Respectful Insolence

As much as I write about the infiltration of quackademic medicine into medical academia, there is one particular area that is being increasingly invaded by such quackery. It’s an area that you wouldn’t necessarily expect, although anyone who’s read The Men Who Stare at Goats might not be so shocked. Yes, I’m referring to the military, and, as I’ve documented time and time again, increasingly our men and women in uniform are being subjected to abject quackery. What they need and deserve is the very best science-based medicine that we as a nation have to offer. Instead, what more and more of them are getting is “auricular acupuncture,” or, as it’s sometimes called, “battlefield acupuncture.” Indeed, a few years ago, while the conflict in Iraq was still raging, the Air Force began teaching physicians being deployed to that conflict “battlefield acupuncture.” Under the malign influence of a Colonel named Richard Niemtzow, a radiation oncologist and Air Force physician who has “pioneered” (if you can call it that) the introduction of this particular form of woo into the military and sold it with an evangelical zeal, the hard-nosed military doctors who want evidence and science to show them the best way to treat wounded soldiers are increasingly being seduced by the lure of alternative medicine.

And now the virus is spreading beyond soldiers with acute and chronic pain syndromes, which was the first population upon which Col. Niemtzow and his acolytes plied their wares. Now, it would appear, acupuncture is being sold for post-traumatic stress disorder (PTSD). Worse than that, though, it’s no longer just acupuncture. It’s reiki. Actually, it’s healing touch, but given that all “energy medicine” modalities, such as healing touch, reiki, and several others, are merely variations on the theme of vitalism, it doesn’t much matter. The only difference between reiki and healing touch is that reiki involves the practitioner’s making symbols with his hands, and healing touch doesn’t necessarily require that. Otherwise, both involve channeling mystical energy from a “universal source” through the healer and into the patient to heal him. At, least, that’s what healing touch practitioners and reiki masters claim to be able to do. Now this quackery is being touted as helpful for soldiers suffering from PTSD:

Healing touch combined with guided imagery produces significant measurable reductions in post-traumatic stress disorder (PTSD) symptoms for combat-exposed active duty soldiers, according to a recent study.

The study, led by the Scripps Center for Integrative Medicine in San Diego, California, involved 123 returning active-duty Marines at Camp Pendleton, California from July 2008 to August 2010.

To be eligible for the trial, participants were screened to confirm that they were currently experiencing at least one of the following PTSD symptoms: re-experiencing of trauma via flashbacks, nightmares, intrusive thoughts, exaggerated emotional responses to trauma, emotional numbness, insomnia, irritability, exaggerated startle response or avoidance of people or places that remind them of the trauma.

Writing in the journal Military Medicine the researcher say they found that patients receiving these complementary medicine interventions showed significant improvement in quality of life, as well as reduced depression and cynicism when compared to soldiers receiving treatment as usual alone.

The healing touch is described thusly:

Healing touch (also called therapeutic touch or Reiki) is an energy-based, non-invasive treatment that restores and balances the human energy field to help decrease pain and promote healing. It is often used as an adjunct to surgery and other medical procedures to assist in pain reduction, decrease anxiety and elicit relaxation.

Yes, indeed. Quackademic medicine somehow found its way into Camp Pendleton!

Now, guided imagery in and of itself might not be quackery. There’s some evidence and some plausibility that it might be helpful for some things, although for most applications it’s probably not ready for prime time yet. Not that that stops woo-meisters from using it liberally, of course, and, as in this case, combining it with more hard-core quackery. And few forms of quackery are as seriously quacky as therapeutic touch, a concept so dumb that even an 11-year-old girl can design a study that demonstrates that it doesn’t work. Apparently the doctors involved with this study don’t read the literature—or don’t care.

As I repeat so often that my audience either yawns or gags every time I do it, whenever I see a study like this described in the lay press, I have to go to the source. I have to look up the original study and see if it actually shows what it is claimed to show. Whenever I do this, quite commonly I find that what the study concludes and what the news report says the study concludes are related only by coincidence. Alternatively, what I frequently find is that the study has at least one fatal error that renders its conclusions not supported by the data. What will it be in this case? Will this be a case in which a well-designed study actually finds that therapeutic touch has objectively measurable effects so compelling that they force us to reconsider the utter implausibility of theapeutic touch?

