Respectful Insolence

Woo invades the military

Imagine that you’re a soldier in Iraq. Imagine further that you’re on patrol in a dangerous area in the middle of summer, the desert heat penetrating your 80 lb pack much the way boiling water penetrates the shell of a lobster. Your heart is racing as you and your unit nervously dart to and fro, every shadow a potentially deadly threat, every alley a refuge from which the enemy can attack and kill. The area’s thick with insurgents and terrorists, and you feel as though you have a huge bullseye painted on both your chest and back.

A loud roar fills your ears, and you feel as though you have no weight. Dazed, you hear a tumult as though from a great distance, but can see nothing. Yelling and gunfire all around, you become conscious enough to feel searing pain in your legs and feel a hot liquid oozing around them.

It occurs to you that it must be your own blood or even perhaps your own urine, but you’re too dazed to care.

“Medic!” you hear someone scream. You feel someone pull your helmet from your head and realize that the sound of gunfire and yelling is getting farther away. Your unit is driving away the insurgents. You open your eyes, and realize that your buddy’s got your back, as you see the medic arrive. Your uniform is stained a disturbing red. You feel the medic wrapping something around your thigh. It’s a tourniquet, which you feel tightening around your leg.

“Bleeding’s better!” you hear the medic say to your buddy. “I’ll take it from here.” Your buddy runs off to join the rest of his unit, and the medic moves his face close to yours. “I think we have the bleeding under control. Let’s get you out of here to get you patched up.” You’re vaguely aware of two corpsmen with a stretcher nearby. The medic leans in again, “Are you in pain, soldier?”

“Yeah,” you say. “It hurts like a sonofabitch. I could really use some morphine or something,” you hear yourself answering. Pain is shooting through your leg, worsened by the tourniquet.

“I’ve got something better.”

Better? you think. I’m in agony here. I need relief!

The medic pulls something out of his pack. You see that it’s a small case. He opens it. It looks something like this:

i-bbe2058fa86ca844e51fbb484e363a36-acupuncturekit.jpg

“What are those needles?” you ask.

“Acupuncture,” replies the medic. “I’ll take care of you.”

“What are you going to do with them?” you say.

“Stick them into your earlobe. It’ll take the pain away.”

“Are you shittin’ me?” you yell. “My leg’s shredded, and you’re going to stick tiny needles in my ear? I need real pain medicine, not woo!”
*****

Yes, I’m exaggerating here to make a point, but unfortunately, based on an article in Miltary.com, I’m sorry to say that I’m probably exaggerating considerably less than I wish I were. Say hello to Battlefield Acupuncture:

LANDSTUHL REGIONAL MEDICAL CENTER, Germany – A medical procedure dating back thousands of years was introduced to patients and medical staff for one week in March at Landstuhl Regional Medical Center.

A limited form of acupuncture, called battlefield acupuncture, was introduced to LRMC doctors who applied the procedure to war-wounded servicemembers and local patients for pain relief, and often with significant results.

Major (Dr.) Conner Nguyen was exposed to acupuncture as both a patient and physician and was equally impressed in both roles. As a patient, Major Nguyen experienced 25 percent increased range of motion and a 50 percent reduction in pain for chronic shoulders and upper back pain he endured for several years.

True, Major Nguyen is not giving acupuncture on the battlefield, but can that be far behind? Battlefield acupuncture is the creation of another officer Col. (Dr.) Richard Niemtzow, who is a radiation oncologist by training but also one of 40 Department of Defense doctors trained as certified acupuncturists. An article from WTOP News two years ago describes how Col. Niemtzow discovered acupuncture:

Col. Richard Niemtzow, a radiation oncologist, received a brochure on acupuncture in 1994. At first he threw it out, but then he decided to learn more about the ancient practice and attended a conference on acupuncture. He was sold. Niemztow started the first acupuncture clinic at McGuire Air Force Base in Ohio and now practices acupuncture at Andrews Air Force Base, the Pentagon and Walter Reed Army Medical Center.

Three or four doctors at Walter Reed practice acupuncture on their patients. Niemztow visits each week, to help relieve the pain for amputees back from Iraq. He says he helps 50 percent of amputees suffering from phantom pain.

I had the opportunity to sit in on patient visits who were referred to acupuncture at Walter Reed and received the treatment for the first time. I witnessed men and women finding relief in a matter of minutes after suffering chronic pain for years.

Niemtzow used various techniques on the patients he developed and are now taught throughout the country. In one technique, he places acupuncture needles into the ear, since the ear is integrated to the central nervous system.

Niemtzow says you interfere with the processing of pain and in a way, turn off the pathway and that’s why pain may go away. Each of the patients he saw were referred back to the clinic for follow-up treatments. He says it is possible their pain will come back.

