The VA and Dr. Tracy Gaudet: Integrating quackery into the care of veterans

I was originally going to write this post for the 4th of July, given the subject matter. However, as regular readers know, I am not unlike Dug the Dog in the movie Up, with new topics that float past me in my social media and blog reading rounds serving as the squirrel. But never let it be said, though, that I don't circle back to topics that interest med. (Wait, strike that. Sometimes, that actually does happen. After all, I have been at this nearly 12 years now. It just didn't happen this time.) This time around, I will be using documents forwarded to me by a reader as a means of revisiting a discussion that dates back to the early days of this blog, before discussing the broader problem, which is the infiltration of pseudoscientific "complementary and alternative medicine" (CAM) into VA medical centers.

The return of the revenge of "battlefield acupuncture"

Today's topic is the Veterans Health Administration (VHA) and its embrace of pseudoscience. VA Medical Centers (VAMCs) provide care for over 8 million veterans, ranging from the dwindling number of World War II and Korean War veterans to soldiers coming home now from our wars in Iraq and Afghanistan. Although there have been problems over the years with VAMCs and the quality of care they provide, including a recent scandal over hiding veterans' inability to get timely doctor's appointments at VAMCs, a concerted effort to improve that quality of care over the last couple of decades has yielded fruit so that today the quality of care in VA facilities compares favorably to the private sector. Unfortunately, like the private sector, the VA is also embracing alternative medicine in the form of CAM, or, as its proponents like to call it these days, "integrative medicine," in order to put a happy label on the "integration" of pseudoscience and quackery with conventional medicine.

Militaryacupuncture1

Of course, I have discussed the intrusion of woo into the military before. For instance, a post I wrote in SBM's first year of existence discussed Col. (Dr.) Richard Niemtzow, a radiation oncologist by training but also one of the Department of Defense doctors trained as certified acupuncturists, and his advocacy for "battlefield acupuncture." (Just type “Richard Niemtzow” and “acupuncture” into the search box of this blog. I’ll wait.) The form of acupuncture that Col. Niemtzow advocated was auricular acupuncture, which involves inserting tiny needles into the ear and leaving them there until they fall out. He even pioneered a program to train physicians in "battlefield acupuncture" and deploying them to combat zones. Not surprisingly, the evidence base cited in support of such a program was—how do I put this?—underwhelming, but that hasn't dampened enthusiasm for the idea and other alternative medicine in the military. Given that my last post on battlefield acupuncture was at least five years ago, I thought I'd take a look again at the infiltration of "integrative medicine," including battlefield acupuncture, into the military and the VHA. Unfortunately, unlike blog bud Clay Jones' satirical—or...is it?—piece about robotic acupuncture, this is no joke. It's really happening.

As goes the military, so goes the VA

Not surprisingly, where the military goes, it doesn't usually take too long for the VHA to follow, largely because its patient base is veterans and many of its physicians come from military medicine backgrounds. Indeed, there is even an organization called the Defense and Veterans Center for Integrative Pain Management (DVCIPM), which has teamed with the Department of Defense (DoD) and the VHA to set up a program called Acupuncture Training Across Clinical Settings (ATACS), to promote battlefield acupuncture (BFA):

ATACS will be deploying certified Battlefield Acupuncture (BFA) trainers to receptive Department of Defense/Veterans Affairs (DoD/VA) medical centers to teach this technique to qualified providers and collect data to assess patient and project outcomes. The intent is that these trained providers will act as "sustainers" and assist with the ongoing incorporation of Acupuncture into practice within the MHS/VHA. Under the discretion of the DoD/VA medical facility leadership, ideal candidates would be physicians, nurses, any healthcare provider that has pain management responsibilities either at the Medical Treatment Facility (MTF) or deployed.

Yes, you read that right. The intent of this program is to "integrate" acupuncture into routine practice in the VHA and DoD medical facilities. Even now, the VHA is claiming:

The Battlefield Acupuncture technique is a unique auricular (ear) Acupuncture procedure developed in 2001 by then Air Force Colonel Richard Niemtzow, M.D, to train Physicians, Physician Assistants, Nurse Practitioners, and other providers to treat pain throughout the MHS and VHA. This technique provides a much needed alternative in cases where the initiation or continuation of opioid analgesics is deemed clinically risky, in cases where current medications and other therapies are not working, and cases where the existence of and potential for substance abuse, addiction and tolerance issues make medication therapies impractical.

