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Therapy or Injury? Your Tax Dollars at Work.

 

 
The U.S. Army Medical Command recently announced a job opening  in the Interdisciplinary Pain Management Center at the San Antonio Military Medical Center at Fort Sam Houston, Texas. Two GS-12 positions were advertised for acupuncturists at a salary of $68,809 to $89,450. As a licensed acupuncturist, a candidate would be expected to

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.

This is wrong on more levels than one. After giving lip service to the politically correct term “evidence based” they proceed to include clearly non-evidence-based modalities in the job description. Rigorous scientists do not classify acupuncture itself as evidence-based, since the evidence is compatible with the hypothesis that it is no more than an elaborate system to provide placebo and other nonspecific effects. And the described duties of the position make it even worse.  

Duties:

  • Diagnose and manage pain disorders and their related neurological and musculoskeletal systems
  •  Prevent or modify the perception of pain using acupuncture and Chinese medicine modalities
  • Apply acupuncture techniques to restore and normalize physiological functions
  • Counsel patients on nutrition, exercise, sleep habits, and stress management
  •  Treat various illnesses/diseases using Chinese medicine modalities such as cupping, moxibustion, and visualization techniques
  • Develop treatment goals in conjunction with fully credentialed providers
  • Evaluate patient progress and response to treatment regimen
  • Prescribe orthotic devices, materials, and appliances
  • Apply supports such as straps, tapes, bandages, and braces as necessary
  • Instruct patients, family, and/or healthcare providers in holistic treatment plans/procedures.
  • Consult with and refer patients to appropriate specialty care providers
  • Promote quality and cost-effective outcomes across the continuum

This raises questions in my mind, and I hope in yours too:

  • When they diagnose pain disorders are they making valid scientific diagnoses, or diagnoses within the mythical TCM system of qi, yin, yang, and the 5 elements (fire, wood, water, metal, earth)?
  • Do acupuncturists even claim to be qualified to prescribe orthotic devices and braces?
  • Are they trained to counsel patients on nutrition, exercise, sleep habits and stress management?
  • There is some evidence that acupuncture works for pain and nausea: some people are willing to accept that evidence while others reject it as compatible with non-specific treatment effects. But there is no credible evidence to support the use of acupuncture in any other condition. How, then, can acupuncturists be expected to “restore and normalize physiological functions”?
  • Are acupuncturists adequately trained to know when to refer patients to appropriate specialty care providers?
  • Even if one accepts the equivocal evidence for acupuncture relieving pain, where is there any credible evidence for cupping and moxibustion?
  • Cupping leaves visible bruises on the skin (see picture) and moxibustion can leave burns; how can these injuries to patients be justified?
  • Visualization techniques have been discredited. Marcia Angell has called them part of a new mind-body “religion” that encourages false hope. 

In an era where we are being asked to study comparative effectiveness and to reduce costs, how can the Army justify hiring acupuncturists to provide unproven services that are based only on prescientific thinking and testimonial “evidence”?
Moxibustion has not been shown to be effective for any condition and it can burn and sometimes permanently scar the skin. I’m not a lawyer, but it sounds to me like this might meet the legal definition of battery. I find it difficult to imagine that patients are made aware of all the pros and cons and are giving true informed consent to these procedures.

We have discussed military acupuncture before. The Air Force is teaching its doctors to do ear acupuncture, a system that was invented in 1957 by a single individual based on his idiosyncratic perception that the shape of the ear looked something like a fetus curled up in the uterus. They call it “battlefield acupuncture.”  And a Navy program is snowing doctors with false and incomplete information and persuading them to adopt acupuncture into their practices.  

Shame on the DOD! I hope a lot of people write their congressmen to protest this misuse of tax dollars.
 

Posted in: Acupuncture

Leave a Comment (28) ↓

28 thoughts on “Therapy or Injury? Your Tax Dollars at Work.

  1. BiolArtist says:

    I made a petition out of this to make it easier to bother the congresscritters…

    http://www.change.org/petitions/the-u-s-senate-protect-our-troops-from-fake-medical-procedures

  2. DevoutCatalyst says:

    I’ve got some MIL-SPEC lucky rabbit’s feet I’ve been trying to unload, maybe now’s the time.

