After yesterday's post on a local news station's credulous promotion of quack acupuncture (but I repeat myself) for pets, I thought I'd stay on the topic of acupuncture for one more day. The reason is that a reader sent me a link to an article in Stars and Stripes that really irritated me, Acupuncture becomes popular as battlefield pain treatment. Longtime readers might remember that I've been writing about the utter ridiculousness and lack of science behind "battlefield acupuncture" and how it makes no sense to be sticking recently wounded soldiers with needles under battlefield conditions. Out of curiosity, before I proceeded to discuss this article and what's going on with battlefield acupuncture in 2017, I decided to try to find my first ever post on battlefield acupuncture. It depressed me a lot to discover that the first time I came across this abuse of our brave men and women in uniform was way back in 2008, when I began with a brief vignette imagining what battlefield acupuncture might look like.
So here it is, nine years later, and nothing has changed. If anything, the infiltration of the quackery of battlefield acupuncture has infiltrated the military even more now than then. You might wonder where the reference to "Dr. Seuss monsters" came from. Don't worry. You won't finish this article without knowing, and it's truly mind-numbingly dumb, as one would expect from acupuncturists. In the meantime, let's see how this Stars and Stripes report starts out:
About 50 flight surgeons from 21 countries wrapped up a day of training at an international medical conference here this week with matching gold-plated studs set in their ears.
Their ears sparkled in the name of medicine: This was a hands-on workshop on battlefield acupuncture, an alternative therapy that’s vying to become a standard practice of care at Defense Department and Veteran Affairs medical centers for acute and chronic pain.
Battlefield acupuncture, a form of auricular or ear acupuncture so named because the tiny needles can be administered quickly in combat without removing so much as a helmet, has been around for more than 15 years.
But use of the technique, once practiced by fewer than a 100 military doctors across the services, is rapidly expanding through a vigorous training program supported by DOD and the VA.
This is stated as though it were a good thing. It's not.
Let's take a step back to when I first discovered the woo that is "battlefield acupuncture." The man most responsible for its promotion was Col. (Dr.) Richard Niemtzow, who is a radiation oncologist by training but, for purposes of this post, one of the foremost proponents of battlefield acupuncture. It should also be noted that "battlefield acupuncture" is somewhat different than regular acupuncture in that it is almost always primarily auricular acupuncture. Basically, the ears are the focus, and auricular acupuncture needles are considerably smaller than standard acupuncture needles. They're also sometimes left in place in the ear for up to several days, basically until they fall out. The idea behind this, presumably, was to come up with an acupuncture method that was easy and could be done under difficult conditions. Unfortunately, there isn't any actual science behind it. When you look at the studies presented in support of the practice, you'll inevitably discover that it's the thinnest of gruel, no matter how much advocates try.
None of this prevented the infiltration of "battlefield acupuncture" into both the military and the VA medical system. None of this stopped the military from deploying acupuncture-trained physicians to Iraq back when the war was still in full swing, with Army Rangers, of all forces, learning it and experimenting with it. None of this has stopped Col. (Dr.) Niemtzow from offering webinars, books, and courses in "battlefield acupuncture" or auricular acupuncture, which he now calls "rapid acupuncture," advertising them with statements like:
The medical mission is to provide the latest innovative acupuncture therapy techniques to patients who have not responded well to traditional Western medicine. Only those acupuncture techniques that have a very high success rate, usually successful during the initial treatments and are cost effective will be employed.
Nowhere is any compelling evidence presented that these techniques "have a very high success rate." There doesn't need to be. It's faith. “Auricular acupuncture” is based on a physiological principle that makes every bit as much sense as reflexology, and I mean that in the worst way possible. Basically, the idea is that parts of the ear "map" to parts of the body, like a homunculus. I was saying this nine years ago. Unfortunately, since then:
About 2,800 providers have been trained as part of the initiative, said Thomas Piazza, the director of the Air Force Acupuncture Program at Joint Base Andrews, Md.
In the Air Force, where the therapy was pioneered by physician and retired Air Force Col. Richard Niemtzow in 2001, close to 60 percent of its bases “are trained up” in battlefield acupuncture, Piazza said. “We’re looking to get battlefield acupuncture as part of standard of care versus a separate thing where we say ‘you can have an alternative medicine.’”
He added: “Sometimes people just want a Motrin and that’s fine, great, we’ve got that, too. But some people just don’t want to take medicines; they just want something else for a change.”