The BFA course – usually 1-2 half days – teaches non-acupuncturist clinical providers the BFA technique. Training in BFA offers providers the opportunity to enhance their clinical practice skills in musculoskeletal and pain management conditions by adding Battlefield Acupuncture technique to their "tool bag." It is hoped that this technique will be a primary or secondary modality to reduce the use of opioids and habit forming drugs.

If acupuncture is, as David Colquhoun and Steve Novella so aptly put it, nothing more than a theatrical placebo, then auricular acupuncture is placebo without a lot of the theatrics. What impressed me most about the FAQ on BFA published by the DVCIPM (see, I can use alphabet soup acronyms and abbreviations like the ones the military uses too) was the utter lack of scientifically compelling evidence. All there is, except for an ancient (2002!) functional MRI study is a small unblinded pilot study that I've discussed before, a larger unblinded study using a grab bag of different forms of acupuncture, discussed here, and a study of the "feasibility of introducing BFA into the aeromedical evacuation system."

Typical of CAM research, this is putting the cart before the horse. First, it should be established that a treatment actually works (i.e., is efficacious and safe). Only then should studies examining the feasibility of integrating the treatment into the aeromedical evacuation of wounded soldiers be undertaken. Unfortunately, this is a metaphor for what the VHA is doing: integrating unscientific and unproven CAM modalities in the absence of compelling evidence to treat, in particular, chronic pain and post-traumatic stress disorder (PTSD), both unfortunately very common afflictions of veterans, particularly combat veterans.

Yet, the VHA is charging full steam ahead to "integrate" dubious treatments into its array of offerings.

Lots of CAM in the VA, but we need more, more, more...

One of the documents a reader sent me was the report, "FY2015 VHA Complementary and Integrative Health (CIH) Services (formerly CAM)." I note that "complementary and integrative health" (CIH) seems to be the new government-sanctioned term for CAM, as reflected not only in this report but in the recent renaming of the National Center for Complementary and Alternative Medicine (NCCAM) to the National Center for Complementary and Integrative Health (NCCIH). One could view this as just another step in the evolution of "integrative medicine." Be that as it may, this report is very revealing, particularly taken in context of the history of CAM/CIH use in the VHA, as represented by major "achievements" touted by the VHA, not the least of which is a 2011 VA survey showing that 9 out of 10 VHA facilities offer at least some CAM/CIH and the expansion of VA funding for studying CAM treatments for PTSD in the same year, because there was "scant evidence" from randomized controlled clinical trials. This report is more recent; so let's take a look.

Here are some of the key findings of the FY2015 report:

  • Most administrative parent facilities offer at least one CIH service to Veterans (93% in 2015 vs. 89%in 2011).
  • Although many facilities offer CIH services, the availability of these services is limited. In facilities offering an individual CIH service, only acupuncture, chiropractic, mindfulness, Stress Management Relaxation Therapy (SMRT), acupressure, and movement practices are offered at a rate equivalent to at least one half day per week.
  • CIH services are offered in all the VA clinical care settings inquired about in this survey.
  • Most CIH services are offered by VA providers, however, a portion of this care is provided by Without Compensation (WOC) providers. The most common CIH services being provided by WOC providers include Yoga (58%), Animal Assisted therapy (52%), and Tai-chi/Qi gong (36%).
  • Chiropractic care and acupuncture are the two modalities most likely to be referred to non-VA care providers by a VA facility.
  • Of the 131 sites offering CIH services, the top perceived factors enabling services are that CIH is consistent with patient-centered model of care (122 sites), promotes well-being (121 sites), being adjunctive to chronic disease management (109 sites), as well as patient preference (104 sites). (Table 1.b.)
  • Providers' perception of the top three services for which veterans are asking for more offerings include acupuncture (80%), chiropractic (80%), and massage therapy (81%).