Nope. The current laws of physics that proclaim therapeutic touch and other forms of energy healing to be physically impossible are safe. There are no data in this paper that make us wonder about them at all because the study does indeed have a fatal flaw, which I’ll get to very soon. In fact, I’d be shocked if my regular readers don’t see it immediately just by reading the abstract:

Post-traumatic stress disorder (PTSD) remains a significant problem in returning military and warrants swift and effective treatment. We conducted a randomized controlled trial to determine whether a complementary medicine intervention (Healing Touch with Guided Imagery [HT+GI]) reduced PTSD symptoms as compared to treatment as usual (TAU) returning combat-exposed active duty military with significant PTSD symptoms. Active duty military (n = 123) were randomized to 6 sessions (within 3 weeks) of HT+GI vs. TAU. The primary outcome was PTSD symptoms; secondary outcomes were depression, quality of life, and hostility. Repeated measures analysis of covariance with intent-to-treat analyses revealed statistically and clinically significant reduction in PTSD symptoms (p < 0.0005, Cohen's d = 0.85) as well as depression (p < 0.0005, Cohen's d = 0.70) for HT+GI vs. TAU. HT+GI also showed significant improvements in mental quality of life (p = 0.002, Cohen's d = 0.58) and cynicism (p = 0.001, Cohen's d = 0.49) vs. TAU. Participation in a complementary medicine intervention resulted in a clinically significant reduction in PTSD and related symptoms in a returning, combat-exposed active duty military population. Further investigation of GT and biofield therapy approaches for mitigating PTSD in military populations is warranted.

Did you figure it out? Did you guess even before you read the abstract? Yes, notice how this is a completely unblinded study, which renders is virtually useless. There are a lot of other serious flaws, but that’s the fatal one, particularly in a study of a condition where objective measures are hard to come by. It’s so bad that I wonder why they even bothered to do the study. In fact, it’s so bad that I wonder why any IRB would have approved it, as it’s unethical to do a study with such an implausible mechanism and a design guaranteed to provide no answer to the hypothesis being tested. Yes, I realize that it’s only a pilot study and that it was only meant to look for indications of efficacy, but that makes it even worse. It also doesn’t help that the authors completely buy into the pseudoscientific rationale behind therapeutic touch:

Participants randomized to the intervention group received a combined intervention of HT+GI. The purpose of combining these interventions was to provide the participant both with practitioner-based treatment (HT) to establish a “safe space” using a nonstigmatizing touch-based therapy aimed at eliciting the participant’s own healing response, whereas also engaging in a self-care therapy (listening to GI CD) that helped the patient to work with trauma-related issues including trust and self-esteem. HT is a type of biofield therapy that involves gentle, noninvasive touch by trained practitioners, who utilize specific techniques with the intention of working with the body’s vital energy system to stimulate a healing response. Two nurses certified in HT, with several years of experience in using HT with patients, provided the HT intervention. Practitioners met on a regular basis to discuss use of specific techniques and ensure intervention delivery consistency. Practitioners utilized three specific HT techniques: Chakra Connection (involving techniques used along the body, intended to stimulate movement of vital energy through the body), Mind Clearing (techniques performed on the head, intended to stimulate mental relaxation), and Chakra Spread (an advanced technique utilized by HT practitioners and generally reserved for patients with more severe symptoms, intended to promote deep healing for emotional and/or physical pain).

Chakra Spread? I had never heard of it before. Fortunately, the power of almighty Google rapidly educated me. You really have to get a load of the nonsensical description that I just linked to. It includes instructions to “focus on the love that God has for this person while slowly spreading both hands outward as far as possible three times”; “pull access energy off the legs and feet by placing your hand over each leg and moving slowly downward”; and “visualize energy being pulled up from the earth through your spine and spreading throughout your body.” I suppose I should be relieved that the Chakra Spread is one of the approved Healing Touch interventions, which also include: Magnetic Clearing, Chakra Connection, Ultrasound, Laser, Scudder, Pain Drain, headache, back and neck techniques, Spiral Meditation, Hopi Techniques, Mind Clearing, Wound Sealing, Chelation, Etheric Clearing, Lymphatic Drain, Full Body Connection, Etheric Vitality. Also remember that this nonsense is taught in quite a few nursing schools and used by nurses in many hospitals. So seeing it in the military is, albeit disappointing, not entirely unexpected. Seeing it used in a quackademic clinical trial at Camp Pendleton is enough to make a marine cry.