I did indeed cringe when I read that last quote, and you should too. Basically, it's a false equivalence in which a theatrical placebo (acupuncture) is represented as being just as effective as proven pharmacologic management and therefore, above all, an equally reasonable choice. That's what this is all about, normalizing quackery and, as "integrative medicine" proponents do, "integrating" quackery with real medicine, and now there are 2,800 military providers who have been trained in "integrating" just this form of quackery. It's a momentum that could well be unstoppable, because once you have thousands of people invested in a technique that technique tends to be offered, used, and, of course, standardized:
Piazza was at Ramstein last week to teach battlefield acupuncture to U.S. and NATO flight surgeons attending an annual international medical conference. One of the appeals of battlefield acupuncture is simplicity. The training is boiled down into a few hours of academic and clinical instruction. In one afternoon, the flight surgeons at Piazza’s workshop could find the five points on each ear — with names like cingulate gyrus and shen men — corresponding to where the needles go, in a particular order.
The training is standardized to ensure it’s done right, Piazza said. “Most of the people we’re teaching to aren’t acupuncturists,” he said. “We say follow this recipe, follow these steps.”
The cingulate gyrus? What the hell? That's a part of the brain, part of the limbic system thought to be involved with controlling emotional responses to internal and external stimuli (among other things). Is Piazza saying that part of the ear maps to the cingulate gyrus in the brain? Then, is he saying that sticking needles into that part of the ear somehow affects the actual cingulate cortex in the brain to block negative responses to painful stimuli? It's hard to interpret his claim otherwise.
Perhaps the funniest part of the article, which was undoubtedly not intended to be funny, was this:
Though side effects and risk of infection are minimal, Piazza told the flight surgeons that one of the hurdles they might face is convincing patients to try a treatment involving needles. “Who likes needles? Most of your patients don’t like needles.
“You’re going to learn this is much less painful than getting your ears pierced,” he said.
“It’s a little uncomfortable but it’s not like being shot,” said Col. Anthony Mitchell, an aerospace medicine resident at Wright-Patterson who was using the training as a refresher.
Yes. That's a ringing endorsement! Use battlefield/auricular acupuncture because it doesn't hurt as much as being shot. Well, even though I've never been shot (thankfully) and hope never to have that experience, I can't argue against the contention that having needles stuck in your ear doesn't hurt as much as being shot. What I can argue with is the implication that that this makes it OK to use a treatment that is quackery. Of course, in the article, Piazza throws out anecdotes and his personal clinical experience in which he stated that he used auricular acupuncture in Afghanistan in 2013 on wounded soldiers being transported to medical facilities as "an adjunct, to see if they didn’t need as much medicine." What he didn't say is whether that adjunct really did result in the wounded soldiers needing less medication.
Of course, this Stars and Stripes includes the usual trope used since time immemorial in articles discussing quackery of presenting the token skeptic view (in this case, that of Harriet Hall), followed by the quack retort:
Piazza said the therapy is backed by more than half a dozen randomized control trials and a number of case reports.
In one study, conducted by Air Force doctors at Nellis Air Force Base, Nev., and published in 2015, battlefield acupuncture was compared to standard pain treatment in 54 DOD patients with an acute sore throat. Acupuncture was associated with reduced sore throat pain for 24 hours and decreased use of pain medication for up to 48 hours. There was no apparent effect on hours missed from work.
Piazza said a group of doctors reported a 64 percent decrease in the rate of medical groundings for deployed pilots who received battlefield acupuncture instead of pain killers for lower back pain.
“We’re not looking to replace medicine,” Piazza said, but the procedure has been shown to reduce the use of narcotics.
Regarding the second claim, I could find no publications in the peer-reviewed medical literature to examine supporting it. Regarding the second claim, I looked up the actual study. (It's what I do.) Let's just say that the study is...underwhelming. Yes, it was a randomized controlled trial looking at 54 patients with acute sore throat. However, it was unblinded, a feature that renders any acupuncture trial pretty much worthless scientifically because it doesn't account for placebo effects. Indeed, it's a pragmatic trial. That means that the intent is to determine effectiveness under "real world" conditions; hence, no sham/placebo controls. In real medicine, pragmatic trials are used to assess the real world effectiveness of treatments already shown to be efficacious in randomized controlled clinical trials. However, given that auricular acupuncture has not been shown to be effective in such trials, doing pragmatic trials studying it is putting the cart before the horse.