Ya think?

One thing that I note is that two years ago the use of acupuncture in the military was uncommon, with Col. Niemtzow lamenting how few acupuncturists there are. In the article in Military.com, it’s clear that the program has expanded considerably. Another thing that I note is that there is no mention of science or well-designed clinical trials to test whether “battlefield acupuncture” does anything at all. I did a little PubMed search for “battlefield acupuncture” and found nothing. Searching for Col. Niemtzow on PubMed, all I found was a bunch of articles in that repository of bad studies of woo, the Journal of Alternative and Complementary Medicine. There was one article in Military Medicine and one in JACM, the latter of which is a photo essay. The article in Military Medicine is indeed a pilot study, but even on those terms it’s not impressive. It was completely unblinded, and no sham acupuncture was used for the controls. Even more odd, the auricular acupuncture needles, which are considerably smaller than standard needles, were left in place in the ear for up to several days until they fell out. Even given the shortcomings of the study that could lead to bias, the results were still not particularly impressive. Although the acupuncture group was reported to decrease by 23% initially and the conventional therapy group not at all, within 24 hours there was no difference. Even by the usually low standards of poorly done “CAM” studies, the results here were not striking.

Since the start of the Iraq War, I’ve seen enough military medicine talks and met enough medical officers to know that wartime is a time of experimentation and innovation, as doctors look for newer, better, more efficacious, and more efficient ways to care for our wounded soldiers. Truly, some advances have been spectacular, advances. Particularly impressive is how the wounded can be evacuated from the battlefield to nearby hospital bases, stabilized (and operated on emergently if necessary), and then evacuated to hospitals in Europe or elsewhere within 12-24 hours of being wounded, showing that getting the wounded to definitive treatment faster does indeed save lives. Sometimes this culture of innovation leads to perhaps a bit more openness to measures before they are validated than would be the case. Usually, it’s because it’s battle, and there isn’t adequate time and because the chaos of battlefield conditions precludes it. That clearly isn’t the case with battlefield acupuncture. What we have are anecdotes of true believers, not well-controlled randomized studies–or even halfway decent observational studies. Evangelism by Col. Niemtzow replaces science, and the result is a growing number of true believers among military physicians.

Our wounded soldiers, indeed all our soldiers, deserve only the finest in science- and evidence-based medicine that can be delivered to them, be it on the battlefield, the mobile hospital, or military hospitals overseas or in the U.S. However, as in academia, there appears to be a big push to introduce so-called “complementary and alternative medicine” into military medicine. Niemtzow’s work is funded by the Samueli Institute for Information Biology. Meanwhile, the Samueli Institute has reportedly been receiving earmarks attached to military appropriations bills, one of which was for $2 million and was for the purpose of developing “a national program for evaluation and research on complementary, alternative and holistic medical practices (also called integrative medicine) for military personnel and veterans.”

Truly the virus is spreading. Acupuncture is just the foot in the door, as woo creeps in, as it has done in academic medicine. How long will it be before we see homeopathy being used in military and VA hospitals? I truly hope I’m just being alarmist, because our soldiers deserve much better.

Comments

  1. #1 Sigmund
    March 19, 2008

    Its a good idea – so long as the enemy is firing homeopathic bullets.

  2. #2 Snark
    March 19, 2008

    Jesus, I thought I had it bad when I waited in an ER for five hours with a migraine only to be given ibuprofen. I’m having to consciously hold my jaw shut.

  3. #3 Martin Robbins
    March 19, 2008

    Orac

    Funny you should bring this up now (or not I guess since it’s the 5th anniversary tomorrow!). I posted a detailed entry on Quacks in Iraq a week or so ago, looking at the use of cutting among the civilian population, and also the beginnings of an Afghanistan-style influx of quack medicine charities like “Frontline Homeopathy”.

    See here: http://layscience.net/?q=node/62

  4. #4 J-Dog
    March 19, 2008

    Jesus Christ on an Acupuncture Crutch…

    I would be royally pissed, and probably go looking for the guy that authorized this as soon as I was able to. This totally fits with the Bush/Chenney doctrine of effing up our own troops though.

  5. #5 daedalus2u
    March 19, 2008

    Actually it was during wartime (WWII) that the first really strong evidence of the placebo effect was noticed. It was pretty obvious to the doctors treating the extremely severe injuries of battle that those soldiers required far less pain medication that would trauma of similar severity in civilians. Eventually it was realized that simply surviving the battle and the knowledge that the battle was over and that they were out of danger was enough to provide a very strong placebo effect on pain relief. Civilians injured in civilian accidents didn’t have the same mental effects pre and post injury, so they didn’t get as big a placebo effect. For the severely wounded in battle there may have also been the realization that they were no longer fit for combat and would be sent home. For the civilians there was the worry of how they were going to cope with the bills, loss of income and other consequences of the injury.