Here’s the thing. The study proposed is designed such that, even if perfectly executed, it can’t falsify its hypothesis. There’s no way to tell whether any improvements in the HT + GI group are due to pure placebo effect or might be due to a treatment effect. Again, there is no blinding whatsoever; so both patient-related confounders (such as placebo effects) and practitioner-related confounders (observation effects, expectation bias) come into full play without anything to check them. That’s leaving aside the numerous other flaws in the experimental design, such as lack of adequate followup, small numbers, lack of adherence monitoring, and low representation from some minority groups. Worse, because the GI is combined with the HT, there’s no way to tell whether any positive result is due to the GI, the HT, or requires both. Ignoring for the moment the utter physical and biological implausibility of therapeutic touch, it is possible to do a study with a rigorous design. Basically, you would set up experimental groups not as TAU versus HT+GI. Rather, you would have the following groups:

1. TAU
2. TAU + HT
3. TAU + GI
4. TAU + HT + GI

In addition, you would have to have additional groups, which, for want of a better term, we would refer to as “sham GI” and “sham HT.” For instance, sham GI could involve giving the soldier incorrect instructions how to do it, and sham HT could involve doing it at the “wrong” places, much as sham acupuncture involves sticking needles into the “wrong” locations. So then we would have the following additional groups:

5. TAU + sham HT
6. TAU + sham GI
7. TAU + sham HT + Sham GI

I realize that’s a lot of groups for a pilot study. If the investigators are so completely convinced that the GI and HT have to go together, the number could be whittled down to two in the simplest configuration:

  1. TAU + HT + GI
  2. TAU + sham HT + sham GI

Then, if this study is to be rigorous, it needs to be double blind. The patients can’t know what they’re getting, and the investigators assessing their PTSD measures can’t know which patient is in which experimental group. If the authors could do the study they published, they certainly could have done this study if they had really wanted to. Apparently they didn’t really want to. Why, who knows? Yes, it’s a lot more of a pain in the posterior to double blind the experiment, and to include sham HT and GI, but then if they got an answer it might have meant something, although given that HT is nothing more than a form of faith healing any therapeutic effect would have had to have come from the GI. As it is, the results showing less depression, less cynicism, and decreased PTSD symptoms tell us nothing. They could all be due to a combination of placebo effects and observer bias. All that work was done for, in essence, nothing and tells us nothing. The faxt that it is randomized and controlled doesn’t matter; the randomization is completely wasted.

Finally, I wanted to conclude by taking a look again at the rationale for combining the HT and GI. A more pseudoscientific load of—if you’ll excuse me, in light of the recent Vice Presidential debate, I can’t resist—malarkey is hard to imagine:

The decision to combine the two complementary medicine interventions was based on consultations with expert practitioners who, based on prior experience with similar populations, suggested that the combination of both biofield healing and GI would synergize to provide maximum effectiveness in reducing PTSD symptoms in the following manner: the GI, which focuses on creating a sense of spiritual safety and deep relaxation, provides an atmosphere where the participant could allow him or herself to safely and deeply engage into a relaxation response and therefore also gain maximum benefit from the interaction with the HT practitioner. The continued pairing of this relaxation response with the positive and trusting interaction with a health care professional and invitation for spiritual grounding and self-connection would further the possibility of the mind–body to “let go” of the residual conditioning of previous trauma, and thus reduce PTSD symptoms. The underlying rationale for combining the two techniques is not unlike the underlying rationale for many psychotherapeutic approaches, where it is understood that establishing trust, rapport, and often also a sense of relaxation are fundamental to the therapy process—it is thought that with this foundation, the engagement in cognitive or behavioral processes to “process and let go” of traumatic experiences for symptom reduction is more effective. Thus, it may be argued that the main difference between these so-called “traditional” psychotherapeutic approaches and these “complementary medicine” approaches are simply the explicit foci of the therapies (i.e., practitioner focus on cognitive or behavioral techniques vs. practitioner focus on spiritual-energetic techniques).. Whether the actual underlying mechanisms surrounding current psychotherapeutic approaches and many practitioner-assisted complementary medicine approaches are different remains to be elucidated.