Here are the sorts of CIH/CAM offered at VHA facilities (click to embiggen):

CAM at the VA

One notes a lot of the usual modalities rebranded as somehow being "CAM/CIH," such as diet, exercise, relaxation, and the like, but there are also acupuncture, which is a modality based on the vitalistic principles of traditional Chinese medicine (TCM), such as the flow of qi, or "life energy." There's also chiropractic, and, as I like to say, chiropractors are incompetent physical therapists with delusions of grandeur, which tells me all the funds wasted on chiropractic would be better used hiring more physical therapists at VHA facilities. And what is this with 13% of VHA facilities offering sweat lodges and 30% offering "energy medicine," which encompasses reiki, therapeutic touch, and other forms of what can only be described as pure quackery?

The naturopaths pounce

As I like to point out any time the topic comes up, naturopathy is a hodgepodge of modalities ranging from traditional Chinese medicine, to reflexology, to supplements, to applied kinesiology, to just about any pseudoscientific medicine you can think of, all mixed with a dollop of diet and lifestyle co-opted from science-based medicine to give the quackery a patina of seeming scientific respectability. All you really need to know to know how bad naturopathy is this: The One Quackery To Rule Them All, homeopathy is an integral part of naturopathy, takes up many hours of instruction in naturopathy schools, and is featured on the NPLEX, the naturopathic licensing examination. In other words, you can't have naturopathy without homeopathy.

Predictably, last fall, seeing the open embrace with which the VHA is inviting quackery into its VAMCs, naturopaths saw their opening and decided to pounce on this opportunity. The largest "professional" organization for the quacks known as naturopaths, the American Association of Naturopathic Physicians (AANP, which unfortunately shares an abbreviation with the American Association of Nurse Practitioners and must be distinguished from such a respectable organization) has teamed up with American Veterans (AMVETS) to lobby Congress to pass a bill that would pay for "natural, non-pharmacological approaches to treating veterans suffering from chronic pain." It was, as you might imagine, nothing more than the usual propaganda for naturopathy that regular readers here are familiar with and therefore easily deconstructed as nonsense.

None of this stopped Tracy Gaudet, MD, director of the VHA's Office of Patient Centered Care and Cultural Transformation from, while speaking at last fall's annual DC Federal Legislative Initiative held by the American Association of Naturopathic Physicians, characterizing naturopathy as "a huge answer for the country, for practice, for patients" that is available "at a pivotal transformational moment" in health care and referring to them as "pioneers" who have been practicing integrative medicine "all along." One notes that, before being hired by the VHA, Dr. Gaudet was a very high profile promoter of "integrative medicine," having served as the director of Duke Integrative Medicine, a "pioneer" institution in quackademic medicine, as well as, before that, the founding director of the University of Arizona Program in Integrative Medicine with Dr. Andrew Weil.

The plan: Advancing Complementary and Integrative Health in VHA

I revisited "battlefield acupuncture" intentionally at the beginning of this post, using it as an introduction to survey the breadth and depth of "integrative medicine" offered at VAMCs, because it is a glaring example of how deeply quackery has embedded itself into military medicine and the VHA. It thus didn't surprise me (although it depressed me) to be sent this memo from the Co-Chairs of the Veterans Experience Committee (VEC) to the Under Secretary for health, dated May 3, 2016 under the subject of "Advancing Complementary and Integrative Health in VHA." The memo is disturbing for a number of reasons, which is why I provide a link to the PDF, for readers who wish to read the whole thing themselves. Because it's a scanned document that's 11 pages long, I won't be typing everything, but I will cite key points in selected excerpts.

First:

VA is shifting the current culture of health care from problem-based "sick care" to "whole health care," which engages and inspires Veterans to their highest level of health and well-being. The Office of Patient Centered care and Cultural Transformation (OPCC&CT) and the Veterans Experience Committee (VEC) have worked with VHA leaders and clinical champions across the system to work towards this transformative goal. One aspect of this mission includes the promotion of complementary and integrative health (CIH) services such as acupuncture, mind-body techniques, yoga, and massage, within the VA healthcare system. CIH services promote self-healing and complement conventional (or allopathic) medical approaches to support Veterans on their path to health and well-being. In 2013, VHA established the Integrative Health Coordinating Center (IHCC) within OPCC&CT. The IHCC is charged with developing and implementing CIH strategies in clinical activities, education, and research across the system. Its two major functions are: (1) to identify and remove barriers to providing CIH across the VHA system; and (2) to serve as a resource for the clinical practices and education for both Veterans and clinicians. Thus, the IHCC supports VHA's strategic plan and the MyVA plan to provide Veterans with "Access to Innovative Health Care." Implementation of CIH services across the enterprise directly supports VA's Strategic Goal #1, to "empower Veterans to improve their well-being," and the VHA Strategic Goal #1, "provide Veterans personalized, proactive, patient-driven health care." This is reinforced by the sustained high degree of congressional interest and support for CIH services, including sections 441 and 442 of the proposed bill S.425. The IHCC receives weekly inquiries of the types and and availability of CIH services within the VA.

