And I thought I was exaggerating when I discussed “battlefield” acupuncture

Ten months ago, I thought I was joking. I really did.

Regular readers may (or may not) remember back in March, when, in one of my usual flights of fancy, I decided that I could write a short fictional interlude, a combat scene. True, I didn’t do it because I wanted actually to write a fictional story (although I have always wondered if I could write decent short stories or a novel if I put my mind to it). Rather, I did it to make a point, and argument, a reductio ad absurdum, if you will, of a program in the Air Force to bring “battlefield acupuncture” to the our fighting men and women in the military. You see, I was rather perturbed. The reason was simple: I happen to believe that the men and women who put their lives on the line for this nation deserve nothing but the best science- and evidence-based medicine. Unfortunately, that’s not what I perceived “battlefield acupunture” to be. So I made up a story of a wounded soldier in Iraq who, after having been seriously wounded, was most disturbed to see a medic bringing him, not the morphine he needed to control his pain, but Colonel Robert Niemtzow‘s special brand of woo, his “battlefield acupuncture, which is in reality acupuncture lite in that it only involves sticking really tiny needles into the earlobe. Heck, this wasn’t even “real” acupuncture! Worse, the studies upon which he based his acupuncture program included a pilot study that was completely unblinded and didn’t use any control at all and a photoessay. Even by the standards of acupuncture studies, these were thin gruel indeed.

Months went by and I didn’t hear anything about Col. Niemtzow or his special brand of woo again. Then in December, right before the holidays, Col. Niemtzow resurfaced. Boy, did he ever resurface with a vengeance! This time around, he was again pushing his “battlefield acupuncture,” but he had also published a new study that purported to show the great efficacy of his technique. Unfortunately, its design was no better than Col. Niemtzow’s previous study–and arguably even worse. Again, there was no real blinding, no real control group. As a clinical trial, it was about as lame as lame can be. Then, shortly thereafter, I found out that he was going to take his woo to a whole new level.

Now the nation is learning just how high Col. Niemtzow’s willing to take his “battlefield acupuncture.” I’m just not sure whether I mean “high” as in height or “high” as in…well, high. See what I mean:

WASHINGTON — Chief Warrant Officer James Brad Smith broke five ribs, punctured a lung and shattered bones in his hand and thigh after falling more than 20 feet from a Black Hawk helicopter in Baghdad last month.

While he was recovering at Walter Reed Army Medical Center in Washington, his doctor suggested he add acupuncture to his treatment to help with the pain.

On a recent morning, Col. Richard Niemtzow, an Air Force physician, carefully pushed a short needle into part of Smith’s outer ear. The soldier flinched, saying it felt like he “got clipped by something.” By the time three more of the tiny, gold alloy needles were arranged around the ear, though, the pain from his injuries began to ease.

“My ribs feel numb now and I feel it a little less in my hand,” Smith said, raising his injured arm. “The pain isn’t as sharp. It’s maybe 50 percent better.”

Acupuncture involves placing very thin needles at specific points on the body to try to control pain and reduce stress. There are only theories about how, why and even whether it might work.

Regardless, the ancient Chinese practice has been gradually catching on as a pain treatment for troops who come home wounded.

Now the Air Force, which runs the military’s only acupuncture clinic, is training doctors to take acupuncture to the war zones of Iraq and Afghanistan. A pilot program starting in March will prepare 44 Air Force, Navy and Army doctors to use acupuncture as part of emergency care in combat and in frontline hospitals, not just on bases back home.

They will learn “battlefield acupuncture,” a method Niemtzow developed in 2001 that’s derived from traditional ear acupuncture but uses the short needles to better fit under combat helmets so soldiers can continue their missions with the needles inserted to relieve pain. The needles are applied to five points on the outer ear. Niemtzow says most of his patients say their pain decreases within minutes.

Here we go again. Once again, the plural of “anecdote” is not “data,” and all that’s been presented in favor of “battlefield acupuncture” is in essence a collection of antidotes. Col. Niemtzow has yet to produce anything resembling a scientifically acceptable clinical trial with appropriate control groups and appropriate blinding of either the patients or the practitioners. All he’s ever produced to support “battlefield acupuncture” are two transparently bad studies that don’t support anything except for the wonders of the placebo effect. Morever, as I (and others) have pointed out before, the military is a very hierarchical system, which makes me wonder whether having a superior officer clearly believe that acupuncture will help enhances the placebo effect in enlisted men undergoing acupuncture. This is not an unreasonable speculation, given that the military trains its members to follow orders without question and that that trained deference to and faith in an authority figure might heighten the expectation of benefit.