Ya think?

This entire lengthy paragraph (and I didn’t even quote the entire paragraph) is the written equivalent of the waving of hands to cast a magical spell, much as Doctor Strange does—or the way that Harry Potter waves his wand around when casting a spell. Heck, healing touch practitioners basically visualize energy flowing through them and through the patient much like this image:

The main difference is that, in the world of Doctor Strange or Harry Potter, magic actually works and has rules. Here, the practitioners of the quackery that is healing touch make it up as they go along, the only rule being, apparently, that wishing makes it so.

Comments

  1. #1 Darwy
    Røde grøde med fløde
    October 18, 2012

    Sigh.

    I don’t understand how studies like this make it past the ‘planning’ stage; it kills me that money gets wasted on BS like this when it could be used to genuinely help others.

  2. #2 herr doktor bimler
    October 18, 2012

    the hard-nosed military doctors who want evidence and science to show them the best way to treat wounded soldiers are increasingly being seduced by the lure of alternative medicine.

    Now we see why they’re resorting to ‘auricular acupuncture’, i.e. needles in the ears.
    It’s because their noses are too hard.

  3. #3 elburto
    October 18, 2012

    Ouch. So that multi-billion dollar military budget of yours (US tax payers) is going toward:

    o “focus on the love that God has for this person while slowly spreading both hands outward as far as possible three times”; “pull access energy off the legs and feet by placing your hand over each leg and moving slowly downward”; and “visualize energy being pulled up from the earth through your spine and spreading throughout your body.”

    How about a dose of transcortical lead therapy for whoever approved this demented “intervention”?

    PTSD isn’t lower back pain, or TATT. Sufferers need real intervention, especially if they’re trained in deadly force and in a country full of guns.

    I have PTSD (caused by abuse) and when I’m having a flashback I am not here, I’m back there, and revert to whatever behaviour will protect me, like screaming or physically lashing out with my hands or feet. Psychologically wounded combat veterans experiencing flashbacks, with likely access to firearms, who’ve *cough* had their PTSD “pulled off their body” in lieu of actual therapeutic intervention, and sent back into their communities or service? Recipe for disaster.

    How long until they’re trialling “therapeutic touch” at a distance? I mean, at least that can facilitate blinding…

  4. #4 StrangerInAStrangeLand
    October 18, 2012

    One question that comes to my life-long civilian mind: How much choice does a soldier have in choosing or rejecting a treatment given to him by a superior officer? If my GP would try to treat me with magic instead of medicine, we would have a few words about this … and then I would switch to another doctor. How far would this be possible if a doctor in the military is convinced of woo and insists on it? What could a soldier do in this case to get the correct, SBM-based and working treatment he/she deserves?

  5. #5 BCM
    USA
    October 18, 2012

    Chakra Spread? New from “I Can’t Believe It’s Not Science!”

  6. #6 Anj
    October 18, 2012

    Stranger…

    From anecdotes, it can take a LOT to get your care transferred. One topic is child birth and the military, gawd, has a terrible anecdotal track record when it comes to labor and childbirth. One woman had her husband pull rank to get her care transferred and without that, she thinks it was very unlikely the transfer would have happened.

    (I’m not a huge believer in anecdotal evidence, but the anecdotal evidence of even competent military child birth care is much smaller than incompetent, pathetic or miserable care. )

  7. #7 Shay
    October 18, 2012

    Oh gawd. And here I was congratulating myself that only the Air Farce would be that stupid.

    I am going to send this to a sergeant major I know and get his reaction.

  8. #8 Denice Walter
    October 18, 2012

    You don’t say! CBT vs hand waving and pin-sticking?

    About those “underlying mechanisms”, there isn’t any mention of possible physiological differences which might predispose certain individuals towards developing PTSD after having experienced trauma… no mention of recent studies, huh? I wonder why?

