Woo invades the military

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

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

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

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

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

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

“I’ve got something better.”

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

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

i-bbe2058fa86ca844e51fbb484e363a36-acupuncturekit.jpg

“What are those needles?” you ask.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ya think?

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

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

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

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