I was unfamiliar with S.425; so I looked it up. It's the Homeless Veterans' Reintegration Programs Reauthorization Act of 2015. It's a bill to reauthorize homeless reintegration programs in the VA until 2020, which is an odd place to put anything about CAM. Be that as it may, this memo makes it very clear that it is official VHA policy not only to offer CAM or CIH services, but to actively promote it and remove barriers to providing CIH services across the entire VHA system, which in military-government jargon means forcing providers to offer them, much as advocates have tried to force residents to learn and offer CAM/CIH. Indeed, the above paragraph is chock full of government bureaucratic jargon combined what Kimball Atwood used to call the "Weasel Words of Woo," complete with rhetoric about moving from "sick care" to "whole health care"; "patient-centered" or "patient-driven" care, which is frequently co-opted to justify the integration of quackery; empowering patients (in this case, Veterans with a capital V); and, of course, "personalized" care. (My head was hurting by the end of this, so thick was the government jargon mixed with "weasel words of woo.")

The purpose of the memo is to request "review and approval" of the Under Secretary of Health a "recommended path forward to provide policy, guidance, and regulatory change required to implement CIH services that meet the definition of basic care as described in the standard Medical Benefits Package (38 CFR 17.38(b))." The VEC notes that "high priority" areas for the "integration" of CIH services in the VHA include chronic pain management, mental health conditions (e.g., anxiety, depression, and PTSD), and chronic disease management (e.g., cardiovascular disease, hypertension, diabetes, and obesity). Also, according to the VEC, the vetting process for new CIH modalities will include:

  • Clinical evidence
  • Licensing and credentialing
  • Clinical practice guidelines, current evidence, community standards, and potential for harm
  • Veteran demand, although it is noted that "the clinical need and appropriateness of any treatment is based on the clinical judgment of the provider and services are not provided solely at the request or preference of the patient" (imagine my relief).
  • Supports transformation of healthcare delivery (whatever that means)

As far as "clinical evidence, the VEC cites the Institute of Medicine recommendation that the same "principles and standards" of evidence should apply to all treatments, but then it immediately starts special pleading for CIH, noting that the "characteristics of some CAM therapies—such as variable practitioner approaches, customized treatments "bundles" (combinations) of treatments, and hard-to-measure outcomes—are difficult to incorporate into treatment-effectiveness studies," which is true. It's also true that these "characteristics are not unique to CAM" but are "more frequently found in CAM than in conventional therapies." What is more common in CAM is special pleading that these difficulties should be excuses for accepting a lower standard of evidence. If, for instance, I were to make the sorts of pleas that I hear from CAM practitioners about, for example, genomic-based personalized, or precision, medicine, where difficulties in randomization and doing clinical trials are epic (a topic I might review again in the future), CAM advocates would lambaste me for special pleading—and rightly so. What I fear is what happens so often with CAM: That a lot of pseudoscience will be "integrated" into VHA offerings based on dubious evidence. It's already happened with auricular acupuncture, after all.

Also I fear this, straight from the memo:

Adjustments to VHA business processes will be required to provide infrastructure of CIH service delivery across VHA. Additionally, CIH services may need to compete for resources with existing VHA programs. These processes have begun and will be reinforced by the clarification provide by this memo.

Yes, barring increased appropriations from Congress (highly unlikely), every dollar directed to CIH services in the VHA is a dollar redirected from science- and evidence-based treatments currently offered. It is a zero-sum game, and the VEC knows that. Even so, Under Secretary David Shulkin approved the memo.

