western medicine a total failure because drugs that are one day hailed as panaceas are later implicated in birth deformities or other serious side effects?
Iridology must be tested on its own merits if it is to be tested at all. One such attempt at objecivity has been published by the Journal of the American Medical Association. That study, published in 1979, intended to measure iridologys ability to detect kidney disease as reflected by abnormal creatinine levels in the blood. A population of 143 subjects was evaluated, one third of whom had laboratory-proven kidney disease (abnormal creatinine clearance). Three iridologists examined photographic slides of the subjects' eyes. Data analysis (see Table One) suggested that the iridologists were unable to diagnose the presence of kidney disease with statistical significance. The researchers concluded that iridology is of no value in discovering kidney disease and may be potentially harmful.(6)
This study was criticized by its most expert participant, Dr.Bernard Jensen D.C. He claimed that the slides he and his colleagues examined were of poor quality. The authors of the Jama article contradicted this by stating that the iridologists were given the opportunity to reject the poor quality slides. I believe that this study was rendered insignificant for the followingh reasons:
1. The instrument reliability factor is questionable. It is true that the quality of iris slides were poor. Many should have been rejected. I believe that iris exams are best performed in vivo, utilizing specialized microscopes. When reading slides, many structural and pigmentary anomalies can easily be overlooked. Depth perception of the iris stroma is also markedly different.
Furthermore, such variables as film speed, film types, room lighting and slide storage methods can account for pictures that are not accurate representations. So, the high false-negative rates (incorrectly labeling as normal those with diagnosed renal disease) can be somewhat attributed to the examination technique itself.
2. It is a universal contention among iridologists that iris indications can appear long before subjective or laboratory indication of any disorder. This undoubtedly accounts for the high false positive rates among the screeners (incorrectly labeling as diseased those with no abnormal creatinine index). Unless the glomerular filtration rate is affected, there will be no abnormal creatinine clearance. So, what of renal disorder that does not affect glomerular filtration at the onset?
Such was the case with j.S., a 51-year-old physician. In the spring of 1979, I warned him of a destructive process arising at the site of the right kidney. (See photo.) At that time there were no subjective complaints. When returned that autumn for reexamination, I repeated my caution. He disclosed that there was a malignant growth on the kidney that had only been recently revealed. Up until that time there was no alteration in his creatinine clearance.
When investigating a discipline that claims to be predictive, arrangements should be made to retest the subjects at a later date. Such a longitudinal study would be difficult for iridologists because of a major ethical consideration: how can we allow experimental subjects to go untreated only to satisfy statistical hunger?
3. Iridologists generally share a different concept and understanding of disease than medical screeners. I'd like to illustrate this by example: I was asked to evaluate the condition of a seven-year-old boy under-going renal dialysis. Medically, his prognosis was unfavorable. This brown-eyed boy showed no classical structural defects in the kidney areas of the irises. The following signs were evident:
1. Bilateral papillary mydriasis pharmacological cause was ruled out.
2. Small, deep lacunae at approximately 30 minutes adjacent to the collarette in the humoral zones of both irises.
3. Interrupted contraction furrows in the ciliary zones of both irises at 27-33 minutes.
According to my assessment, the child's true and underlying condition involved adrenal weakness, autonomic nerve weakness, autointoxication and serious emotional factors (fears, uncertainty, self-doubt, distrust). Failure of renal function was an expression of the disease, but not the disease itself. I believe that only by addressing these factors could we have offered any hope for recovery.
(Note: It was interesting to learn that the child's father, who presented the case, had undergone a five-year-long sex-exchange operation. He was originally the child's biological mother. Could this explain the uncertainty, lack of trust, and the self-doubt?)
It appears that the JAMA study yielded questionable results and information as to the value of iridology as an assessment tool. I might mention, though, that the publication of the study caused the cancellation of a seminar engagement I had at the National College of Chiropractic. Apparently, my student sponsors were threatened with suspension if I made the appearance. It amazes me how quickly the college administrators had forgotten the ridicule their own profession had experienced for so many years at the hands of the medical establishment.
One for Our Side
A study was undertaken at the University of Rochester in 1981 that proved to be more favorable. Twenty-one subjects were used for the study, six from the out-patient department at a major medical center and 15 from a well-person setting.(7)
Health histories were completed for each subject and provided the information base on health and wellness. Photographic slides were submitted to me and my students at the Santa Fe College of Natural Medicine for health and illness evaluation. Using only the iris slides, and knowing the age and sex of each person, we were to evaluate them according to levels of wellness and specific organ pathology.
This information was compared with data from the health histories. We rejected nine subjects' slides for the wellness study and 13 sets of slides for the pathology study. We also noted that even for the slides not rejected, quality standards were low. Table Two summarizes the pertinent findings of the wellness assessment.
The agreement rate of 50% is not statistically significant. It should be noted that we gave low wellness ratings for all subjects evaluated. Here, a longitudinal format could have been employed. I believe our findings suggested the possibility of latent disorders. Besides, our standards are generally higher and so stated in advance of our participation in the study.
The investigator concluded that the Wellness rating as presented by this study was not a valid way to assess iridology and the information received neither supported nor rejected any assumption of validity for iridology.(8)
Table Three lists all organ pathologies present by history in subjects not rejected by our group. The agreement of our findings with the health histories is also noted. Organ pathology mentioned by us but not present by history is not shown because the predictive value of iridology was not being explored.
Subjects 6, 7, 16, and 22, all rated low wellness from the health histories, and all from the out-patient department, had a total of 10 specific organ pathologies. We identified eight of these for an 80% acceptance ratio. So, we fared better (by ll %) with the subjects who were chronically ill. This can be suggestive of the predictive nature of iridology, but a small sample size precluded any conclusion to that effect. The investigator stated, The evaluation of organ pathology was the most successful part of the study in spite of the technical problems and the results were suggestive. While accepting the restrictions of such a limited sample, he concluded that, The data suggested a possible ability for iridology to assess specific organ involvement in chronically ill individuals.
Here too, I question the significance of the study on the ground that I previously discussed. Photographic analysis is limiting; patients will not be examined at a later date; and, finally, the concepts and rhetoric of disease differ widely between the rationalists (medical screeners) and the empiricists (iridological screeners).
There is no shortage of phenomenological and clinical evidence in support of iridology. These are the foundation of iridological practice. We develop theories based upon the observation of iris phenomena in relation to patterns of disorder. Then we set out to test our theories, always considering the uniqueness of each individual case. In other words, we have based our theories on the practice of diagnosing and healing.
Iridology does not measure a static phenomenon; nor does it assign a label to a disorder. We observe processes that have often been in motion for generations, with their own unique individual reactions and expressions. Difficulty in classifying and quantifying will always be an obstacle to scientific research on the subject.
1 Relman, A.S.; 1-Holistic Medicine, New
England Journal of Medicine, 1979.
2 Duke-Elder, S.; System of Ophthalology 1/Vol. 2; Henry Kimpton, London, 1961.
3 Stan, Dennis J.; Medical Journal of
4 Patrick Trevor-Rope; Grins Journal of
5 Hall, Dorothy; Iridology, First Edition
Victoria, Nelson 1982.
6 Simon, A., Worther D., Mitas, J. A.: An
Evaluation of Iridology, Journal of the
African Medical Association 1979 #242.
7 Whitling Harlen, D.; 'An Evaluation of
Iridology as an Assessment Tool for
Nurse Clinicians.' School of Nursing
Univ. of Rochester. New York, 1981.