  3. Janet Camp says:

    The Mayo clinic also offers acupuncture, cupping, etc.

    All of this is a travesty–medically, and of the educational system that spawns such poor thinking skills.

    Dr. Hall, are you aware of what group or individual is bringing these proposals to the military?

  4. cervantes says:

    Yes, I would be very interested in the etiology, as it were, of this job description. Does it reflect an idiosyncratic decision by a particular officer, or is there some broader program in the military medical system? Is there any legislative language behind this? Whose idea was it, in other words, and is this an isolated example or part of something bigger?

    Inquiring minds want to know.

  5. NYUDDS says:

    Thanks to BiolArtist for the petition link. I hope everyone can find time to sign the petition form. Unfortunately, it is the same ol’ stuff, what Jann Bellamy called “Legislative Alchemy,” and it shows itself again: It doesn’t matter what you or I or science thinks…it only matters what a legislator thinks because, in large measure, legislators control how and what you practice.

  6. mousethatroared says:

    Firstly, Thanks to HH for writing about this and thanks to Biolartist for setting up the petition (which I signed)

    Secondly, This probably makes me a bad person, but when I saw the salary range, I thought. “I’m in the wrong line of work.”

    I worked as a military contractor shortly after college, doing graphic design and photo processing for military administrative support, weapon development research and proposals to congress, etc. While I was just a tiny cog in a huge machine, I did do many things that were needed by the military and my job did required specialized training in design, software, hardware, photo development techniques, etc. In the early 90′s I earned $18,000, which a web calculators tells me would $31,000, adjusted for inflation, today.

    I could have gone to Accupunture School instead of Art School and gotten a government job for 70 to 90 grand instead of 20 to 30 grand? Sheesh.

  7. Harriet Hall says:

    “Dr. Hall, are you aware of what group or individual is bringing these proposals to the military?”

    No, I’m not. Does anyone know how we could find out?

  8. Is there any chance this quackery is to help “appease diversity” in the military? Ie, Chinese-Americans that feel they are entitled to receive treatments based on their own (fake) cultural history?

  9. Angora Rabbit says:

    “Are they trained to counsel patients on nutrition, exercise, sleep habits and stress management?”

    And of course, nutrition counseling is reimbursable by dietitians, and since I’ve recently sent several of our dietetics graduates into the Army for their internships, I know that military personnel already have access to dietitians. So why on earth have a chiropractor provide this when the personnel already exist? And how could a chiropractor possibly do it better when they receive zero training in real nutrition?

    My Devil’s Advocate asks if chiropractors are more appropriate to counsel on how to use nutrition for pain management? A quick reality check confirms that there is no chapter on pain management in our dietetics clinical text book. Because It Doesn’t Exist. There is no scientific basis for primary pain management using nutritional interventions.

    There is nothing here re: nutrition counseling that an R.D. couldn’t do better.

  10. Angora,

    I’m asking for my own education. Is there any “degree” in nutrition in the USA that carries any weight (besides being a R.D.)?

  11. DKlein says:

    “Cupping leaves visible bruises on the skin (see picture) and moxibustion can leave burns; how can these injuries to patients be justified?”

    An acupuncturist I know explained away the friction rub and burn injuries from cupping as a good thing: the injuries are actually toxins coming out through the skin and show the cupping “worked.”

  12. DavidRLogan says:

    @Angora Rabbit (or anyone)

    Hey there. Do you consider dietary interventions an adjunct to “primary pain management”? (apologies if the answer to this is obvious)…It’d be surprising if no connection between diet and pain existed in any way, even to the point where there’d not be an adjunctual recommendation to change the diet (though I’m open to this surprising conclusion, if you have more to say).

    That said, even if dietary intervention were an adjunct to pain management, I agree with you there’s no reason to believe chiros would know anything. But I have an axe to grind against chiros so I’ll leave that argument to others.