Indeed the process had already begun long before this memo was sent to the Under Secretary, and is continuing. It is, unfortunately, a very big deal because the VHA runs the largest healthcare system in the US and has a great deal of influence because of that. Just as the VA pioneered the use of electronic medical records in the 1990s, it could be now "pioneering" the infiltration of quackery into an enormous health care system.

Our veterans deserve much better than this. They deserve the best science-based medicine we can offer. Unfortunately, thanks to "competition for resources" by an ever-growing CIH program at the VA and "marching orders" demanding more CIH/CAM, they are likely to be getting more woo and less science-based medicine.

Militaryacupuncture4

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It’s a bill to reauthorize homeless reintegration programs in the VA until 2020, which is an odd place to put anything about CAM.

This is a standard technique for lawmakers to get some pet provision enacted: attach it to a motherhood-and-apple-pie bill such as this one.

It doesn't help that too many in the military are clueless, and military culture doesn't promote asking a lot of questions. But the real problem is that too many in Congress are clueless.

By Eric Lund (not verified) on 25 Jul 2016 #permalink

"It doesn't help that too many in the military are clueless"

We're not clueless about the fact that we have little or no input into Congressional decision-making.

By shay simmons (not verified) on 25 Jul 2016 #permalink

Acupuncture is a theatrical placebo, but the number of somatics, chronic pain, and malingerers we have in the military demands it. As a former primary care doctor in the military, there is only so much you can do from some of these patients, who take up inordinate health care resources, physician and behavioral health both. If people want to try tai chi, guided imagery or whatever, and acupuncture to keep them off opiates then that is okay with me. No one I have worked with thinks otherwise - in fact most view integrative health appointments as just 'one more encounter' for a proven somatic - which IS evidence based.

In a perfect world, no, we wouldn't be using acupuncture. But, in that world you would have access to a wide variety of non addicting pain medications. In my old clinic, we had a couple of NPs who did acupuncture, it wasn't a big deal and some of the patients liked it, some didn't. We weren't diverting resources from evidence based practice, and the vast majority of MDs in the group understood it for what it was.

The truth is that in the future people will not be prescribed opiates for non cancer pain. We need a good tool belt for dealing with these patients which may or may not include acupuncture.

By Militarycritcare (not verified) on 25 Jul 2016 #permalink

in fact most view integrative health appointments as just ‘one more encounter’ for a proven somatic – which IS evidence based.

I'm afraid this is neither evidence- nor science-based.

"I’m afraid this is neither evidence- nor science-based"

- okay, but it is standard of care to have regular appointments for somatization disorder. No, I haven't read the current literature on the subject.

By Militarycritcare (not verified) on 25 Jul 2016 #permalink

"There is only so much you can do for some of these patients."
True, but does that justify using a placebo and telling patients it is an effective treatment? Medical ethicists universally condemn the use of placebos and the practice of lying to patients.

By Harriet Hall, … (not verified) on 25 Jul 2016 #permalink

"The truth is that in the future people will not be prescribed opiates for non cancer pain."

That may well be true, but there isn't anything on the horizon at the moment that I have come across and there are plenty of causes of chronic pain that only repond to opiates or possibly NSAIDS (but that's no good for people eho can't tolerate them). Have you seen anything that might replace opioids for something like abdominal adhesions?

ATACS will be deploying certified Battlefield Acupuncture (BFA) trainers to receptive Department of Defense/Veterans Affairs (DoD/VA) medical centers to teach this technique

Which fittingly suggests that some medical centres are telling the acupuncturists where to stick it.

By Rich Woods (not verified) on 25 Jul 2016 #permalink

So what is the theory behind accupuncture?

Biomeridians?

Does the needle make an antenna so your body channels healing entities from alpha centauri?

Why does this persist? This seem like a very easy thing to prove false. I thought the only people that did this were ex-carnies and Indian street-vendors.

So what is the theory behind accupuncture?

Sticking needles in the body at certain specified points along vaguely defined meridians is supposed to induce a flow of qi, which is supposed to be some kind of vaguely defined vital force, that will alleviate whatever condition the patient is suffering from.

Yes, calling that a theory is being generous.

There have been comparative studies of real acupuncture with a kind of sham acupuncture that simulates inserting the needles rather than actually inserting them. The latter turns out to be just as effective as the former, implying that acupuncture "works" via the placebo effect.