Not that any of this stops Col. Niemtzow and his acolytes. Indeed, it’s very depressing to see hard-nosed military men fall for the woo-iest of woo:

Niemtzow and his colleague Col. Stephen Burns administer about a dozen forms of acupuncture _ including one type that uses lasers _ to soldiers and their families every week.

Col. Arnyce Pock, medical director for the Air Force Medical Corps, said acupuncture comes without the side effects that are common after taking traditional painkillers. Acupuncture also quickly treats pain.

“It allows troops to reduce the number of narcotics they take for pain, and have a better assessment of any underlying brain injury they may have,” Pock said. “When they’re on narcotics, you can’t do that because they’re feeling the effects of the drugs.”

Niemtzow cautions that while acupuncture can be effective, it’s not a cure-all.

“In some instances it doesn’t work,” he said. “But it can be another tool in one’s toolbox to be used in addition to painkillers to reduce the level of pain even further.”

Smith says the throbbing pain in his leg didn’t change with acupuncture treatment but that the pain levels in his arm and ribs were the lowest they’ve been since he was injured. He also said that he didn’t feel groggy afterward, a side-effect he usually experiences from the low-level morphine he takes.

In other words, acupuncture “works,” except when it doesn’t.

I can’t emphasize enough just how thin the evidence upon which “battlefield acupuncture” rests is. We have Drs. Niemtzow and Burns’ anecdotes, of course. We also have two uncontrolled, unblinded studies that seem almost custom designed to produce a seemingly “positive” result. No, check that. There’s no “almost” about it. Col. Niemtzow could have done a scientifically rigorous study to test whether his “earlobe acupuncture” that he now plans to take to our combat troops in Iraq and Afghanistan. In fact, his ambition to bring woo into combat knows no bounds:

Ultimately, Niemtzow would like troops to learn acupuncture so they can treat each other while out on missions. For now, the Air Force program is limited to training physicians.

He says it’s “remarkable” for the military, a “conservative institution,” to incorporate acupuncture.

“The history of military medicine is rich in development,” he said, “and a lot of people say that if the military is using it, then it must be good for the civilian world.”

That’s exactly what I’m afraid of and exactly what Col. Niemtzow is counting on. The military is viewed by the vast majority of Americans as a hard-nosed, no-nonsense sort of institution. That’s why it’s probably true that, if the military is using it, civilians will likely believe it’s effective. Indeed, I’m sure that that’s exactly what advocates of acupuncture are counting on.

Unfortunately, the military is not as hard-nosed as is generally believed. I wish it were, but it’s not. If you don’t believe me, check out The Men Who Stare At Goats by Jon Ronson. If anything, Ronson’s book shows that there’s no woo like military woo, as he demonstrates as he describes a secret wing of the U.S. military called First Earth Battalion, which was created in 1979 with the purpose of creating “Warrior Monks,” soldiers capable of walking through walls, becoming invisible, reading minds and even killing a goat simply by staring at it. Some of the characters involved seem well-meaning enough, such as the hapless General Stubblebine, who is “confounded by his continual failure to walk through his wall.” General Stubblebine, as readers of this blog might recall, later remade himself into a warrior for “health freedom,” better known as the freedom of quacks to do whatever they want without any government interference.

I’ll say it before, and I’ll say it again–as many times as I have to. Our men and women serving out country in the military bear enormous burdens and suffer incredible hardships in the defense of this country. They willingly place themselves in harm’s way in the service of you and me through our government. When they are wounded, they do not deserve quackery. They do not deserve woo. They deserve only the very best science- and evidence-based medicine to treat their injuries. Unfortunately, ideologues like Col. Niemtzow have hijacked the military’s desire to do whatever it can to help wounded soldiers and used it to infiltrate the military with their ideology and pseudoscience. That they have succeeded based on essentially no scientifically valid studies is a disgrace. Our wounded soldiers deserve better. Every man and woman serving their country deserve better. They deserve science- and evidence-based medicine, not quackery.