  13. Alia says:

    On a side note – cupping is not only a Chinese tradition, it used to be quite popular where I live (that is in Poland). When I was a kid, I could not stand oral antibiotics, I would start vomiting almost immediately. So whenever I had an infection (and I used to get a lot of ARI, bronchitis, etc), there was only one choice – intramuscular injection or cupping. That was what the doctor said. My mother did not want to subject me to injections, so I got the cupping – and let me tell you, when administered by my mother (she’s a trained nurse), it was really preferable to injections.
    And let me put it straight – I used to believe that cupping was science-based, that there was some kind of mechanism that would make it work. Now I know better and I know that I would probably get better on my own anyway if I just stayed in bed for a while (you must stay in bed for at least 48 hours after cupping, that’s what our tradition claims). But at that time I really loved cupping, what with the alternative.

  14. cervantes says:

    SH — Sure, you can get master’s degrees and doctorates in all sorts of aspects of human nutrition, e.g. here:

    http://nutrition.tufts.edu/academics/degree-programs

    These aren’t really intended as clinical degrees, for the most part.

  15. Jimmylegs says:

    @DKlein:

    I would have asked “Why the cups, can’t we just use a hot iron?” and “Does more damage = more healing (toxin release), if so why not just burn the patient all over?” Is there something unique to the back, why not the arms, chest, face, etc.? Also a good question would be: “What toxins, how do you know it’s there, what do the toxins do, and how does he cupping make the toxins go away?”

    The idea is so drowned in BS that any answer they would come up with, another question could be formed. I would think at one point the question of evidence and “how do you know” would come up.

    As a side note, I can take pictures of peoples bones sticking out and horrible bodily damage, but that cupping picture is so gross.

  16. hcspirit says:

    So now the military is endorsing woo-based-medicine?

    I came here because of my outrage when I read a pamphlet at my doctor’s office (at a supposedly respected major medical center) promoting a “Mindfulness and Chronic Pain” program. It’s bad enough that this stuff exists, anywhere. It’s worse that my taxpayer-funded insurance program would pay for such “treatment”, were I mistaken or desperate enough to seek it, when it ought instead to pay for, and encourage, pain management modalities that work.

    This is not academic for me: I’m disabled with a condition that is known to cause chronic severe pain. Regrettably our first line weapons against severe pain aren’t much different from what was available a couple of millennia ago. These same tools are subject both to abuse and to, conversely, overzealous prosecution of doctors who sincerely prescribe for pain, but have their prescriptions diverted. It doesn’t take a genius to understand that societal pressures exist to push pain patients into “non-drug” therapies, whether or not they actually work. Nor does it take a genius to realize that, given a finite pool of money, every instance of taxpayer-funded pain management nonsense also entails denying effective care to some additional person, somewhere else in the system, or leads to lack of funding for some other important government function. It is, in short, immoral.

    Furthermore the pamphlet that so enraged me did so precisely because I understood exactly what they were misappropriating. I’m probably, in the eyes of some of you here, a visitor from “Planet Woo”: I’m a (conventional, not New Age) mystic. Planet Woo, however, loathes my kind of mystic. I don’t fall for the notion that highly subjective internal experiences (which is what spirituality is) have a whole lot to say in the realm of evidence and falsifiability — the world in which medicine operates. Science is science. Mysticism is art. Unless also trained as a scientist in the relevant field, mystics had best keep their mouths shut and their ears when it comes to science. And, barring training and experience in the field (most established religions expect quite a bit of it, of which thinking you’ve had a spiritual experience when you’re high doesn’t count), doctors make atrocious gurus (yes, I mean you, Dr. Weil).