By Eric Lund (not verified) on 25 Jul 2016 #permalink

The latter turns out to be just as effective as the former, implying that acupuncture “works” via the placebo effect.

Interesting, Eric Lund #10. Just what is this 'placebo effect'? Is it some form of psycosomatic healing? Mind over body, the patient was still 'healed' or have an imaginary non-pain?

I should think that the needles cause a release of endorphins that kick the process off -- Just speculating.

Chronic pain is real. There are some painful disorders with real, visible, physical changes that are greatly improved when the pain is treated.

I have been dealing with chronic pain a very long time now, and regularly reduce meds or attempt to as new therapies become available for treatment. It horrified me to consider a future where some arrogant doctor will jam needles into imaginary energy channels and assure me that I feel better because they tell me I do. That is the height of condescension and paternalistic medical care.

Gilbert @11: Interesting you should suggest endorphins - there's a nice article over at Science Based Medicine that discusses just that (and how the little evidence that exists is around electro-acupuncture, not plain acupuncture).

By JustaTech (not verified) on 25 Jul 2016 #permalink

Gilbert,

In the studies that showed equal benefit from sham acupuncture, the benefit was modest in both cases. I'm not aware of any studies showing any affect of acupuncture on actual healing (as in, actually removing the cause of the pain). Personally, I'm very doubtful that endorphins are involved; the level of benefit seems to be within the margin of error, which suggests that like most placebo effects, it's not really an effect -- it's just observer bias. You can also get comparable levels of relief from playing video games, listening to soothing music, going for a walk in a pleasant environment . . . in short, I think it's just distraction.

This is not to say distraction is worthless. It absolutely isn't, and distraction can definitely be helpful in managing pain. The problem I have is when extra abilities are attributed to the treatment that the evidence simply doesn't support. It may successfully distract the patient, but it isn't really directing healing energy towards a site of injury or anything like that, and acupuncture has known risks that other forms of distraction do not have. Acupuncture involves puncturing the skin (it's right there in the name, after all) and there have been serious injuries as a result. Infection is always a risk, of course, along with metal allergy risks, but less well known are the hazards of accidental injury to a vein or nerve or even puncturing an organ, which really has happened.

For this reason, I think it would be very dishonest to suggest it is actually having a material benefit to the patient, when all the evidence really supports is that it is an effective distraction.

By Calli Arcale (not verified) on 25 Jul 2016 #permalink

I always love those who go on about opioids not being used in non-cancer pain, which would result in those with chronic pain from various non-cancer diseases to go untreated, in unremitting pain.
Since I got up for the day (night snift), I've had an incessant spasm, which is quite painful, in my right calf and mild spasming in the left calf. I'll be seeing doctor this morning.
Meanwhile, my wife is in unremitting pain from a herniated L5-S1 and every cervical disc is also failing toward her spinal cord. At peak pain, her BP rises to 180/100, with a pulse in the 120 range.
For some reason, she's showing mild LVH and atrial flutter confirming remodeling of her heart.
Needless to say, when she has her hydrocodone, her BP remains within the normal range.
Her doctor appointment is 15 minutes before mine is and she meets her neurosurgeon next month.

As for battlefield accupuncture, had someone suggested that to me while I was still in uniform, they'd find themselves tied to a tree in the artillery impact area.
The smallest needle we used on an active battlefield was 18 gauge and I kept some 12 gauge catheter insertion units on hand. 18 gauge being the minimum gauge that could deliver blood to a patient who has suffered significant trauma.
While I couldn't carry blood in the field, I could carry normal saline or lactated ringers and air ambulances now carry blood for immediate infusion of those who are running dangerously low on blood.
Opiates still will remain in use on the battlefield, as military operational related wounds are horrific and agonizing.

Yes. Luckily we now control the Poppy Fields of Afghanistan! We have an unlimited supply of opioids for our entertainment and pain management.

Have you ever done heroin?

By PuppyBoners (not verified) on 25 Jul 2016 #permalink

@#16, I've never had heroin, however, UK hospitals use it for post-operative pain management.
Currently, my drug of choice for pain management is tramadol, 50 mg, QID and which is most often only taken BID.
That said, I have had morphine after a major injury and post-operative. I respect that drug a great deal and do find that opiates should be a last recourse, not a first recourse for treating pain.