Not that ever stopped acupuncturists from doing such trials before. After all, it's the way they generate "positive" trials. After all, doing rigorous randomized controlled trials with good shame acupuncture controls generally find that acupuncture is indistinguishable from sham acupuncture.
Earlier in this post, I said that the funniest thing I read in the article was the reference to the "cingulate gyrus" on the ear. I was wrong. The "cingulate gyrus" didn't invoke Dr. Seuss in a truly nonsensical way. Air Force Lt. Col. Patricia Macsparran did:
Air Force Lt. Col. Patricia Macsparran, the aerospace medicine consultant to the Air Force Surgeon General, incorporates acupuncture into her practice daily.
She’s a licensed acupuncturist with more than 300 hours of training.
She explains the science behind it with a reference to Dr. Seuss. When the body perceives pain, it sends a lot of fluid with anti-inflammatory products to fix it, she said. Under a microscope, those products “look a lot like Dr. Seuss monsters,” she said, and the body has a hard time clearing them out. “Acupuncture is sort of like a traffic cop,” she said. “If you know where to place those needles to push ionic flow to get things moving, you basically release that traffic jam so the body can heal itself.”
Battlefield acupuncture “is just scratching the surface,” she said. “Every organ in the body, including the brain, is represented on the ear. It’s a microsystem.”
Theodor Seuss Geisel is doing backflips in his grave. Or maybe not. After all, it's not the reference to Dr. Seuss monsters that's so dumb. I suppose certain immune cells could be described that way under the microscope. However, the rest is, without a doubt, the most ridiculous "explanation" for how acupuncture "works" I've ever heard, and, believe me, I've heard more contortions of science, hand waving, and pseudoscience than I can remember, but I've never seen an acupuncturist likening inflammatory products looking like "Dr. Seuss monsters" or likening sticking acupuncture needles into the skin as being like a "traffic cop" who "releases "ionic flow" to get things moving" so that the body can "heal itself. The entire passage above is what I like to refer to as "woo babble." It's like the technobabble that Star Trek fans (particularly Next Generation fans) are so familiar with, in which science-y-sounding terms are strung together as "explanations" to various phenomenon or used as a plot device to get our heroes out of trouble, only with woo instead. Oh, and Dr. Seuss.
Unfortunately, "battlefield acupuncture" is one small, albeit particularly egregious example of the "integration" of quackery into medicine, in this case military medicine. There is actually an active effort to normalize such quackery in medicine, but it seems to be particularly bad in military medicine, including the VA. It's being promoted by not just the military and the VA but by the National Center for Complementary and Integrative Health (NCCIH).
I've said it before more times than I can remember. Our men and women in uniform are putting their lives on the line in the defense of us all. They deserve the very best science-based medicine that we can offer. Unfortunately, there seems to be more enthusiasm for offering them quackery like "battlefield acupuncture" than actually improving the science-based medical offerings that benefit them. It's a scandal that no one's talking about.
"Dr. Seuss monsters"? Maybe she means macrophages, or some other phagocyte. But this is ridiculous. It's so ridiculous that it puts the U.S. armed forces to shame. Just because some military physicians allowed themselves to be duped by Chinese charms is no reason to expose the U.S. armed forces to the same practice.
What would Col. Potter say?
Before I forget, here's some fresh <A HREF="https://www.integrativepractitioner.com/whats-new/news-commentary/"<gri… for the mill. With so much to choose from, I would hardly know where to begin.
The military should pay more attention to voodoo acupuncture, the way to neutralize the enemy by sticking needles in toy soldiers.
When the body perceives pain, it sends a lot of fluid with anti-inflammatory products to fix it, she said. Under a microscope, those products “look a lot like Dr. Seuss monsters,” she said, and the body has a hard time clearing them out.
I would certainly like it if my body perceived pain, that would be great, but unfortunately it doesn't work like that and the pain all seems to happen in my mind where I can't get away from it. Anyway, like everyone else, I am keen to hear more details about these microscopic monsters. Do they look like this? Or this?
“Acupuncture is sort of like a traffic cop,” she said. “If you know where to place those needles to push ionic flow to get things moving, you basically release that traffic jam so the body can heal itself.”