    On an entirely lighter note:
    the *other* Quackademic thread which hosted Reiki stylist, Marg, for many weeks has run out of um.. energy. HOWEVER here we are again: quackademia and energy healing. uh-oh.

  9. #9 THS
    October 18, 2012

    Uh-oh indeed. I was thinking same before I scrolled to Denice’s 10:02 comment. Also: “hard-nosed” military doctors? Could we find a study where soldiers were ordered to improve – with good efficacy?

  10. #10 Mu
    October 18, 2012

    There is a reason this is coming from the military – they’re desperate in regards to PTSD. They keep getting soldiers back from the front with a PTSD diagnosis, and that typically lead to a medical discharge as combat related (aka full benefits) injury. That blew the VA budget out of the water, and lead to “reevaluations” by stateside medical teams to avoid the discharge. So now they’re stuck with a bunch of treatment requiring soldiers, sky-high suicide rates, bad publicity for the high rate of divorce etc. Plus cost pressure for treatments, and you don’t need a MD to wave your hands.
    On the other hand, it’s basically psychiatric treatment, and a large part of that is make the patient believe something else. If that works via “Chakra” it’s about as plausible as a session on Freud’s couch. It’s all in your head.

  11. #11 qetzal
    October 18, 2012

    I like how the “approved Healing Touch interventions” tries to co-opt other favorite woos like Magnetic and Chelation. Ultrasound is pretty impressive, too! I wonder how that works? Does the healer vibrate their hands really fast? Or maybe they just screech at you in a really high-pitched voice.

    What about the Laser Healing Touch? Do they shoot beams of light from their fingers? I guess as long as they’re doing magic, they might as well get some superpowers out of the deal, right?

    I’m confused about the headache one though. How is headache an intervention?

  12. #12 Krebiozen
    October 18, 2012

    I was interested in the effect sizes in this study. Cohen’s d ranges from 0.49 to 0.85. Cohen’s d is a measure of the difference between means expressed as a multiple of the standard deviation. So the maximum effect seen in this study was less than one standard deviation. That really isn’t very impressive, and I very much doubt it translates to clinical significance. Or perhaps I need my chakras spread to deal with my cynicism.

  13. #13 BG
    October 18, 2012

    Why, I had Chakra spread on my bagel this morning (“you think it’s butter, but it’s not”) this morning!

    @ Shay, and others, in advance: please, folks, let’s take it easy before piling on here. I served in the Air Force, proudly, in an allied health career field, and I can state without hesitation that patient care standards in military medicine are as just as high as in the civilian sector, and you will find dedication to patient care that is nothing short of inspiring. If you want to start comparing military and civilian health care with respect to medical horror stories, bungled patient care, tales of woo infiltrating the profession, etc., we’ll be here all day. It exists on both sides of the fence, so let’s not go there, please.

    Shay: If the point of sending this to a sergeant major you know (which is, of course, an Army and Marine Corps enlisted rank, not Air Force) is that you’re looking for confirmation about how ridiculous the “Air Farce” can be, what’s the point? The branches all rib one another about their differences and perceived shortcomings, but we’re all on the same team, and anyone with a brain who has served will acknowledge that and can see beyond it. If you want to talk about Army and Marine Corps nonsense, I know a few Air Force chief master sergeants who will oblige, but again, what’s the point?

  14. #14 Denice Walter
    October 18, 2012

    @ Mu:

    As elburto eloquently describes ( re flashbacks), PTSD is indeed physical and those who suffer, suffer physically as well as psychologically. I imagine that there is also a social aspect: it affects your life and commerce with others.

    Here’s the great problem with alt med: they deride SBM for being *non-spiritual* yet they adamantly refuse to treat whatever causes great suffering – physical and psychological- because they will never admit that meds help anyone. I suppose it’s more *spiritual* to suffer.

    Their odd beliefs about mind, soul, spirit as being somehow ultra-physical or emanating from the ultra-mundane leads them to sample wildly, un-testable hypotheses about the origins of psychological problems.
    Perhaps casting out the *bad* energy is a bit like casting out a demon..

