Nearly all AK tests are subjective, relying solely on practitioner assessment of muscle response. Specifically, some studies have shown test-retest reliability, inter-tester reliability, and accuracy to have no better than chance correlations.[1][22][23] Some skeptics have argued that there is no scientific understanding of the proposed underlying theory of a viscerosomatic relationship, and the efficacy of the modality is unestablished in some cases and doubtful in others.[4][4] Skeptics have also dismissed AK as "quackery," "magical thinking," and a misinterpretation of the ideomotor effect.[24][25] It has also been criticized on theoretical and empirical grounds,[24] and characterized as pseudoscience.[26] With only anecdotal accounts claiming to provide positive evidence for the efficacy of the practice, a review of peer-reviewed studies concluded that the "evidence to date does not support the use of [AK] for the diagnosis of organic disease or pre/subclinical conditions."[8]