That looks like an analogy, it has the formal structure of an analogy, but analogies are really supposed to make some sense and not be just some piece of stupid that fell out when a moron left her mouth open.
Suppose acupuncture is really more like a set of road cones?
I was at a course on regional anesthesia taught by the military several years ago. This topic came up, and when I came back to work I complained about it to my military CRNA. She did bring an important fact into the discussion about true battlefield conditions. She explained on the actual battlefield narcotics may need to be withheld so the soldier can continue to shoot his weapon and further defend himself until he can be evacuated. This is a scenario few of us have had to face or study.
Sticking needles in a soldier who needs to continue to defend himself seems, at best, counter-productive.
I think it particularly relevant that acupuncture is being used in the context of analgesia in battle.
Because that is what we...and by that I mean science based, reasonable people...are engaged in...not a battle, but a war against the ignorant world of pseudoscientific piffle. As a physician, I am completely aghast that such magical nonsense if being pushed onto people who need the very best that modern science and technology can offer. It just goes to show how dangerous it is when a purveyor of woo with vested interest gets into a position of influence. I hope to goodness we never see such nonsense being pushed onto the Australian military!
At least this is a field where Canada is thankfully lagging well behind. I thought it was bad enough that people could get a chit to go to a Chiroquackter, and be referred to a Nutritionist. I'm sorry, but when I was in the field, I wanted Ranger smarties (Tylenol, Motrin, etc) to damped the discomfort, not some idiot sticking needles in my ears. How the hell am I supposed to monitor the comms if I have needles where the headset rests? Granted if it's a thorax, abdominal, or head wound, the standard shot of Morphine is out, but acupuncture? Give me a break. Well to use the stereotype. It is an air-farce doc and not a real soldier promoting this.
@ Greg E
At the time of compulsory military service in France, people said: Military medicine is to medicine what military music is to music.
Having had a kidney stone or two I suggest the VA give all the vets who come in with severe pain from a kidney stone acupuncture instead of morphine sulfate or Dilaudid. When the patient figures out that he's/she's not going to get any real pain relief and climbs painfully out of the wheelchair to break the jaw of the idiot who prescribed the acupuncture maybe a light will go off.
Do an image search for "microscopic monsters". It really does look like a Dr Seuss fantasia. However, these wee beasties are mostly tiny arthropods and other parasites. Leukocytes can also look wild and shaggy under scanning EM. Not so with conventional light microscopy.
There's a reason "military intelligence" is on everybody's list of favorite oxymorons. That such a ridiculous idea as "battlefield acupuncture" wasn't laughed out of the room the first time it was suggested is an indictment of our military brass. You don't even have to know that acupuncture is bunk to see this. You don't even need to know more about battlefield medicine than you can glean from MASH reruns to see this (I am in that category). You need to evacuate the injured soldiers ASAP, and stopping to stick needles in their ears, even if it only takes a minute each, interferes with that. Those minutes can make the difference between life and death.
The first time this was proposed, all it would have taken is for one general to tel Col. Niemtzow something along the lines of, "This is the most ridiculous idea I have ever heard. Speak no further of it." Now, of course, it's too ingrained to eliminate that easily. But it should be, because this is more wasteful than a $600 hammer: At least you get a hammer for the taxpayers' $600.
In her Dr. Suess comment, Air Force Lt. Col. Patricia Macsparran obviously is referring not to inflammatory cells, but the Toxins released as part of the inflammatory process (and which TBruce is overlooking when he examines inflamed tissue under the microscope).
It's as obvious as Morgellons critters, and you don't even need to use the 40X objective.
I also routinely see ionic flow during my daily pathology work, and stage cancers according to their output of chi.
Get with the times, TBruce!!!
I don't...wait what?
What the hell does the appearance of microorganisms have to do with the means by which they are treated? Who cares if they look like Suess characters, Pokemon or microscopic Corgis? That is the dumbest thing I have ever heard within the realm of medicine, especially combined with my inference of the quote that she thinks magical-looking things must only be fought with her own brand of magic.
I read on another skeptic blog (I think) that acupuncture as practiced today actually has very little basis in TCM originally, and was mostly invented by a European guy who threw in the TCM angle as an appeal to antiquity crossed with an appeal to the exotic. So while the Chinese may have generated their share of woo, we might not be justified in blaming them for acupuncture, except to the extent that they fell for the con. The blame for inventing it may lie with the same sort of folks who gave us homeopathy.