    While SB psychology is not perfect, at least it admits that conditions such as PTSD have physical and psychological components and there are tested methods to address both: meds and cognitive ( and related) therapy.

  15. #15 Shay
    October 18, 2012

    BG — the point of sending this to Sgt Maj Burke is to get his always-eloquent and usually profane reaction to the notion that some of his Marines are being treated for PTSD with woo instead of something that actually, you know, works.

    One of these days I’ll have to stop snarking about the Air Force, I suppose. Two of my nephews fly C-130s.

  16. #16 Mu
    October 18, 2012

    DW, I’m not saying that PTSD is not a real diagnosis with real physical symptoms. I’m saying that the woo might just act just like a lot of the cognitive treatments, in making the patient deal with his issues in a relaxed, stress free atmosphere where somebody is caring. The claimed mechanism of action might be nonsense, the effect might not be.
    So I strongly doubt the ethics of doing this to active duty soldiers, there cannot be an informed, coercion-free consent to be part of a trial.

  17. #17 Denice Walter
    October 18, 2012

    @ Mu:

    Sure. At least about the caring part and stress-free parts; spas are nice too.. Still, I’d wager that the woos don’t provide a set of strategies for the person to work on and try out in the real world- I’d guess it’s more like,” Think good thoughts.” not aimed at problem solving in the social/ occupational realm.

  18. #18 Narad
    October 18, 2012

    What about the Laser Healing Touch? Do they shoot beams of light from their fingers?

    There appears to be a practical gap in frequency coverage that starts at the near-IR and extends to the near-UV, although this should be surmountable.

  19. #19 Bronze Dog
    October 18, 2012

    Why, I had Chakra spread on my bagel this morning (“you think it’s butter, but it’s not”) this morning!

    Look, we’re skeptics, here. I can’t believe it’s not butter just based on your anecdote alone. [/snark]

    I finally watched the movie version of The Men Who Stare at Goats and had some laughs, though it’s disturbing that there are such wacky things going on in the military. I’m sympathetic to cutting military spending, and projects like this would be the first easy cuts. (The first hard cuts would involve reduction in excuses to send our troops into combat without clear, realistic goals.)

    As for blame, I imagine a lot of this comes from higher-ups who fancy being able to allocate money to their pet woo beliefs.

  20. #20 Denice Walter
    October 18, 2012

    @ Narad:

    That site is a keeper! And I thought that I had seen it all…
    Tom Om? Symbols for accessing your local gnomes, goblins, fairies, elf (sic) and angels.
    Help for Gaia.. but what about for your average guy- uh?

  21. #21 PA_in_VA
    October 18, 2012

    As an Army National Guard PA, currently activated to care for Wounded Warriors, I wish I could say that I am completely surprised by this. I will say that the woo is not *yet* as widespread on the military side of the house as it is on the civilian side (as a Guardsman I work in both), but we are apparently now performing Accupuncture in-house in some of our pain management clinics on both the Army and VA sides. Interestingly, none of my patients who are getting the accupuncture think it is helping (go figure). The civilian NP in the office across from mine would really like to send them all for Reiki, but so far no one is taking her up on it.

  22. #22 Politicalguineapig
    October 18, 2012

    I wonder if the rise in quackery could be related to a rise in evangelicals in the military. Evangelical Christians, as a rule, are very credulous and susceptible to all kinds of nonesense. So there’s a set of very credulous people who are dealing with a very hard to treat disorder, and naturally, they’ll seize on the quickest, easiest option- which is woo.

  23. #23 David N. Brown
    October 18, 2012

    I’d say the real problem here is that the advocates of “reiki” haven’t made up their minds what to present themselves as. I could see two ways they could make a credible case for their methods at least being considered, particularly for a psychiatric condition such as PTSD: First, they could present the physical-contact aspects as a form of physical therapy (pretty much the route chiropractors successfully took to a bare minimum of acceptance). Second, they could defend the overtly metaphysical premises of reiki as a form of religious counseling. But as long as they not only hang in the middle, but cloud matters further with truly grandiose claims about “cures”, they undermine themselves.