By Wzrd1 (not verified) on 26 Jul 2016 #permalink

In reply to by PuppyBoners (not verified)

Tramadol? You be careful with that, I recall that was what killed Prince..!

@Amethyst, that's fine. Doctor bumped me up to hydrocodone, 10 mg, for pain after repeatedly catching my wife after gallbladder and umbilical hernia repair surgery and it seems, a dodgy disc may well have failed.
L4-L5, to be specific. It was bulging for well over 25 years.
My wife's umbilical hernia, secondary to failure of the upper portion of two cesarean section surgeries, which were our eventual successful issue.
The failure attempted a zipper mode failure.
Now, I am left with sensory failure of significant parts of my left leg and worse, failures on the right.
Saw doctor today, hence, the medication change and scheduling for diagnostic imagery and specialists.
For, "Better living through chemistry" is actually a bad joke here. While life can be sustained or even extended, that isn't the be all and end all. I make that joke in person, merely as whistling at the gallows wind.
We both have significant damage to our spinal cord, for me, mostly lumbar, for her, essentially her entire cervical spine having severe disc disease and L5-S1 creating a massive problem that shall be soon addressed.
I'll add my own posterior lens capsule opacification, after lens replacement, lattice degeneration of the retina and one remaining cataract.
And I'm in my mid-50's, as is my wife.
Our dental condition is even more of a perfect train wreck.

By Wzrd1 (not verified) on 26 Jul 2016 #permalink

In reply to by Amethyst (not verified)

the little evidence that exists is around electro-acupuncture, not plain acupuncture

JustaTech #13, perhaps the successful acupuncturist triboelectrically drags his feet on the carpet.

@Amethyst #18: Fentanyl, actually. He was also known to abuse Percocet. It wouldn't surprise me if he had Tramadol on board as well. Polypharmacy is often part and parcel of drug overdoses.

@Wzrd1 #15: your reaction is hardly surprising and what I would expect to hear from people I've known who've served in Afghanistan or Iraq.

A good friend of mine is a Navy nurse and was in charge of nursing at the NATO hospital in Kabul a couple of years ago. I asked her about this "battlefield accupuncture." She said she had never heard of it before, and knew of no one who was using it in Afghanistan while she was there.

Which makes me think the good doctor is training docs who just want the CEU credits, and never make use of what they are "taught."

It's still an expensive boondoggle.

More useless crap that comes from the Japs.

I'll take the morphine please.

It is important to note that BFA should never be used in isolation for treatment of chronic non cancer pain. Our team at CAVHS in Integrative Medicine clinic, has seen favorable results when BFA is used in combination with stretching exercise and yoga, healthy nutrition, increasing water intake to hydrate fascia, management of chronic stress which is a HUGE component of chronic pain by using mindful breathing and relaxation therapies. We use group classes and offer choices to our veterans who are interested in alternative COMPLEMENTARY approaches.
Lets face it;our track record using traditional medicine ONLY and using Opioids to treat CNCP is self evidently abysmal in the level of overdoses, dependency and unhealthy veterans.
Our team functions by looking at the entire patient starting with their timeline, their genetics, their antecedents and triggers. This approach enhances a positive open relationship that allows the patient to set goals for themselves. Health is NOT something that comes in a pill bottle or can be handed to a patient in an office. Patients need to understand the mind body connection. We as providers have a duty to inform our patients of these processes and to offer them alternative choices whether it be stretching, yoga, mindful breathing, setting health movement or nutritional goals. Our veterans deserve more and I applaud Dr. Gaudet and Dr. Kligler for thinking outside the box and offering meaningful health promotion to our veterans.
Providers should embrace the opportunity to obtain some new tools to offer chronic pain patients.
No-one should suggest that acupuncture should be used in isolation for our Veterans. I would encourage anyone who is in healthcare to open their minds to new additional approaches.
I am proud to be a primary care provider nurse practitioner at CAVHS for the past 14 years and I do not hesitate to state that I repeatedly hear very favorable commentary from our veterans who participate in complementary health approaches. I find our biggest critics have zero training or exposure to holistic health. Lets give holism a chance, our patients deserve it.