    “Mindfulness” isn’t just a buzzword. It’s a specific term in Buddhism. The pamphlet I have in my hand makes it abundantly clear to those who know their -isms that the program is a little bit of Vipassana meditation wrapped up in a brown paper bag (nothin’ quite like seeing a cutesy New Age silhouette of a woman in the lotus posture with illustrated chakras coming from my doctor’s office). I have no quibbles with Vipassana and those who choose to practice it. I have big big issues with those who shovel a little bit of dumbed-down Vipassana at desperate and vulnerable Christians, Jews, Muslims, and atheists as perhaps their only hope for pain relief. It’s wrong in so many ways I’m almost at a loss as to where to begin. It’s a violation of freedom of conscience to covertly introduce religion as a medical treatment, it is an injustice to the depth and beauty of authentic Vipassana, it fails to understand that the practices of Vipassana it attempts to rip off have exact equivalents in every religion already practiced by patients and so, even if these methods were to reduce pain (which I doubt), it unjustifiably provokes spiritual crises in suffering individuals… I could go on nearly forever with this. But the number one very wrong thing with this program is that, as medicine, it kills.

    The only place for mindfulness meditation at a medical center is in the chaplain’s office.

    “Traditional Chinese Medicine”, too, is religion. It’s a species of folk Taoism (and not a particularly sound species at that: I liken it to our native species of Christian snake handlers). If it has any place at all, anywhere in the military, it’s with the chaplain, though before it warrants being allowed in such a location it ought to be stripped of any medical pretentions, because it’s not medicine. Indeed, the military ought to keep as close an eye on it as it legitimately ought to were it to enlist a snake handler as a minister. The military has excellent reason to restrict or ban that which adversely affects troop readiness. Instead, it promotes the Chinese equivalent of snake handling as medicine? I’m guessing you can buy a lot of state of the art body armor for the cost of a TCM practitioner — both the upfront costs, the opportunity costs, and the damages.

    I was hoping when I began my search that I’d find well-organized groups ready and able to take on government-funded woo with the likelihood of winning. I’ve found the groups. I’ve also found that for the moment anyway. it’s the Dark Ages that seems to be winning. Oh well: you fight because your position is right, not because you expect imminent victory.

  17. NYUDDS says:

    @cervantes: I went one step further with your link and came up with this:

    http://publichealth.tufts.edu/Admissions/Apply-to-PHPD-Programs/Joint-MS-with-New-England-School-of-Acupuncture

    For the life of me, I can’t fathom why scientifically-trained medical school deans, faculty board, etc. allow this stuff to see the light of day. Maybe I’ll listen to the man who said: “Follow the money!”

  18. joebrence9 says:

    While I suspect the mechanism and effects of cupping are exaggerated and misunderstood (I myself am quite ignorant on its claims and methods), I did read this blog post a few months back by a phD student who studied the neurophysiological effects of cupping on brain mapping (on a reputable blog): http://bodyinmind.org/the-influence-of-cupping-therapy-on-body-image-in-neck-pain/

  19. BiolArtist says:

    I read that study, joebrence9, and was quite disappointed. One of the commenters, David Kennedy, took the time to explain the drawbacks of the study design.

    For those of you who don’t click through to the study, “brain mapping” does not refer to the representation of the body on the sensory cortex of the brain. (That would require fMRI to study, probably, which is more expensive than paper and pencils.) It means “draw me a picture of what your painful body feels like.” Has this been validated as a quantitative research tool? As presented, I don’t see how much of an improvement it is over “Wow, my neck stopped hurting!” I understand they are looking for distortions based on how severely the area bothers the person, but if the researchers don’t know how much distortion would be present simply due to lack of figure drawing skill, it seems this might affect the results.

    (My figure drawing classes are recent enough I definitely remember how hard it was to get the proportions right, even for students with art backgrounds.)

  20. joebrence9 says:

    Agreed BiolArtist. I am not in support of cupping and have zero exposure to it besides Romy’s post to BodyinMind.org. I do find it interesting though that something did appear to happen to percieved body image via the participants drawing but as you stated, “is this a valid quantitative tool”— and the answer is no.

    Pain is very, very complex and I suspect “cupping” will deliver short term results, if the patient has the belief and expectation that it will deliver results. One can not deny this placebo and the non-specific effects. I am interested that if the brains virtual representation of body does not match the actual body (because of the raising of the skin within the cups), may something happen? Similar to the phantom limb in a mirror box?