    David N. Brown
    Mesa, Arizona

  24. #24 PA_in_VA
    October 18, 2012

    Since the number of Christians of any stripe in the Army is in fact dropping precipitously, along with a corresponding rise in Atheist/Agnostic and Pagan Soldiers, I seriously doubt it. And I am both a Christian (mainline Protestant) and a firm believer in SBM, so I don’t think the two go as hand-in-hand as many in the sceptic community seem to think. In fact I would think that the rise in Paganism of various stripes would be more likely to lead to magical thinking.

    In reality I think it is related to nothing more than “all our colleagues on the outside are offering this, so we have to too”, partially as a way to keep the money in the system that’s lost when referring patients for civilian care and partly to make sure everyone knows how “compassionate” our care is after all the scandals when the first group of Soldiers came back from OEF/OIF.

  25. #25 Jay Gordon
    October 18, 2012

    This Great Dane is about to give birth. When I saw the title “Dog Bless You,” I thought of you.
    Early labor last night. Probably deliver today. And, the bears in the Alaskan snow storm are just great.
    http://explore.org/#!/live-cams/player/great-dane-service-puppies-indoor-puppy-room

    Best,

    Jay

  26. #26 PA_in_VA
    October 18, 2012

    There is also a *lot* of pressure to do everything in our power to take care of these guys and gals who are coming back with horrendous physical and emtional injuries. Working at a CBWTU there is tremendous pressure to give the patient what they want, regardless of whether it is clinically necessary. We providers and our NCMs are constantly banging our heads against a wall trying to get patients to accept appropriate care, while being pressured by the command to be more “understanding”, which often translates into repeated referrals for non-medically indicated care. These facilities are under a microscope from when it comes to patient complaints as no-one wants to be accused of even the appearance of patient neglect after Walter Reed a few years back..

  27. #27 Grant
    October 18, 2012

    [off-topic]

    ‘Pakistan polio worker shot dead in Quetta’

    http://www.bbc.co.uk/news/world-asia-19977508

  28. #28 Sastra
    October 18, 2012

    Perhaps part of the push for this is coming from the public relations department. A good number of people who advocate for peace and criticize the military vociferously are often enthusiastic defenders of “holistic” forms of therapy. So connect the military with alternative medicine woo and … concerns are abated? The sides are united? I don’t know. The strategy may have occurred to someone somewhere, who knew better but gave it the green light anyway.

  29. #29 JustNuts
    October 18, 2012

    I’m not sure how you can do “Sham HT” since it’s already a sham!

  30. #30 Guerilla Surgeon
    October 18, 2012

    God, battlefield acupuncture – They should watch ‘homeopathic emergency room’ Google it, it’a funny.

  31. #31 Narad
    October 18, 2012

    Even worse, auricular acupuncture is a purely French invention. Because your ear looks like an inverted fetus. See? Makes perfect sense.

  32. #32 nastylittlehorse
    in bed
    October 18, 2012

    Off topic but – Orac you have got to have a word with someone about your advertisers, I’m getting side-panel ads for scientology and their ‘stress tests’. Just doesn’t seem right…

  33. #33 Sialis
    October 18, 2012

    I’d be interested in hearing what people think about non-profit run programs like this one that started out of the Washington, D.C. area. The organization is called Team River Runner and they have since expanded to having chapters in several states across the U.S.

    http://www.teamriverrunner.org/?q=node/212

    http://www.wtop.com/41/3050905/Wounded-warriors-make-a-splash-for-a-good-cause

  34. #34 jre
    October 18, 2012

    Orac – if it soothes your tarriel cells a bit, let me assure you that not all military doctors are taken in by this stuff.
    I just got back from a panel review of military injury research during which the surest way to get pummeled was to float a positive result without significance, or a negative result without power. The difference between that experience and the sorry examples you’ve cited? The colonel in charge of our panel stood up at the start and said [paraphrasing] “This program is about good science, not rosy expectations. All I want to see is the science.” And, you know what? That’s all we got.

