Archive for May, 2009

Aid Station Acupuncture

Posted in Military, skepticism on May 8, 2009 by 556caliberatheist

Recently I traveled from my small FOB to a larger FOB in order to take the Commander to a meeting. I stopped in the Battalion Aid Station to pick up some meds and cholera pamphlets for the Iraqi Army.

Laying on a litter face down was a soldier and standing over him was our PA. I walked over to see what was up and saw little more than our PA practicing acupuncture on the soldier.

“Hey Sir, isn’t that a little bit hokey?” I asked while looking over his shoulder trying to get a better look. Me being a private (actually as of today Specialist so, yay for me) I had to use a little caution.

“Yeah, I used to think so too.” He said not even looking up from his patient.

I let it rest at that. For now.

I tried to think of something to say while keeping the conversation light. I was a lower enlisted dealing with a medical officer (my boss) and this was truly risky.

I joked around with the other medics about what we’ve been dealing with at our little FOB, where everyone in the unit was being stationed and our plans once we got back home. Meanwhile I was poking around and taking as much in as I could about the patient.

It seems he was being treated for back pain. The needles were sterile and true acupuncture needles. I thought it was time for me to crack a joke.

“You know, even though I am Asian I don’t know anything about acupuncture. How’s this supposed to work?” trying best as I could to hide my incredulity.

“Well…” he said again not meeting my eyes “The Chinese believed there to be path ways of energy coursing though the body. The needles act as adjuncts for this energy.”

My skeptical circuits and fuses were blowing. I couldn’t think of a non-offensive tactful way to put it. I blurted it out.

“So what’s the current real medical view on acupuncture?”

Looking back I should have known better. I should have held my questions until after his patient had left. It’s never good to question a medical treatment in the presence of the patient.

I think he panicked a little at my question, it was clear. I could also tell that he didn’t want this lowly private asking too many questions. He mumbled something along the lines of his training in alternative therapy and reflexology (!) and how he has practiced acupuncture for years. I left it at that and before I left he had hooked up the acupuncture needles to some alligator clips attached to an electronic device (I was instantly reminded of an E-Meter) which sent the skin around the needles twitching.

I have several huge problems with acupuncture. First of all basic research has not been sufficiently been carried out to determine it’s effectiveness as a treatment.  Second of all the standards for licensing vary state by state and some states require no license at all. Over 20 states allow chiropractors to perform acupuncture with less than 200 hours training.

So…

Acupuncture is at best controversial. Because of acupuncture’s very nature it is almost impossible to perform a double blind placebo study on it’s efficacy. The best study that I have read about got around this by performing sham acupuncture.

From Wikipedia:

In a Mayo Clinic study, they recruited 103 women between the ages of 45 and 59, which had menopause, who reported that they had at least five hot flashes per day and were not using any other treatments for them. Half were randomly assigned to receive a series of standardized acupuncture treatments. For those receiving real acupuncture, the needles were placed at the same spots in the arms, legs and lower belly and the other half received sham treatments in which needles were placed superficially near the same locations but away from so-called pressure points. The researchers knew who was receiving sham treatment, but the women did not. By the end of the six weeks, there was no difference between the groups. 61 percent of the sham group were still experiencing hot flashes, while 62 percent of the women who got actual acupuncture still reported having hot flashes as well.

That is a single study but to me it speaks volumes.

Let’s talk a little about the placebo effect. I am a health care professional and I can speak from experience that placebos can be extremely effective if used correctly. Typically the more invasive the procedure is the stronger the placebo effect. It’s not 100% but what is? I have given injections of normal saline and told patients that I have given them a strong sedative. The invasiveness of an injection and my assertion is all that it takes sometimes for them to be dozing off right before my eyes. I have seen patients claim drug effects to occur long before they should be taking place.

Acupuncture is invasive. Any placebo effect would be huge with such a well known and invasive procedure. That does not make it bad medical practice. The notion of energy flowing though the body thing may be hokum but if it works it works.

The first rule is do no harm.

So does acupuncture cause any harm? All the information I have read says no. With sterile needles and clean procedure there is actually very little risk.

Again, from Wikipedia:

In a Japanese survey of 55,291 acupuncture treatments given over five years by 73 acupuncturists, 99.8% of them were performed with no significant minor adverse effects and zero major adverse incidents (Hitoshi Yamashita, Bac, Hiroshi Tsukayama, BA, Yasuo Tanno, MD, PhD. Kazushi Nishijo, PhD, JAMA). Two combined studies in the UK of 66,229 acupuncture treatments yielded only 134 minor adverse events. (British Medical Journal 2001 Sep 1). The total of 121,520 treatments with acupuncture therapy were given with no major adverse incidents (for comparison, a single such event would have indicated a 0.0008% incidence).

So if this treatment is safe and in some cases effective who am I to say that it shouldn’t be practiced in our aid station? After all I myself have used the placebo effect and have seen, a majority of the time, great results. Even if acupuncture is only a placebo and has no other medical benefit but it relieves a soldier of pain I have no problem with that.

I don’t know if it’s an approved medical treatment in the US Army but in any case the placebo is a valuable tool that intentionally or not, medical professionals have used to treat every imaginable affliction with a decent rate of efficacy.

In the Army and especially during a deployment soldiers are asked to do the impossible. My gear, armor, weapon and ammunition weights in close to 80 pounds of extra weight I am carrying. Back pain, shoulder pain, muscle cramps, foot problems are all daily problems for soldiers. Relief comes in the form of simple OTC medications such as mortin and naxproxin.

I am open to the possibility that acupuncture may help some patients full in the knowledge that it may be less than scientific. Until more clinical tests and studies are done I remain dubious and skeptical but open minded.

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