The good news is, as of a couple of years ago, this nonsense wasn't actually being practiced on the battlefields of Afghanistan. This from a good friend of mine who commanded a nursing trauma unit at the UN hospital in Kabul, which is where the doctors all are.
i>While deployed to Afghanistan in 2013, Mitchell used battlefield acupuncture on wounded patients during air evacuation.
“This was just an adjunct, to see if they didn’t need as much medicine” during transport, he said.
While I don't imagine members of the military can sue for malpractice would there not be some way to charge a physician incompetence or malpractice for this under military law?
My doctor sent me to physiotherapy after I badly sprained my ankle last spring. Several weeks in the usual exercises and stretches were not having any measurable effect, so the therapist suggested acupuncture in my foot.
I let her try 2 sessions of it, but the only noticeable difference was an additional source of pain in the skin/muscles/tendons where she stuck the needles. I stopped going to physio altogether shortly thereafter.
Now, with a still painful and messed up ankle almost a year later, and an MRI showing tendon/ligament damage and a soft tissue mass in my foot, I am scheduled to see an orthopedic surgeon soon.
The acupuncture was clearly a waste of time. The physiotherapy wasn't much better.
Get with the times, TBruce!!!
I'd love to. What drugs are you taking?
Just because some military physicians allowed themselves to be duped by Chinese French charms is no reason to expose the U.S. armed forces to the same practice.
FTFY, as alluded to by Psalmanazaar above.
Hmm. My friend was there right around that time. She didn't know anything about it and had never heard of it. So it sounds like he was doing some kind of "trial" and I'll bet it wasn't successful. Military medicine is often cutting edge; if something works they start using it.
And no, you can't sue a military doctor :(. The government is immune from lawsuit.
What the hell does the appearance of microorganisms have to do with the means by which they are treated?
Viruses do not look like bacteria, and neither look like parasitic vectors like Plasmodium. Even within bacteria, they don't look alike. There are different treatments for these things, e.g., antibiotics don't work on viruses, and sometimes the appearance of a microscopic organism is a clue to what it is, e.g., filoviruses (Ebola et al.) have a rather distinctive appearance. Appearance is certainly not the only or even primary determining factor, but there are times it makes sense to consider it. And I'm not going to blast someone for attempting a layman's-level analogy like comparing these things to Dr. Seuss monsters.
Speaking of which: Given the image at the top of the post, a link to a YouTube video of Thurl Ravenscroft singing "You're a Mean One, Mr. Grinch" is obligatory.
While I don’t imagine members of the military can sue for malpractice would there not be some way to charge a physician incompetence or malpractice for this under military law?
The traditional way of dealing with an officer who repeatedly endangers their troops in a war zone doesn't usually involve a lawyer.
This is the sort of thing we can write our congressmen about. It's not a partisan issue, so they might just be able to pass some kind of law against it if we're lucky...
FTFY, as alluded to by Psalmanazaar above.
The French con-man who pulled the whole auricular-acupuncture scam out of his arse based it on a magical-thinking analogy between the structure of the human ear and the shape of the human fetus.
He may not have thought through all the implications -- like, how is this supposed to work when you extend the grift to the veterinary market?
The traditional way of dealing with an officer who repeatedly endangers their troops in a war zone doesn’t usually involve a lawyer.
But ISTM that this would be much harder to pull off against somebody in the Medical Corps. Much harder to simultaneously have the means and opportunity, while having some assurance that you will hit your target with minimal collateral damage.
I see this "working" in the same way that you hear stories about dentists on base who have lots of service members come through and insist on no anesthetic to prove that they're tough.
At the same time I am righteously pissed that DoD is willing to waste money on this, but there's no money at the VA for inexpensive programs to reduce HepC.
What I don't get is, when did the US Air Force begin treating sore throats with narcotics and now, acupuncture?
Seriously, terpin hydrate with codeine was removed from the national formulary in the 1990's because there was no evidence that the crap actually worked.
As for battlefield acupuncture, thankfully, my teams were never subjected to that. We stuck with that which is proven to be effective for pain management, morphine 15 mg IM and rapid evacuation of the casualty.
We had two innovations that also proved highly effective, air ambulances had blood on board, which saved thousands of lives and the other innovation was bringing back the tourniquet.