    Placebo treatments like acupuncture are only going to work if the patient believes they are going to work. Injured soldiers don’t get to pick and choose the treatments that are inflicted on them (other than theoretically). Placebos are cheaper and don’t have the potential for abuse that narcotics have, so they will become the military’s preferred first line treatment for pain.

    No doubt some soldiers will believe what they are told, and that the placebos they are given will be effective for their pain. No doubt the CAM providers want to get on the military procurement gravy train like all the other war profiteers. CAM providers don’t need to do research, so they can generate more profit, a portion of which can be turned back via lobbying to ensure continued use by the military.

  6. #6 Fidel, MD (LTC, USAF, RET)
    March 19, 2008

    WTF, over?

    The problem in combat is you’re already punctured….

    Oh, and Landstuhl hasn’t been in combat for about 63 years….

  7. #7 angrydoc
    March 19, 2008

    I found this comic a while ago…

    http://angrydr.blogspot.com/2006/12/doctor-is-out.html

  8. #8 angrydoc
    March 19, 2008

    I found this comic a while ago…

    http://angrydr.blogspot.com/2006/12/doctor-is-out.html

  9. #9 Bob O'H
    March 19, 2008

    The problem in combat is you’re already punctured….

    …acutley.

  10. #10 Citizen Deux
    March 19, 2008

    As a member of the US military, I would not want to see any corpsman coming towards me with anything not scientifically proven. However, the military is a hot bed for experimentation (good and bad). I wonder if the placebo effect of acupuncture can not be harnessed in some positive way.

    I seem to recall reading about some efficacy of acupuncture – divested of its Chinese association with Chi / Qi / meridians – in regards to mitigating pain.

    In fact, one of the best anti-woo docs has a good site on acupuncture Campbell

  11. #11 Citizen Deux
    March 19, 2008

    As a member of the US military, I would not want to see any corpsman coming towards me with anything not scientifically proven. However, the military is a hot bed for experimentation (good and bad). I wonder if the placebo effect of acupuncture can not be harnessed in some positive way.

    I seem to recall reading about some efficacy of acupuncture – divested of its Chinese association with Chi / Qi / meridians – in regards to mitigating pain.

    In fact, one of the best anti-woo docs has a good site on acupuncture Campbell

  12. #12 Martin
    March 19, 2008

    Lol, you can tell the comment submission form is screwed up thanks to all the repeat posts – now I don’t feel quite so stupid.

    “No doubt the CAM providers want to get on the military procurement gravy train like all the other war profiteers.”

    CAM providers are already moving into places like Iraq and Afghanistan to peddle their wares to the locals (http://layscience.net/?q=node/62).

  13. #13 DavidCT
    March 19, 2008

    I wonder how much Acupuncture they use in the Chinese army – particularly on the officers.

  14. #14 Oldfart
    March 19, 2008

    It’s easy to see how “battlefield acupuncture” might appeal to the Bushies. With “battlefield homeopathy” soon to follow. That way they can substitute all those expensive and hard-to-store pain-killers with re-usable needles and water…………….at a huge savings.

  15. #15 Oldfart
    March 19, 2008

    It’s easy to see how “battlefield acupuncture” might appeal to the Bushies. With “battlefield homeopathy” soon to follow. That way they can substitute all those expensive and hard-to-store pain-killers with re-usable needles and water…………….at a huge savings.

  16. #16 Oldfart
    March 19, 2008

    It’s easy to see how “battlefield acupuncture” might appeal to the Bushies. With “battlefield homeopathy” soon to follow. That way they can substitute all those expensive and hard-to-store pain-killers with re-usable needles and water…………….at a huge savings.

  17. #17 Oldfart
    March 19, 2008

    OOps. I kept getting an “Internal Server Error” and didn’t notice that my statement had posted already. Sorry.

  18. #18 vlad
    March 19, 2008

    I’m with daedalus2u. It’s nothing more than plecebo effect but I don’t see anything wrong in harnessing it in the cases that it works. Its’ cheap easy and relatively safe. I think the use of the term “battlefield acupuncture” is a horrific misnomer as when I heard it I envisioned the scenario Orac painted. If some wounded vets want acupuncture to treat his/her pain cause he/she are afraid of drugs or can’t handle side effects why not. Now the second someone proposes (or even remotely considers) field medics carry acupuncture needles and 100C diluted lead and Sarin I’d be worried.