  21. norrisL says:

    Wishing I was American so that I could sign the petition! What stupid halfwit thought that this was a good idea?
    Stuart

  22. Daniel M says:

    Unfortunately there are some real quacks in the military. My wife worked as a medic at a military hospital, and there was a PA there whose first line treatment involved making people meditate, prescribing Chinese herbal remedies, and giving acupuncture, and he sometimes would refuse to prescribe real medication until at least meditation and acupuncture were tried.

    My wife also saw a military DO for migraines, and ridiculously he said that migraines were caused by stagnant blood in the back and neck, so he told us to do a version of cupping every week where we were supposed to take the handle of a reflex hammer, apply lotion to the back and neck, and scrape the skin until deep bruises were produced. Obviously he wasn’t very bright, since he thought causing more stagnate blood would fix a problem he claimed was caused by stagnant blood in the first place.

  23. lilady says:

    (What I do for science…)

    I located the rather long transcript of the Department of Defense Appropriations Hearing for Fiscal Year 2012:

    http://www.gpo.gov/fdsys/pkg/CHRG-112shrg99104433/html/CHRG-112shrg99104433.htm

    Scroll down a wee bit past the opening statement of Daniel Inouye, for the testimony of Senator Thad Cochran (Republican-Mississippi) to locate this…

    “This leads into the use of evidence-based practices aimed
    at the most effective care. As an example, Army medicine now
    strengthens our soldiers’ and families’ behavioral health and
    emotional resiliency through a campaign to align the various
    behavioral health programs with the deployment and reset cycle,
    a process we call the Comprehensive Behavioral Health System of
    Care. Under the leadership of the Deputy Surgeon General, Major
    General Patty Horoho, this program uses multiple touch points
    to assess both the health and behavioral health for a soldier
    and the family. Coupled with the advances in battlefield care
    under the Joint Theater Trauma System, we have made great
    strides in managing the physical and emotional wounds of war.
    Additionally, we have developed a comprehensive pain
    management strategy to address chronic and acute pain that many
    of our soldiers face. This strategy uses state-of-the-art
    modalities and technologies. It focuses on the use of non-
    medication pain management modalities, incorporating
    complementary and alternative or integrative approaches, such
    as acupuncture and massage therapy, yoga, and other tools. We
    were recently recognized by the American Academy of Pain
    Medicine with a Presidential commendation for the impact on
    pain management in the United States.”

  24. RD says:

    Thank you Angora Rabbit! Agree 100%

    I agree that this position is not qualified to provide nutrition information.

    I think nutrition can play a round about role in pain management, but I believe to truly manage pain, treating the source is the first step. If a person is overweight/obese, this can increase inflammation in the body, possibly increasing pain. Also the heavier the person is, the more stress on their joints etc. In general wt loss, if possible, can sometimes help decrease pain but again, it depends on the source or reason for pain.

  25. agitato says:

    @Harriet Hall

    I’m wondering if the decision to hire acupuncturists is because of this:

    http://www.arapmi.org/pain-management-task-force.html. Then you have to click on ‘report’ and go to

    Section 4.2.1 called Complementary and Integrative Pain Treatment Medicine.

    Made me want to scream.

  26. cervantes says:

    NYUDDS — I’m appalled to see that joint degree offered by Tufts and the New England School of Acupuncture. I’ve written to a colleague in the Tufts public health program to inquire about it. Note that it seems to be only a marketing gimmick — you get separate diplomas. But still . . .

  27. mikey says:

    Cupping was explained to me once as acting on a few fronts:
    by causing superficial bruising, it leads to platelet aggregation and the subsequent influx of WBCs and other chemotactic factors that accelerated the healing process locally.

    By increasing the potential space between tissue layers there was improved lymphatic drainage while mechanical stimulation of the tissue which resulted in opiate (and presumably other neurotransmitter) release centrally, as well as local improvement in adhesions between the fascia layers.

    Finally there’s the “it feels good” factor, similar to massage, which arguably is very fleeting and of limited therapeutic value. As for the use in treating respiratory illness, is there a mechanism that could be improving WBC production or potentiating their function?

    I don’t know. But it sounds a lot better than “it makes your qi move better.”

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