The US Army originally trained that once a tourniquet was used, the limb was lost. Right until a physician fought against that idiocy, observing how long orthopedic surgeons have a tourniquet on a patient who is undergoing surgery. Now, every service member carries their own field dressing and tourniquet.
Seriously, if that Colonel would've come up to my team and suggested plying his needles, I'd have retired two pay grades lower in rank. That's because, he'd get no due respect from me and he'd be instructed quite firmly on where he could stick his knitting needles.
I imagine the field medics wouldn't bother with this. They really would be the ones to do it. Once they get to the field hospital, the staff have other things to think about than acupuncture.
I can't help but wonder if the military docs are just using this "training" as a free day off with travel.
One gets one's CE units where one can find them.
Pity that they didn't replace that training with something useful, like treating hydrogen fluoride inhalation injury.
The second document is now the golden standard for such injuries. That's because in Afghanistan, the new mine resistant vehicle (MRAP) fire suppression system was targeted, resulting in the halogen fire suppression system being triggered and the suppressant being superheated by an RPG round, which then degraded to HF, which exposed the vehicle occupants to inhalation injury.
Calcium Gluconate is now available for ambulances, including an form that is administered by nebulizer.
Oddly, that innovation has saved lives and still does not involve sticking pins in service member ears.
Wzrd1: I thought the standard treatment for sore throat was water<tea with honey< milkshake/popsicle < straight honey.
Then again I know a Marine who didn't sleep for two days because the sore throat he had from mono woke him up every time he swallowed. Then again, that was college, which is the same as "terrible home care".
Personally, I'm partial to honey and lemon. It's quite soothing and chilled, even more soothing.
Or saline gargles with hypertonic saline solution.
The latter also helps with a toothache, which of course, only occur on holiday weekends.
Yeah, EPV infections can be quite painful, although most don't get such severe symptoms.
Actually, I wonder if any of the attendees sporting newly pierced ears were men.
According to this link,
they are still prohibited for men.
Members are prohibited from attaching, affixing or displaying objects, articles, jewelry or ornamentation to or through the ear, nose, tongue, or any exposed body part (includes visible through the uniform). EXCEPTION: Women are authorized to wear one conservative, diamond, gold, white pearl, or silver pierced, or clip earring per earlobe.
According to The Balance
this also applies to men off duty on military installations.
Wzrd1: interesting article. Nebulized calcium gluconate. Love it :)
Shortly after the medical team that was emergency dispatched to Afghanistan to treat these victims (too unstable to transport out of country) developed that protocol, four more victims were transported for treatment.
And the protocol was ignored in favor of more rapid transport. :/
Well, until they hit the field hospital, where it was initiated.
All survived that attack.
any exposed body part (includes visible through the uniform)
Nipple rings are fine. Good to know.
Updated mental image of Wzrd1:
RE: herr doktor #37
Egads I thought our conversations were to devolve into food. This is what happens when the menz are left to their own devices.
Food? Sure, I'll play.
I picked up one of these last week
I'm still learning. Dunno if I like it yet.
I do real well low and slow on the smoker, and hot and fast on the grill. This is... different. No fire.
That certainly looks intriguing. That might help me a bit when I make a couple of gallons of pasta sauce.
Immersion circulator, there are a bunch of companies that make similar units.
They look easier to figure out than that Brother sewing machine I just bought. ;)
I've had pretty good luck with my NuWave Burner, using it like a sous-vide machine. Set it for the temperature you want and forgot about it. Nothing can overcook that way.
I never thought about cooking meat in bags, though. Do you brown it first? Or afterwards?
Maybe you could use a little blowtorch like on a creme brulee--there we are: Cooking completely re-invented!
Browning afterward seems to be the standard recipe. Otherwise the brown crunchy bits would be brown, but soggy.
My original thought was to use it for fish and other seafood. I've done swordfish a coupla times, but it seems underdone. I need to up the cooking temp, I believe.
I've reheated deep frozen pork shoulder and it was OK, but it was done, sure (it was done when I froze it), but it wasn't really as good as it could have been. Again, I think it's a temperature problem.
Dunno how it would fit in making a gallon (or more) of red sauce.
My next try is potatoes. Bag up some spuds, butter, a bit of EVOO, and some spices, put it on the (almost) boil, and come back after a while. We'll see.
Johnny, there are the size you spoke of and purchased and larger, commercial sized units.
