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.
- 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.
This article was originally published in the Science-Based Medicine blog.