Bringing woo to disaster areas

Almost two years ago, I discovered something that disturbed me greatly. Basically, I learned the story of an Air Force officer named Col. Richard Niemtzow, MD, PhD. Col. Niemtzow is a radiation oncologist who has over the last decade fallen deeply into woo. Specifically, he has become known for a technique that he has dubbed “battlefield acupuncture,” a technique that he has promoted energetically (word choice intentional) and ceaselessly, to the point where, sadly, the military is starting to take it seriously even though the evidence Col Niemtzow has presented in favor of the technique is at best the thinnest of gruel, with no controls and no blinding. He’s even managed to convince the military to deploy acupuncturists to Iraq to take care of wounded soldiers. No doubt soon he’ll manage to get acupuncturists deployed to Afghanistan too, since that’s where the fighting increasingly is. As I pointed out, that’s just what our wounded heros need: Quackery instead of medicine. I was thoroughly disgusted.

War, disaster, violence, if there’s one thing I’ve noticed about quacks, it’s that they labor under the delusion that they are real health care providers and that what they do will actually help people in dire straights. That’s why they think their woo can contribute whenever disaster strikes.

And few disasters can rival the scale of the earthquake in Haiti two weeks ago.

True to form, the woo-meisters have invaded. We have Homepaths Without Borders planning a trip to Haiti in order to bring quackery to the injured, homeless, and starving masses. Just as bad, if not worse, and as if the Haitian people didn’t have it bad enough already, they also have Scientologists invading their devastated island to bring Xenu to cure them of their injury and disease in the wake of the earthquake that killed at least 150,000 people:

Amid the mass of aid agencies piling in to help Haiti quake victims is a batch of Church of Scientology “volunteer ministers”, claiming to use the power of touch to reconnect nervous systems.

Clad in yellow T-shirts emblazoned with the logo of the controversial US-based group, smiling volunteers fan out among the injured lying under makeshift shelters in the courtyard of Port-au-Prince’s General Hospital.

A wealthy private donor provided his airplane to fly in 80 volunteers from Los Angeles, along with 50 Haitian-American-doctors, in a gesture worth 400,000 dollars, said a Parisian volunteer who gave her name as Sylvie.

“We’re trained as volunteer ministers, we use a process called ‘assist’ to follow the nervous system to reconnect the main points, to bring back communication,” she said.

“When you get a sudden shock to a part of your body the energy gets stuck, so we re-establish communication within the body by touching people through their clothes, and asking people to feel the touch.”

What the heck is that supposed to mean, “reestablishing communication,” “reconnecting the nervous system”? It’s faith healing, and faith healing doesn’t do much good for broken bones, crushed spleens, fractured skulls, and severed spinal cords. Actually, it doesn’t do much good for anything that can’t be improved with a placebo. Yet, this is what Scientologists are bringing to the suffering masses in Haiti. As one of the real doctors snorted, “I didn’t know touching could heal gangrene.”

Speaking of healing gangrene, surgeons are desperately needed in Haiti, surgeons who can debride dead tissue and amputate gangrenous limbs. They’re getting them, too, but unfortunately, they’re also getting surgeons who carry a bit of baggage with them in the form of woo. True to form, it would appear that acupuncturists are planning on joining the homeopaths. I know this because Lisa Marcucci, MD, trauma surgeon and medical acupuncturist, wrote an astonishingly brain dead defense of Col. Niemtzow’s “battlefield acupuncture.” Worse, it was published on a blog that is normally a reliable source of medical information, Inside Surgery. In an article entitled Battlefield Acupuncture (Niemtzow Technique) and No Needle Battlefield Acupressure (Marcucci Technique) for Pain Control in Acute Traumatic Injury in Haiti:

One of the more distressing items being reported out of the developing medical catastrophe in Haiti is the lack of even rudimentary anesthesia and analagesia for the treatment of amputations and severe acute traumatic injuries.

One possible strategy for treating patients in pain that is rapidly effective, and has little mortality or serious morbidity risk is the use of battlefield acupuncture, a technique pioneered by Air Force Col Richard Niemtzow, MD PhD in 2001.

Because Dr. Niemtzow’s battlefield acupuncture technique is most effective when using specialized small, gold-plated needles that are not always readily available, I have adapted his work to a technique I call battlefield acupressure.

It is truly horrific the level of medical catastrophe going on in Haiti right now. Thousands of people have died; thousands more are injured, many seriously. The medical infrastructure is utterly inadequate to the needs of the people right now, and, despite the outpouring of good will and aid from the rest of the world, it will still be quite a while before international aid reaches levels that begin to address the suffering of the Haitian people. Many will die of their injuries and disease before things get better; many will remain homeless for a long time; some will even die of violence, given that desperate people will do desperate things. The scale of the devastation and human suffering is beyond the ken most people. It’s only human nature to want to help, and Dr. Marcucci wants to help.