If my research hits good enough paydirt, I'll sink in $2k for a large unit. It'd be worth the lowered stirring time to me.
I typically make two gallons of pasta sauce a month. Scorching is a problem, due to the nature of an electric stove and a thin walled pot, not to mention single source at the bottom heat.
Stirring helps lower it, but lacking a two gallon flask and chemical heater/stirrer unit, I'm at an impasse.
Unfortunately, I had work to keep me from proper deep research, now it's my "weekend", so once I fix a major database problem with my MythTV server I just rolled together, that'll hopefully be trivial research.
Honestly, this is a first learning of these devices, although more primitive devices are intimately familiar to me.
Quite familiar. I've frequently joked with unit cooks about a 21 gun immersion heater salute.
They operate on gasoline dripped onto a cast iron plate, flooding the unit at the right time *would* result in both a launched chimney pipe and any aircraft nearby receiving a missile launch warning.
And no, you can’t sue a military doctor :(. The government is immune from lawsuit.
There are a few moving pieces here, but sovereign immunity doesn't extend that far, because of the Federal Tort Claims Act (you have to sue the government rather than one of its employees). The military is instead shielded by the Feres doctrine (to wit).
^ Upon reflection, "instead" was probably too strong a word, but I'm too tired to review the official-duties part of the FTCA.
I hate that our military is subjecting soldiers to acupuncture and just saw that Norton Children's Hospital (formerly Kosair's in Louisville, Ky) is now offering acupuncture for kids. The head of the department is Mark McDonald, M.D. who is a pediatric critical care doctor by training and so has no excuse.
Sadly, Col.. Potter approved the use of acupuncture to treat Major Winchester's back pain--and it was shown as effective. The MASH episode was titled (ironically?) "Back Pay."
Does anyone know who is actually behind this? I noted weeks ago that the Revolution4TRUTH website didn't have an "About Us" page and only listed a few, lame anti-vaccine clubs as supporters. Even on their "Donations" page you can't find out who you are donating to. They may be sending a check to Charlie Manson in his cell for all they know.
Yes, I'm aware that all these anti-vaccine clubs are all run by the same small group of grifters who create new "Organizations", with membership = 4, whenever the need arises.
But, who is actually the person behind this? Who thought it up? Who is running it? Who is the head honcho(s)? Who gets the "donations"?
I'll also note that missing from their pathetic list of speakers is one Andrew Wakefield.
It seems that it has finally dawned on them that Wakefraud is box office poison outside their cloistered little anti-vax bubble. He's very good at rousing the party faithful and picking their pockets but in the outside world he is considered the Bernie Madoff of science and medical fraud. Well... there was probably an important UFO conspiracy convention this weekend that he and Polly had to attend.
This does seem to be more geared to the True Believers™ since most of the speakers are so obscure that they will be known only to those who dwell in the anti-vaccine cult's info-bubble.
Sorry, the above comment was meant for today's article, not this one. That's what I get for having 2 tabs open at the same time.
Sorry Orac and please delete this and the above.
I was hoping you were going to pick this up Orac, as I saw it in the Stars and Stripes myself. Sadly, that was in the lobby of the Middle East TMC where I am currently serving as a deployed PA and yes, this crap is full-blown at this installation.
One of the IM docs also specializes in "integrative pain management", so this is huge here. Worse, unlike most modalities he uses, this one is easy to teach, so he trained a bunch of other PAs and MDs how to perform it and got them "certified" as battlefield acupuncturists. There is supposed to be another training in the next 6 weeks or so, and I am sure I will be expected to attend. There is a lot of demand for it by the patients, and judging by the reaction I got for merely suggesting I was skeptical of the utility, I just keep my head down now.
I will say, seeing to one of the Ortho surgeons (a DO no less) stand up in a clinician meeting and tell the primary driver of nonsense to go pound sand about myofascial release one day was pretty glorious though.
Copyleft@52: But that's not nearly as ridiculous as the battlefield acupuncture being promoted in our military today, for two reasons:
1. Unlike certain other forms of woo (such as homeopathy or reiki), acupuncture has an at least superficially plausible causal mechanism, and the research showing that it doesn't work hadn't been done yet.
2. The treatment takes place behind the lines, not on the battlefield, so the practitioner can take the time to use best practices. It's not like the treatment was delaying Winchester's evacuation to a hospital.