By Olive Phillips (not verified) on 12 Aug 2016 #permalink

@Olive Phillips,

Since Battle Field Acupuncture is, by definition, presumably performed under battle field conditions as distinct from a weekly visit to a clinic at the hospital, how do the soldiers also have time to perform yoga and stretching exercises, improve their nutritional intake, and increase their water intake (beyond gulping from their canteen when they get thirsty) on the way back to the hospital?

By squirrelelite (not verified) on 12 Aug 2016 #permalink

Ms. Phillips, prove your statements by posting the PubMed indexed studies by your clinicians. Make sure to provide evidence that they follow standard infection control protocols by actually wearing gloves (unlike the photo at the top of the page).

I am sorry, but unless you provide verifiable evidence you are just making an argument from blatant assertion. Sorry, there is one thing I learned from the lack of housing in Ft. Leavenworth when my dad was at the Command and General Staff College... we had to live in a small town in Missouri, the "Show Me State."

So show me the peer reviewed PubMed indexed papers from your institution that support your statement.

Since Battle Field Acupuncture is, by definition, auricular

FTFY. It's French, decidedly not traditional, and based on an insane homuncular premise.

Sorry, Narad

I didn't take time to reread the article and had forgotten the specific meaning.

By squirrelelite (not verified) on 13 Aug 2016 #permalink

Olive: "Our team functions by looking at the entire patient"

This is a great thing. When I rotated through a couple of VA hospitals years ago, physicians commonly focused in on the patients' noses, big toes, or sometimes just the right earlobe, ignoring vital body parts and systems. It's a good thing we have holism now.

By Dangerous Bacon (not verified) on 13 Aug 2016 #permalink

Olive... if its called Battlefield Acupuncture then presumably it is intended to work on the effing battlefield.

I can't wait to see how a corpsman with a little sack of needles handles a sucking chest wound.

By shay simmons (not verified) on 13 Aug 2016 #permalink

@29 He'd probably have to have lots of crystals, and a whole pile of flower remedies...and draw a longer lifeline with Biro.

Our team at CAVHS in Integrative Medicine clinic, has seen favorable results when BFA is used in combination with stretching exercise and yoga, healthy nutrition, increasing water intake to hydrate fascia, management of chronic stress which is a HUGE component of chronic pain by using mindful breathing and relaxation therapies.

I'm sure that BFA used in combination with a shot of morphine would have favorable results, too.

I would have no problem with all of the approaches that you mention, and neither, I expect, would the rest of us here. It's when demonstrably useless techniques, such as BFA, therapeutic "touch" and reiki are brought in. I have asked the question for 40 years: Why does holism need to include quackery? If you could answer this question, I could "open my mind", as the holism promoters keep urging me.
as part of its

Sorry, Narad

I didn’t take time to reread the article and had forgotten the specific meaning.

Oh, no, please pardon me for coming off as scolding; I just found more humor value in cutting to the chase. Terseness has gotten me into trouble before.

FTFY. It’s French, decidedly not traditional, and based on an insane homuncular premise.

I was reminded to look back at an earlier RI thread about Nogier's ear-piercing grift:
http://scienceblogs.com/insolence/2015/12/29/more-acupuncture-tooth-fai…

Towards the end of it, a True-Believer Licensed Acupuncturist from Brooklyn pops up to reassure us that Nogier's scam was based on folk practices, and it is being improved appropriated by Chinese fraudsters, so auricular acupuncture counts as Age-Old Oriental Wisdom despite its recent provenance.

By herr doktor bimler (not verified) on 13 Aug 2016 #permalink

Speaking of cutting to the chase, I was thinking of asking Ms Phillips to skip to abut 1 hr 40 minutes into the movie and suggest when would be a good time to pull a few soldiers aside for a nice relaxing treatment of BFA to relieve their stress, and where in the field hospital she would suggest performing the treatments.

https://youtu.be/-BD0SriEG3M

I was also curious whether repeated treatments with small needles might have a prophylactic effect against an assegai.

But, since she seems to be a one-off, I'll leave it as an exercise for the interested reader.

By squirrelelite (not verified) on 13 Aug 2016 #permalink