But first she wants to whine about how badly advocates of science-based medicine treat acupuncture:

Despite the fact that acupuncture has been in use for the treatment of pain for 3000 years, its’ use today still remains somewhat controversial and has many reputable critics in the medical establishment.

These authorities point out the lack of compelling, unimpeachable level 1 evidence to support its’ use and cite existing studies concluding the effect affect of acupuncture is no better than placebo.

Well, yes. That’s true. I’ve documented it time and time again right here on this very blog. Just search for “acupuncture” in the search box in the left sidebar if you don’t believe me. Basically, acupuncture doesn’t work better than a placebo. Indeed, sham acupuncture works just as well as “real” acupuncture, and neither of them are more than elaborate placebos. Contrary to claims of any specific actions due to acupuncture or any clear mechanism, we know that it doesn’t matter where the needles are placed, and it doesn’t even matter if the needles penetrate the skin. Toothpicks produce the same result. I do like how Dr. Marcucci whines about how there is no “unimpeachable” level 1 evidence. Actually, it’s a lot more than that; the totality of the evidence supports the conclusion that acupuncture is no more than a placebo. Small, pilot projects produce seemingly positive results, but the bigger and better designed the study, the less the effect, and apparent effects due to acupuncture disappear completely in the largest, best-designed studies using the best acupuncture placebos.

Not that this stops Dr. Marcucci from making a classic argumentum ad populum and an even more classic appeal to authority, logical fallacies both:

What remains inconvertible, however, is that acupuncture is widely sought by the public and its’ use has now been adopted by major academic medical centers such as Harvard University, Stanford University, UCLA Medical Center and the University of Maryland where it is used in the oncology and trauma units.

It is also widely used in the Veterans Administration and throughout the United States Military, where it is now being taught to special operations forces, medics, nurses, and physicians alike for use literally on the battlefield as well as in fixed medical facilities.

Therein lies the danger of the infiltration of woo into academia and the military, promoted by men like Col. Niemtzow. “Authorities” that should know better are coopted by quackery. How are lay people supposed to know that these authorities don’t know what they’re talking about when it comes to various forms of pseudoscience? After all, medical authorities are using it! There must be something to it, right?

Wrong. As we have seen, academia has been coopted. Quackademic medicine has infiltrated medical schools and hospitals.

Then, Dr. Marcucci launches into a totally disingenuous rationale for why to her it’s appropriate to bring acupuncture to suffering Haitians:

And, in judging whether this would be an acceptable treatment modality for Haitian patients, what is also irrefutable is the complete absence in many situations of any modern level 1 evidenced care currently being practiced in Haiti.

As an example, some practitioners are being forced to amputate limbs on awake patients placed on bare wood tables under dirty bedsheets (i.e., Civil War era medicine).

In this situation, perhaps the lack of a wide body of level 1 evidence for acupuncture use and the ongoing academic dispute about its efficacy is a nicety that the medical community and Haiti can not now afford.

In other words, to boil it down to surgeonspeak – it may work, likely won’t hurt, but you gotta try something because we are cutting off people’s legs without narcotics or anesthesia.

In other words, because the destruction of Haiti’s medical infrastructure has led doctors to be forced to operate under primitive conditions without adequate medicine or surgical supplies (i.e., forcing them to use techniques with less than “level 1 evidence”), then we should abandon all scientific pretense! Send in the woo!

Yes, it is horrible that amputations are being done without anesthesia. People are suffering. However, if you can send acupuncturists in, why can’t you send real doctors in with real anesthetics, or at least with real morphine? Morphine’s cheap and abundant. It may not by itself serve as adequate anesthesia for an amputation, but it can do a hell of a lot more than placebo medicine like acupuncture. Heck, just calmly holding a patient’s hand can do at least as much as acupuncture, no woo needed.

Sadly, though, Dr. Marcucci can do nothing but lay down the woo:

  1. All pain signals in the body reflex through one or both of the earlobes on its way to the brain.
  2. In many patients, there are 5 main points that can be stimulated through needles or pressure on each earlobe that will partly or totally block this reflex, thus diminishing or eliminating patients awareness/experience of pain.

This is nothing but the purest nonsense. There is no physiologic or neurologic basis to make such a claim. That a surgeon–a trauma surgeon, no less!–would make such a claim and actually believe it is profoundly disturbing. It turns out that Dr. Marcucci is actually the person who founded Inside Surgery. Clearly, I haven’t been paying enough attention to this blog; so I did some searches. I didn’t find anything about acupuncture other than this post or links to this post. Apparently disaster finally got Dr. Marcucci to let her woo flag fly on her blog. Before that, she had not mentioned that she is a medical acupuncturist.

Remember how I used to joke (well, not exactly joke) that I wanted to put a paper bag over my head like the unknown comic and then later a Doctor Doom mask over our “favorite” creationist neurosurgeon Dr. Michael Egnor? I think it may be time to get the metal mask out again. I’ve found a surgeon who embarrasses the profession and, through the profession of surgery, me just as much Dr. Egnor does.

The Haitian people deserve better. Much better.