Also remember that Col. Potter was regular Army, so he himself had no medical training beyond (presumably) basic first aid. Admittedly, Maj. Winchester did not have that excuse.
Col. Potter was a fully qualified surgeon on MASH. He was frequently portrayed operating with the rest of the surgeons. In fact, he was admired by the other surgeons for his skill.
Reality (#53) writes,
Sorry, the above comment was meant for today’s article, not this one. That’s what I get for having 2 tabs open at the same time.
At least your honest about it, Reality.
Col. Potter was regular Army
Potter was regular Army in contrast to Col. Blake, the first CO in the series, who, like most of the characters, was there because he had to be. Both were considered bona fide surgeons. The one who was portrayed as bumbling was Frank (Major Burns), whom Winchester replaced.
In another MASH episode they ran out of pain killers and Col. Potter has the unit use placebo pain killers (sugar pills). Potter tells everyone the only way these pills will work is if we sell the idea to the patient (theatric placebo).
Last night, my subconscious kept trying to stitch together some narrative involving "Dr. Seuss Monsters from the Id", a la Forbidden Planet. Thanks, Orac!
Wzrd1 @47 I've got an ANOVA and I'm pretty sure if you tried to use it to both heat and circulate pasta sauce all you'd do is destroy the heater/circulator. It's only meant to heat water.
So far I haven't found anything to do with my ANOVA that's revolutionary. I haven't liked the short ribs and the potatoes were a little underdone (which was probably because they started cold not room temp). I did successfully pasteurize some eggs to make mayo for company (I don't take chances with other people's little kids).
I've heard that you can use an immersion circulator to de-activate the enzyme in avocado that causes browning, but I haven't tried it yet.
As I said, there are commercial models, designed more like trash pumps than water pumps. But, those cost in the thousands of dollars range, so I'll not likely be experimenting with them.
Theatric placebo can work. The problem is it doesn't always work, and lying to a patient is unethical.
When I worked as a correctional nurse, the physician I worked for would prescribe "Cebostat" to the drug seekers for their "chronic pain" (this was before the explosion of prescription opiate abuse). They were placebos, sugar pills. It was a "shut 'em up" prescription since the jail discouraged the use of opiates without a clear medical indication.
These guys would come back to jail and beg for "Cebostat." They'd tell me how much better it was than Vicodin.
The placebo effect can work. It's just not ethical, and it's not predictable or reliable.
I’ve got an ANOVA and I’m pretty sure if you tried to use it to both heat and circulate pasta sauce all you’d do is destroy the heater/circulator.
Statistical software is powerful, but not that... Oh. Different ANOVA.
HDB: Soon enough I'm sure we'll see someone use an ANOVA to do some kind of study where they'll use ANOVA to analyze the data, just to get a funny title on their paper.
US bloggers xenophobia concerned the Chinese have taken over the US military!
His bible and patriotism made him write this blog!
It appears that someone decided to read only the title and not a word of the blog itself, then comment out of pure, sheer and unadulterated ignorance.
Ease up on the Foster's, mate.
"I typically make two gallons of pasta sauce a month. Scorching is a problem, due to the nature of an electric stove and a thin walled pot, not to mention single source at the bottom heat.
Stirring helps lower it, but lacking a two gallon flask and chemical heater/stirrer unit, I’m at an impasse."
Have you tried starting on the stove top then finishing in the oven? Just pour into a Non-reactive roasting tin, cover with foil if you don't want evaporation, no foil and stir every 30mins if you do, and leave on the lowest setting.
If you want to get really fancy use the roasting tins to setup a Bain Marie with some smaller containers.
Also IIRC Alton Brown used a cast iron skillet as a very good heat diffuser if you're desperate
But a large roasting tin can hold 2 gallons, or just split between two.
Really large roasting pans like that tend to be significant scald hazards when moving out of an oven.
I'll stick with the deep stock pot, which won't slosh out and leave me badly scalded. :)
Wzrd1 and Mongrel: I'm pretty sure my stockpot would fit flat in my cast-iron skillet, so I can see how that would work.
I've also made apple butter in my roasting pan (really the only way I would make apple butter, otherwise it's a splattery mess).
I have seen an attachment you can buy that fits on top of a pot that stirs automatically. As I recall I saw it on a list of "things that don't really work" but I would think with a good amount of fiddling you could get something like that to work. Maybe even wind-up so you don't have to worry about electric cords?