The military uses some of the most technologically sophisticated machinery and innovative medical techniques in history. But a disturbing current of pseudoscience in the military is wasting money, perpetuating myths, and putting our troops in danger. I am a retired U.S. Air Force colonel, so this hits close to home. An organization I was once proud to belong to has become a source of embarrassment.*
An ongoing DoD failure is the infiltration of quackery into military medicine. It’s not as dangerous to our troops as a bomb detector that can’t detect bombs, but it’s wasting tax dollars and medical resources on unscientific mumbo-jumbo that “works” only as a placebo. In some cases, it is demonstrably harmful.
Acupuncture is based on a mythical, nebulous energy called qi that has never been detected, even though scientific instruments are capable of measuring quantum energies at the subatomic level. It is said to flow through hypothetical meridians and to be altered by sticking needles into hypothetical acupuncture points. Originally, there were 360 acupuncture points, corresponding to the days of the year, which is not surprising since the idea grew out of astrology. Now so many acupoints have been described that one wag suggested there was no place left on the skin that wasn’t an acupuncture point in someone’s system.
Many proponents of acupuncture reject the esoteric explanations but believe acupuncture has a real physiological effect. Various mechanisms have been proposed, but none is convincing. Needling can release pain-killing endorphins in the brain, but that’s a nonspecific effect: Placebo pills do the same thing, and just throwing a stick for a dog releases endorphins in the dog’s brain.
We don’t need to know how it works to know if it works. Acupuncture has been tested repeatedly and found wanting. Studies have shown that it doesn’t matter where you stick the needles, and it doesn’t matter whether you pierce the skin. Stimulating intact skin with toothpicks or electricity works just as well. The crucial factor seems to be whether patients believe they are getting acupuncture.
The claimed benefits of acupuncture range from treating infertility to aiding smoking cessation, but the evidence argues against its usefulness for anything but easing pain and possibly nausea. A recent comprehensive review of the literature by Edzard Ernst found little evidence that acupuncture is even truly effective for pain. He also found 95 published cases of serious adverse effects, including death. There is a double standard here: The quality of evidence offered to support acupuncture would not pass muster for a proposed prescription drug.
Some acupuncturists have accepted that the evidence is lacking and are now saying: “Maybe it’s just a placebo, but let’s use it anyway. Placebos are good.” But placebos amount to lying to the patient. Surely our troops deserve better.
The Air Force is training its doctors in “battlefield acupuncture,” mainly due to the efforts of one man, Col. Richard Niemtzow. He reports that there are 40 physicians practicing acupuncture in the military, and that he and one other practice it full-time. He teaches ear acupuncture, a modern variant invented in 1957 by Paul Nogier, a French doctor. Nogier imagined that the external ear looked something like a fetus curled up in the womb. He imagined that every part of the body was represented on the auricle, the outer part of the ear, and that stimulating points on this homunculus could affect distant corresponding organs. (This kind of thinking was parodied in the BMJ in John McLachlan’s butt reflexology spoof, in which he pretended to have found that all parts of the body were represented on the buttocks and that inserting needles there was more effective than using the traditional acupuncture points.) Niemtzow has further refined ear acupuncture to five points on the ear stimulated with short needles that fit under a helmet. He has published no credible clinical research to show that this works.
The Navy offers a training course for physicians that was enthusiastically described by Capt. Elwood Hopkins in a three-part article for Navy Medicine Live. It is a sad account of a doctor being led down the garden path by a charismatic acupuncturist. The teacher offered biased information, and the student succumbed to a series of logical fallacies, allowing himself to be seduced by anecdotal evidence.
It can’t be stressed often enough that the plural of anecdote is not data. Uncontrolled observations usually lead us astray. Observing that some number out of 1,000 patients improved with acupuncture is meaningless unless we know how many would have improved without it. Hopkins admits that some patients don’t respond, saying it is “never clear why.” I think I can guess why.
The Army has been using acupuncture to treat post-traumatic stress disorder, despite a lack of evidence that it works. And now it is hiring acupuncturists for its pain clinic at Fort Sam Houston at an annual salary of $68,809 to $89,450. The job description says the candidate will “offer a full array of the most current and emerging evidenced based approaches in integrative medicine for patients with acute and chronic pain who have not responded well to conventional treatment modalities.”
One could argue that acupuncturists have nothing “evidence-based” to offer in the first place, but what is really alarming are the duties listed for the position. They include things acupuncturists are clearly not trained to do, like prescribing orthotics and braces and counseling patients on nutrition. Worse, the duties include providing cupping, moxibustion, and visualization techniques, none of which are effective and two of which directly injure patients. Cupping is the application of glass bulbs filled with heated air to the skin. It creates a vacuum as the air cools, sucking up wads of skin into the bulbs and leaving ugly bruises. Moxibustion involves burning mugwort on or near the skin and can cause burns and permanent scars (and does so deliberately in some forms of moxibustion).
The DoD is not only wasting tax dollars but is also condoning deliberate injuries to the skin of military patients under the fiction of medical treatment. At Change.org there is a petition begging Congress to put a stop to this nonsense.
In this modern era, we should be looking at the best science, not reverting to anecdotal evidence and pre-scientific belief systems. We should be looking at comparative effectiveness and evidence-based treatments and ways to reduce costs. The adoption of acupuncture by military medicine is a step backward. But with strong advocates of alternative medicine on both sides of the aisle, we’re not likely to see changes any time soon.
Correction, Aug. 21, 2012: This article originally referred to the U.S. military using a dowsing rod technology and conflated that device, called ADE 651, with an unreliable bomb-sniffing technology, called RedX. The U.S. military did not use the dowsing rod technology, although the Iraqi military did. The U.S. did fund and use the RedX sniffers. The paragraph has been removed. (Return to the top of the article.)
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