“Dr. Seuss monsters”: The quackery that is “battlefield acupuncture” continues to metastasize

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.