  19. #19 Hey Zeus is my homeboy
    March 19, 2008

    Oldfart- on the other hand there are legions of antivaxxers out there who crucify Bush and Co. for being in the pocket of big pharma. Can’t have it both ways.

    But he is an asshole.

    There appears to be a growing crop of D.O.s in the military (personal observation). I’ll let the physicians get snarky and speculate as to why that is.

  20. #20 Melissa (oddharmonic)
    March 19, 2008

    I’m not surprised. When I received regular medical care through a stateside military treatment facility (MTF), acupuncture would have been a vast improvement in service.

    The “treatment” I received over three years at one MTF for chronic sinusitis and a several month bout of dysfunctional uterine bleeding can be summed up as enough ibuprofen tablets to fill a gallon-sized pickle jar (I took a photo to prove it), samples of popular allergy medications, three months’ worth of Ortho Tri-Cyclen, and over a dozen pregnancy tests.

    Military healthcare is excellent for immunizations and life-threatening injuries. I put my money on free market medicine for everything else.

  21. #21 Ginger Yellow
    March 19, 2008

    “In one technique, he places acupuncture needles into the ear, since the ear is integrated to the central nervous system.”

    As opposed to the rest of the body, which is completely disconnected and operates autonomously. Zombies!

    That said, I don’t have all that much of an issue with using acupuncture honestly to allieve chronic pain in vets. Just so long as they don’t woo it up and admit that sham acupuncture is just as effective. I’d have a serious problem with using it on the battlefield – I’m not aware of any studies showing any form of acupuncture having an effect on acute pain.

  22. #22 AndreasB
    March 19, 2008

    “Oh, and Landstuhl hasn’t been in combat for about 63 years….”

    It is however the U.S. facility where a large part of their injured soldiers from Iraq and Afghanistan are ferried to for treatment. So while they’re definitely not on the battlefield, a case can be made that the facility is in combat.

  23. #23 PalMD
    March 19, 2008

    I know that there are hundreds of thousands of American soldiers,sailors, and marines working like hell out there. I fear for their lack of leadership. My dad was (forced to be) an army doc in Korea, and he saw no end of stupidity, and no way to protest it.

    Morphine is cheap, easy, and just wonderful. Give it to them when they hurt. Jeez.

  24. #24 PalMD
    March 19, 2008

    I know that there are hundreds of thousands of American soldiers,sailors, and marines working like hell out there. I fear for their lack of leadership. My dad was (forced to be) an army doc in Korea, and he saw no end of stupidity, and no way to protest it.

    Morphine is cheap, easy, and just wonderful. Give it to them when they hurt. Jeez.

  25. #25 Inquisitive Raven
    March 19, 2008

    Orac, I thought you should know that the problem of this page causing my browser to dump itself from memory (down the to Quicklaunch icon) has manifested again. I can get around it by stopping the page from loading as before all the ads come up, but it’s a pain in the posterior. I suspect that the site has broken something with new ads.

  26. #26 ecoli
    March 19, 2008

    Good post… I responded to it in my own blog.

    Using ‘alternative medicine’ in our armed forces makes no sense. Could you imagine if we built the Air Force’s planes and weapons with ‘alternate physics’?

  27. #27 Chris Noble
    March 20, 2008

    Isn’t bleeding a natural response of the body to eliminate toxins such as lead from bullets?

    A holistic medic would not interfere with the body’s natural mechanism to heal itself.

  28. #28 natural cynic
    March 20, 2008

    Since wew’ve done so well in Afghanistan, acupuncture isn’t needed since a ready supply of the raw stuff [opium] is always close by.

  29. #29 speedwell
    March 20, 2008

    And what do they do if you have your hear shot off? Stick needles in your leg?

  30. #30 speedwell
    March 20, 2008

    What, I didn’t get a preview. I meant to type “ear”, of course.

  31. #31 Eric Bloodaxe
    March 20, 2008

    I do hope it happens, what are the Americans doing in Iraq? What did the Iraqis ever do to them?

  32. #32 Colleen Mahaney
    March 20, 2008

    As a student nurse, I think we should do whatever gives the patient relief. If they feel better with morphine- ok, but it does have alot of drawbacks like depressed resps and bp, decreased CNS acuity, not to mention the addiction issues. If conventional painkillers worked for PLP, I would gladly dispense it. However, most pain meds don’t touch it. If I can make a patient feel better with acupuncture, meditation or heavy metal music on their Ipod- I’m happy to do it!

  33. #33 Dan Green
    March 21, 2008

    For an amazing account of non-medical woo in the military, I recommend the book, “The Men Who Stare at Goats” by Jon Ronson.

  34. #34 Tim Murtaugh
    March 26, 2008

    Testing testing.