  35. #35 Politicalguineapig
    October 18, 2012

    PA in Va: Oh, sorry, I didn’t know that. My only data about religion in the military comes from Daily Kos, and I admit that I was extrapolating from their data- which is a few years out of date and somewhat skewed.
    In regards to the opinions of skeptics, I suspect that many of them were raised outside the church (as I was) or were escapees from evangelical communities. Since the only group of Christians that the media pays attention to are evangelical Christians or Catholics, it’s easy to wind up with a pretty screwy idea of what Christianity *is.*

  36. #36 PA_in_VA
    October 19, 2012

    Politicalguineapig – Nah, this year the media also pays attention to Mormonism :)

    I grant your point, It’s frequently rather bemusing to see what sorts of things I supposedly believe as portrayed on TV.

  37. #37 PA_in_VA
    October 19, 2012

    Politicalguineapig – Nah, this year the media also pays attention to Mormonism :)

    I grant your point, It’s frequently rather bemusing to see what sorts of things I supposedly believe as portrayed on TV.

    The military’s attitude toward religion has shifted so much in the last 2 or 3 years that it is now not uncommon to hear chaplains ask for permission, or at least assure the audience that there is no intent to exclude other belief systems before offering a benediction. Apparently the rote phrase now being taught in the chaplains course is something like “And now let me pray in my believe tradition as you pray in yours.” I’ve heard it several times now and it is always a little odd on the ear, if well-intended.

    Sastra- The really weird thing is how many of those vociferous anti-military peace advocates actually serve as civilian medical providers in the DOD. Particularly as NPs and LCSWs.

    I hereby promise not to take up battlefield accupuncture, no matter how many bad studies support it, Good grief. So how much of a delay does that cause in getting the Soldier to definative care? That golden hour sure ain’t getting any longer.

  38. #38 Bronze Dog
    October 19, 2012

    jre:

    The colonel in charge of our panel stood up at the start and said [paraphrasing] “This program is about good science, not rosy expectations. All I want to see is the science.” And, you know what? That’s all we got.

    I’m not military, but I salute your colonel.

  39. #39 Politicalguineapig
    October 19, 2012

    PA_in_VA: Yeah, and it’s amazing how much the media seizes onto one facet of religion and ignores everything else. I don’t care about *anyone’s* underwear- if they have to ask about the odder bits, couldn’t they ask if Romney plans to ban alcohol, coffee and chocolate?
    In my case, I knew a few Christians in high school, but it wasn’t until college that I found out about ‘progressive Christianity.’ Even though I know better now, I still have a fixed idea that ‘progressive,’ ‘scientist’ and ‘Christian’ are contridictory terms.
    It’s interesting to hear about the shift in the military’s mindset. I have to apologize for my remarks before hand; I do have a lot of fixed ideas about people- I’m trying not to do that, but it’s really hard to break that habit.

  40. #40 Jon
    October 20, 2012

    During World War II, it was circumcision to prevent…name a condition. Any condition. It doesn’t even matter if it’s not penis-related; circumcision prevents it. (Circumcision, by the way, passes the Rath Test: All quackery will eventually make insane assertions wrt HIV and develop a persecution complex.)

    These days, it’s far more. But a lot of it isn’t even the military’s doing. The military often gets projects they don’t even want specifically because Congress appropriated money to that. (See, for instance, the Osprey.)

    On top of that, though the government funds the National Academy of Sciences, I’m convinced our government is anti-science. During the Clinton-Bush years, they continued to pour money into cold fusion research, never mind that it is perpetual motion.

  41. #41 Shay
    October 20, 2012

    Can’t help it; when I read the words “battlefield acupuncture” I think of bayonets.

    Seriously. It sounds like a euphemism, like “Irish confetti” for a brick.

  42. #42 PA_in_VA
    October 21, 2012

    Politicalguineapig: No need to apologize, you’ve been perfectly polite and reasonable, which is all I hope for out of folks these days. More than I hope for some days on the internet.

    Shay: I am hereby stealing that as a euphemism. Though if I ever find myself somewhere with a bayonet, someone somewhere has made a wee miscalculation.

  43. #43 Shay
    October 22, 2012

    You could probably do a dandy field-expedient tracheotomy with one.

  44. #44 Chaya
    NM
    October 30, 2012

    Stranger – You will see variation in this, but the bottom line is that a soldier’s doctor gives him orders, and he must obey them. The government owns the soldier and also owns doctors to keep the soldier in fighting trim.

    The relationship between veterans and their doctors is different.